Abstract
Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US. Potentially modifiable CVD risk behaviors (tobacco smoking, obesity, physical inactivity, unhealthy diet) and risk factors (hypertension, diabetes, dyslipidemia) are all markedly elevated in persons with SMI. Evaluations of programs implementing integrated medical care into specialty mental health settings have not shown meaningful effects on CVD risk factor reduction. Rigorously tested, innovative interventions are needed to address the large burden of CVD risk in populations with SMI. In this article, we describe the design of a comprehensive 18-month intervention to decrease CVD risk that we are studying in a randomized clinical trial in a community mental health organization with psychiatric rehabilitation programs. The individual-level intervention incorporated health behavior coaching and care coordination/care management to address all seven CVD risk behaviors and risk factors, and is delivered by a health coach and nurse. If successful, the intervention could be adopted within current integrated care models and significantly improve the physical health of persons with SMI.
Highlights
Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US [1,2,3,4,5]
Rigorously tested, innovative interventions are needed to address the large burden of CVD risk in populations with SMI
The study was conducted in partnership with a large community mental health organization that provides outpatient services including psychiatric rehabilitation programs (PRPs)
Summary
Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US [1,2,3,4,5]. The American Heart Association set strategic goals to improve cardiovascular (CV) health to ideal levels for each risk factor and reduce CVD mortality by 20% for all Americans by 2020 [11]. Together with high prevalence of substance use, unemployment, low-income and social isolation, these factors make implementing effective CVD risk reduction interventions challenging for this population [13,14,15,16,17].
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