Health status of young adults with serious mental illness enrolled in integrated care.

Publisher: Wiley-Blackwell Country of Publication: Australia NLM ID: 101320027 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1751-7893 (Electronic) Linking ISSN: 17517885 NLM ISO Abbreviation: Early Interv Psychiatry Subsets: MEDLINE

Original Publication: Carlton,VIC, Australia : Wiley-Blackwell

Mental Disorders*/epidemiology ; Mental Disorders*/psychology ; Hypertension*/epidemiology ; Delivery of Health Care, Integrated*; Humans ; Male ; Young Adult ; Adolescent ; Adult ; Health Status ; Obesity

Aims: People with serious mental illness (SMI) are more likely to develop chronic health conditions and die prematurely. Timely identification of modifiable health risk factors may enable early intervention. We aimed to describe the physical health characteristics and service utilization of young people with SMI.
Methods: Young people with SMI enrolled in an integrated community mental health clinic (CMHC) and primary care program were assessed for physical and mental health history and past year service utilization.
Results: A total of 122 participants, ages 16-35 (m = 27.0 ± 5.0 years), half male, 78.3% White were assessed. Half smoked cigarettes, half had obesity, almost half (47.5%, n = 56) had hypertension, and about a third had laboratory metabolic abnormalities. The group averaged 10.7 ± 5.1 h of sedentary behavior per day. Obesity was associated with high blood pressure, prediabetes, poor self-rated health abilities, sedentary behavior and low health satisfaction. Over half had been to the emergency department (ED) for a medical reason (55.0%, n = 66) and 24.6% had been hospitalized for a health condition in the past year. Over half had a lifetime cardiovascular risk score indicating a 50-67% chance of having a cardiovascular event; simply quitting smoking would reduce the number with this risk by almost half. Most physical health diagnoses were not recorded in the CMHC record.
Conclusion: Young people with SMI newly enrolled in integrated care had high rates of smoking, obesity, hypertension, and other cardio-metabolic abnormalities contributing to high risk for future disease. Research is needed to examine appealing, scalable interventions to improve health, reduce unnecessary medical care, and prevent disparate chronic disease in this group.
(© 2022 John Wiley & Sons Australia, Ltd.)

American Diabetes Association. (2021). 2. Classification and Diagnosis of Diabetes: Standards of MEDICAL Care in Diabetes-2021. Diabetes Care, 44(Suppl. 1), S15-S33. https://doi.org/10.2337/dc21-S002.
Abdullah, A., Wolfe, R., Stoelwinder, J. U., de Courten, M., Stevenson, C., Walls, H. L., & Peeters, A. (2011). The number of years lived with obesity and the risk of all-cause and cause-specific mortality. International Journal of Epidemiology, 40(4), 985-996. https://doi.org/10.1093/ije/dyr018.
Afshin, A., Reitsma, M. B., & Murray, C. J. L. (2017). Health effects of overweight and obesity in 195 countries. The New England Journal of Medicine, 377(15), 1496-1497. https://doi.org/10.1056/NEJMc1710026.
American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. [see comment]. Journal of Clinical Psychiatry, 65(2), 267-272.
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., … Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice Guidelines. Circulation, 140(11), e596-e646. https://doi.org/10.1161/cir.0000000000000678.
Bandara, S. N., Kennedy-Hendricks, A., Stuart, E. A., Barry, C. L., Abrams, M. T., Daumit, G. L., & McGinty, E. E. (2020). The effects of the Maryland Medicaid health Home waiver on emergency department and inpatient utilization among individuals with serious mental illness. General Hospital Psychiatry, 64, 99-104. https://doi.org/10.1016/j.genhosppsych.2019.12.004.
Becker, H. E., Stuifbergen, A., Oh, H. S., & Hall, S. (1993). Self-rated abilities for health practices: A health self-efficacy measure. Health Values: The Journal of Health Behavior, Education and Promotion, 17(5), 42-50.
Bergamo, C., Juarez-Colunga, E., & Capp, R. (2016). Association of mental health disorders and Medicaid with ED admissions for ambulatory care-sensitive condition conditions. The American Journal of Emergency Medicine, 34(5), 820-824. https://doi.org/10.1016/j.ajem.2016.01.023.
Cabanas-Sánchez, V., Martínez-Gómez, D., Esteban-Cornejo, I., Castro-Piñero, J., Conde-Caveda, J., & Veiga, Ó. L. (2018). Reliability and validity of the youth leisure-time sedentary behavior questionnaire (YLSBQ). Journal of Science and Medicine in Sport, 21(1), 69-74. https://doi.org/10.1016/j.jsams.2017.10.031.
Callaghan, R. C., Veldhuizen, S., Jeysingh, T., Orlan, C., Graham, C., Kakouris, G., … Gatley, J. (2014). Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. Journal of Psychiatric Research, 48(1), 102-110. https://doi.org/10.1016/j.jpsychires.2013.09.014.
Capp, R., Hardy, R., Lindrooth, R., & Wiler, J. (2016). National Trends in emergency department visits by adults with mental health disorders. The Journal of Emergency Medicine, 51(2), 131-135.e131. https://doi.org/10.1016/j.jemermed.2016.05.002.
Carraça, E. V., Encantado, J., Battista, F., Beaulieu, K., Blundell, J. E., Busetto, L., … Oppert, J. M. (2021). Effect of exercise training on psychological outcomes in adults with overweight or obesity: A systematic review and meta-analysis. Obesity Reviews, 22(S4), e13261. https://doi.org/10.1111/obr.13261.
Chwastiak, L. A., Rosenheck, R. A., McEvoy, J. P., Stroup, T. S., Swartz, M. S., Davis, S. M., & Lieberman, J. A. (2009). The impact of obesity on health care costs among persons with schizophrenia. General Hospital Psychiatry, 31(1), 1-7. https://doi.org/10.1016/j.genhosppsych.2008.09.012.
Compton, M. T., Daumit, G. L., & Druss, B. G. (2006). Cigarette smoking and overweight/obesity among individuals with serious mental illnesses: A preventive perspective. Harvard Review of Psychiatry, 14(4), 212-222. https://doi.org/10.1080/10673220600889256.
Correll, C. U., Robinson, D. G., Schooler, N. R., Brunette, M. F., Mueser, K. T., Rosenheck, R. A., … Kane, J. M. (2014). Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: Baseline results from the RAISE-ETP study. JAMA Psychiatry, 71(12), 1350-1363. https://doi.org/10.1001/jamapsychiatry.2014.1314.
Cotes, R. O., de Nesnera, A., Kelly, M., Orsini, K., Xie, H., McHugo, G., … Brunette, M. F. (2015). Antipsychotic Cardiometabolic side effect monitoring in a state community mental health system. Community Mental Health Journal, 51(6), 685-694. https://doi.org/10.1007/s10597-015-9833-0.
Defining adult overweight and obesity. (2021). Retrieved from https://www.cdc.gov/obesity/adult/defining.html.
Dickerson, F., Origoni, A., Schroeder, J., Adamos, M., Katsafanas, E., Khushalani, S., … Yolken, R. (2018). Natural cause mortality in persons with serious mental illness. Acta Psychiatrica Scandinavica, 137(5), 371-379. https://doi.org/10.1111/acps.12880.
Dickerson, F., Origoni, A., Schroeder, J., Schweinfurth, L. A., Stallings, C., Savage, C. L., … Yolken, R. (2016). Mortality in schizophrenia and bipolar disorder: Clinical and serological predictors. Schizophrenia Research, 170(1), 177-183. https://doi.org/10.1016/j.schres.2015.11.010.
Dickerson, F. B., Brown, C. H., Kreyenbuhl, J. A., Fang, L., Goldberg, R. W., Wohlheiter, K., & Dixon, L. B. (2006). Obesity among individuals with serious mental illness. Acta Psychiatrica Scandinavica, 113(4), 306-313.
. (2013). Drug information handbook a comprehensive resource for all clinicians and healthcare professionals (22nd ed.). Lexi-Comp.
Druss, B. G., von Esenwein, S. A., Glick, G. E., Deubler, E., Lally, C., Ward, M. C., & Rask, K. J. (2017). Randomized trial of an integrated behavioral health home: The health outcomes management and evaluation (HOME) study. The American Journal of Psychiatry, 174(3), 246-255. https://doi.org/10.1176/appi.ajp.2016.16050507.
Elshaug, A. G., Rosenthal, M. B., Lavis, J. N., Brownlee, S., Schmidt, H., Nagpal, S., … Saini, V. (2017). Levers for addressing medical underuse and overuse: Achieving high-value health care. Lancet, 390(10090), 191-202. https://doi.org/10.1016/s0140-6736(16)32586-7.
Goff, D. C., Lloyd-Jones, D. M., Bennett, G., Coady, S., D'Agostino, R. B., Gibbons, R., … American College of Cardiology/American Heart Association task force on practice Guidelines. (2014). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice Guidelines. Circulation, 129(25 Suppl 2), S49-S73. https://doi.org/10.1161/01.cir.0000437741.48606.98.
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., … Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the Management of Blood Cholesterol: A report of the American College of Cardiology/American Heart Association task force on clinical practice Guidelines. Circulation, 139(25), e1082-e1143. https://doi.org/10.1161/cir.0000000000000625.
Janssen, I., Clarke, A. E., Carson, V., Chaput, J. P., Giangregorio, L. M., Kho, M. E., … Chastin, S. F. M. (2020). A systematic review of compositional data analysis studies examining associations between sleep, sedentary behaviour, and physical activity with health outcomes in adults. Applied Physiology, Nutrition, and Metabolism, 45(10 (Suppl. 2)), S248-S257. https://doi.org/10.1139/apnm-2020-0160.
Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627. https://doi.org/10.1001/archpsyc.62.6.617.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11556941.
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Lowe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317-325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004.
Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000). Smoking and mental illness: A population-based prevalence study. Journal of the American Medical Association, 284(20), 2606-2610.
Li, C., Birmaher, B., Rooks, B., Gill, M. K., Hower, H., Axelson, D. A., … Goldstein, B. I. (2019). High prevalence of metabolic syndrome among adolescents and young adults with bipolar disorder. The Journal of Clinical Psychiatry, 80(4), e1-e8. https://doi.org/10.4088/JCP.18m12422.
McClave, A. K., McKnight-Eily, L. R., Davis, S. P., & Dube, S. R. (2010). Smoking characteristics of adults with selected lifetime mental illnesses: Results from the 2007 National Health Interview Survey. American Journal of Public Health, 100(12), 2464-2472. https://doi.org/10.2105/AJPH.2009.188136.
McLaren, J. L., Brunette, M. F., McHugo, G. J., Drake, R. E., & Daviss, W. B. (2017). Monitoring of patients on second-generation antipsychotics: A National Survey of child psychiatrists. Psychiatric Services, 68(9), 958-961. https://doi.org/10.1176/appi.ps.201500553.
Moore, B. J., Stocks, C., & Owens, P. L. (2017). Trends in emergency department visits, 2006-2014. Agency for Healthcare Research and Quality Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb227-Emergency-Department-Visit-Trends.jsp.
Morrato, E. H., Campagna, E. J., Brewer, S. E., Dickinson, L. M., Thomas, D. S., Miller, B. F., … Lindrooth, R. C. (2016). Metabolic testing for adults in a state Medicaid program receiving antipsychotics: Remaining barriers to achieving population health prevention goals. JAMA Psychiatry, 73(7), 721-730. https://doi.org/10.1001/jamapsychiatry.2016.0538.
NIDA. (2012). Resource Guide: Screening for Drug Use in General Medical Settings. Retrieved from https://archives.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settingson.
Okoro, C. A., Dhingra, S. S., & Li, C. (2014). A triple play: Psychological distress, physical comorbidities, and access and use of health services among U.S. adults with disabilities. Journal of Health Care for the Poor and Underserved, 25(2), 814-836. https://doi.org/10.1353/hpu.2014.0103.
Olfson, M., Wang, S., Wall, M., Marcus, S. C., & Blanco, C. (2019). Trends in serious psychological distress and outpatient mental health care of US adults. JAMA Psychiatry, 76(2), 152-161. https://doi.org/10.1001/jamapsychiatry.2018.3550.
Pillinger, T., McCutcheon, R. A., Vano, L., Mizuno, Y., Arumuham, A., Hindley, G., … Howes, O. D. (2020). Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: A systematic review and network meta-analysis. Lancet Psychiatry, 7(1), 64-77. https://doi.org/10.1016/s2215-0366(19)30416-x.
Plummer, F., Manea, L., Trepel, D., & McMillan, D. (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 24-31. https://doi.org/10.1016/j.genhosppsych.2015.11.005.
Promoting integration of primary and behavioral health care. (2020). Retrieved from https://www.samhsa.gov/grants/grant-announcements/sm-17-008.
Saunders, T. J., McIsaac, T., Douillette, K., et al. (2020). Sedentary behaviour and health in adults: an overview of systematic reviews. Applied Physiology, Nutrition, and Metabolism, 45(10 (Suppl. 2)), S197-S217.
Scharf, D. M., Schmidt Hackbarth, N., Eberhart, N. K., Horvitz-Lennon, M., Beckman, R., Han, B., … Burnam, M. A. (2016). General medical outcomes from the primary and behavioral health care integration Grant program. Psychiatric Services, 67(11), 1226-1232. https://doi.org/10.1176/appi.ps.201500352.
Soberay, A., Tolle, L. W., Kienitz, E., & Olson, A. (2021). The Hope health and wellness clinic: Outcomes of individuals with serious mental illness in a bidirectional integrated care clinic. Community Mental Health Journal, 57(4), 675-683. https://doi.org/10.1007/s10597-020-00730-4.
Soda, T., Richards, J., Gaynes, B. N., Cueva, M., Laux, J., McClain, C., … Jarskog, L. F. (2021). Systematic quality improvement and metabolic monitoring for individuals taking antipsychotic drugs. Psychiatric Services, 72(6), 647-653. https://doi.org/10.1176/appi.ps.202000155.
Tam, J., Warner, K. E., & Meza, R. (2016). Smoking and the reduced life expectancy of individuals with serious mental illness. American Journal of Preventive Medicine, 51(6), 958-966. https://doi.org/10.1016/j.amepre.2016.06.007.
The American College of Cardiology ASCVD Risk Estimator Plus. (2021). Retrieved from https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/.
The health consequences of smoking -- 50 years of Progress: A report of the surgeon general. (2014). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved from www.cdc.gov/tobacco.
Wakefield, S., Aligeti, M., Rachamallu, V., Baronia, R., Aynampudi, R., Parmar, A., … Masodkar, K. (2020). Metabolic monitoring of child and adolescent patients on atypical antipsychotics by psychiatrists and primary care providers. American Journal of Therapeutics, 27(5), e425-e430. https://doi.org/10.1097/mjt.0000000000000853.
Walker, E. R., Fukuda, J., McMonigle, M., Nguyen, J., & Druss, B. G. (2021). A qualitative study of barriers and facilitators to transitions from the emergency department to outpatient mental health care. Psychiatric Services, 72(11), 1311-1319. https://doi.org/10.1176/appi.ps.202000299.
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr., Collins, K. J., Dennison Himmelfarb, C., … Wright, J. T., Jr. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and Management of High Blood Pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association task force on clinical practice Guidelines. Hypertension, 71(6), 1269-1324. https://doi.org/10.1161/HYP.0000000000000066.
Yano, Y., Reis, J. P., Colangelo, L. A., Shimbo, D., Viera, A. J., Allen, N. B., … Lloyd-Jones, D. M. (2018). Association of Blood Pressure Classification in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure guideline with cardiovascular events later in life. JAMA, 320(17), 1774-1782. https://doi.org/10.1001/jama.2018.13551.
Zhao, G., Ford, E. S., Li, C., Strine, T. W., Dhingra, S., Berry, J. T., & Mokdad, A. H. (2009). Serious psychological distress and its associations with body mass index: Findings from the 2007 behavioral risk factor surveillance system. International Journal of Public Health, 54(Suppl 1), 30-36. https://doi.org/10.1007/s00038-009-0004-3.

1H79SM080245-01 United States SM CMHS SAMHSA HHS; 1H79SM080245 United States SU SAMHSA HHS

Keywords: hypertension; obesity; schizophrenia; serious mental illness; smoking

Date Created: 20220608 Date Completed: 20230216 Latest Revision: 20230321

20231215

10.1111/eip.13302

35672918