Knowledge of Metabolic Syndrome and Cardiovascular Disease Risk Among People With Mental Health Problems

Introduction: People with mental health problems are at great risk for developing metabolic problems that lead to diabetes, cardiovascular disease and early death, often by as much as 25 years (Young et al. 2018). There are many factors associated with this increase in risk including genetic factors, psychiatric symptoms such as anergy and lack of motivation, lifestyle behaviors (Ince, Günüşen, N. P., Özerdem, & Özışık, 2017) and social determinants of health such as poverty and access to care (Ryan, Abrams, Doty, Shah & Schneider, 2016). Furthermore, it is well known that medications used to treat mental health problems contribute substantially to increased risk (Ballon et al., 2018; Spertus, Horvitz-Lennon, Abing & Normand, 2018). In 2004 the Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes (Olson, Delate, & Duagn, 2006) identified standards for assessing and monitoring people at risk for developing metabolic syndrome and the subsequent chronic diseases that can develop. Assessing and monitoring risk is most successful when collaboration among medical and psychiatric providers occurs. While it is clear that medical and psychiatric providers are knowledgeable of the health care needs for those with mental health problems, it is less clear what those experiencing mental health problems know about their risks and strategies to reduce their risks.

Purpose: The purpose of this study was to determine what people with mental health problems report regarding their knowledge about their risk for metabolic syndrome, diabetes and cardiovascular disease. Further, to identify risks they believed to be associated with these chronic diseases and whether their psychiatric and/or medical providers assessed and monitored risks routinely.

Methods: We engaged the Massachusetts National Alliance on Mental Illness (NAMI) to help us identify individuals 18 years or older who may be interested in participating in a survey related to metabolic risks. Massachusetts NAMI informed their membership through their website which included a link to our survey. Local chapters were also informed about the study directly through the Massachusetts NAMI office and were asked to inform their members about the study. The survey, powered by Qualtrics was a knowledge survey designed by the authors to reflect a similar survey developed previously for psychiatric nurses (Bolton, Knight & Kopeski, 2016). The survey also queried discussions specifically related to metabolic risk, diabetes, CVD and lifestyle behaviors with psychiatric and medical providers during appointments. The research was approved by the University of Massachusetts Lowell Institutional Review Board.

Results: People with mental health problems are highly knowledgeable about factors related to metabolic risk and the associated chronic diseases. They also have a good understanding of many lifestyle behaviors which can contribute to unhealthy outcomes. The results also indicate that psychiatric providers rarely provide guidance related to health or health behaviors nor do they routinely consult with the individuals’ primary care providers. Primary care providers assessed critical values regularly but did not consistently provide guidance regarding lifestyle behaviors.

Conclusion: Much work remains in providing comprehensive health care to people with mental health problems; they remain at risk for significant morbidity and early mortality when compared to the general population. Greater collaboration, new models of care, and advocacy on the part of advanced practice nurses and physicians is critical. Family members must also be engaged to support positive health outcomes for this population.