Abstract
BackgroundUnhealthy lifestyle constitutes a cause of increased morbidity and mortality in people with severe mental illness. The aim of this mixed-method pilot study was to investigate the feasibility and preliminary effectiveness of an intervention to promote a health-conscious lifestyle in comparison to care as usual among people with severe mental illness receiving accommodational support in community settings.MethodsThis was a prospective, quasi-experimental, controlled study over four six-month assessment points (t0, + 6 months, + 12 months, + 18 months) with 70 persons with severe mental illness receiving community based accommodational support. Mental health staff members of the housing facilities were trained in Motivational Interviewing and conducted a six-week health course with the intervention group participants in addition to care as usual. Next to the primary outcome - self-rated physical well-being (FEW 16) - anthropometric parameters and unhealthy behaviours (diet, physical activity, alcohol and tobacco consumption, and oral hygiene) were examined. Effectiveness analysis was conducted using mixed-effects regression models with propensity score adjustment to control for selection bias. One year after the end of the intervention, semi-standardized expert interviews were conducted with 12 of these employees and evaluated by content analysis.ResultsThe qualitative interviews with mental health staff underline the intervention’s feasibility in people with severe mental illness in sheltered housing, and the acceptability of and satisfaction with the intervention among mental health workers. But in this pilot study no superiority of the HELPS intervention compared to routine care could be demonstrated in terms of the investigated outcomes.ConclusionsThe findings of this pilot study underscore the feasibility and acceptability of health promotion programmes based on Motivational Interviewing and highlight the need to further develop multi-modal programs according to the needs of the target group. Long-term and sustainable support for healthy lifestyles of people with severe mental illness receiving community mental health care requires multi-modal concepts and organisational change.Trial registrationDRKS00011659, date of registration was 2017/02/15; retrospectively registered as date of first enrolment was 2017/01/24.
Highlights
Unhealthy lifestyle constitutes a cause of increased morbidity and mortality in people with severe mental illness
There is an urgent need for interventions addressing modifiable lifestyle risk factors to reduce the excess mortality among people with severe mental illness (SMI), as recently postulated by the Lancet Psychiatry Commission [1]
Despite the recommendation to promote the physical health of people with severe mental illness in relevant treatment guidelines [30], to date such interventions have hardly been neither applied nor explored in Germany
Summary
Unhealthy lifestyle constitutes a cause of increased morbidity and mortality in people with severe mental illness. Apart from suicide and accidental death, two-thirds of deaths in persons with SMI are due to physical illness [6] like cardiovascular disease [4, 9, 10], respiratory disease and several types of cancer [5, 7] This high somatic co-morbidity and mortality can be attributed to environmental and organisational issues (e.g., inequalities in healthcare access and delivery, lack of resources, professional incompetence due to separation of mental health services from other medical services) [10,11,12] and to medication side effects (e.g. weight gain due to antipsychotics) [12,13,14]. Individuals with mental illness are more likely to consume alcohol [24], with doubled odds of risky alcohol consumption for patients with schizophrenic disorder and three times higher odds among patients with depression in comparison with the general population [15]
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