title: Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review.
abstract: People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.
authors.affiliation: Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; bmcginty@jhu.edu.
authors.forename: Emma E
authors.initials: EE
authors.lastname: McGinty
authors.affiliation: Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
authors.forename: Julia
authors.initials: J
authors.lastname: Baller
authors.affiliation: National Institute of Mental Health, Bethesda, MD;
authors.forename: Susan T
authors.initials: ST
authors.lastname: Azrin
authors.affiliation: National Institute of Mental Health, Bethesda, MD;
authors.forename: Denise
authors.initials: D
authors.lastname: Juliano-Bult
authors.affiliation: Division of General Internal Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Daumit
mesh_terms: D001521:Behavior Therapy / Q000379:methods; D001714:Bipolar Disorder / Q000150:complications*; D016642:Bupropion / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000517:prevention & control* / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy*; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*; D015438:Health Behavior; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000628:therapy; D006973:Hypertension / Q000150:complications / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use; D009043:Motor Activity; D018722:Nicotinic Agonists / Q000627:therapeutic use; D009765:Obesity / Q000150:complications / Q000628:therapy*; D050177:Overweight / Q000150:complications / Q000628:therapy; D040242:Risk Reduction Behavior; D012559:Schizophrenia / Q000150:complications*; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D000068580:Varenicline / Q000627:therapeutic use
chemical_list: D018765:Dopamine Uptake Inhibitors; D007004:Hypoglycemic Agents; D018722:Nicotinic Agonists; D016642:Bupropion; D008687:Metformin; D000068580:Varenicline
keywords: intervention; medical; obesity; schizophrenia; somatic; tobacco