Jill Stein

September 08, 2011

September 8, 2011 (Paris, France) — Researchers report early favorable results with a program that helps patients with mental disorders make healthy lifestyle choices, thereby reducing their mortality risk.

The British program, known as the Helping Everyone Achieve Long Term Health (HEALTH) Passport, is intended to decrease the burden of chronic disease in patients with mental illness. Patients with mental health disorders are known to have a lower life expectancy than general medical patients, in part because of higher rates of chronic diseases and because they are more likely to engage in unhealthy lifestyles.

Results of a study, released here at the 24th European College of Neuropsychopharmacology (ECNP) Congress, show that psychiatric inpatients who participated in the program reported that they intend to reduce their number of risk factors for chronic diseases by a mean of 1.7.

This reduction would, in turn, halve the number of psychiatric inpatients deemed to be at high risk because of the presence of 4 or more risk factors.

Mr. Matthew Megson

"We are encouraged by the findings, even though we don't yet have hard data on how patients' intentions will translate into actual lifestyle changes," principal investigator Matthew Megson, who is in his final year at Warwick Medical School in Coventry, United Kingdom, told Medscape Medical News. The HEALTH Passport program is unique in that it is the first health-promotion scheme to educate patients about the 10 main risk factors for chronic disease in a simple, accessible format.

The study by Mr. Megson and his team, entitled Preventing Chronic Disease in People with Mental Health Problems: the HEALTH Passport Approach, won the ECNP Best Poster Award.

Focus on Risk Factors

The HEALTH Passport program aims to help patients achieve long-term good health by understanding why risk factors are important. It also provides patients with a score of their current health performance and produces a 1-page action plan, called a passport.

Patients undergo a brief interview with a physician or nurse, after which they are given a health score for their risk of developing a chronic disease; this is noted on their HEALTH passport.

The HEALTH passport lists 2 facts about each of the 10 most common "health downfalls," along with a simple action plan. The document focuses on the importance of normal weight, physical activity, fruit and vegetable consumption, smoking cessation, the avoidance of alcohol or drugs, safe sexual practices, cancer screening, emotional well being, blood pressure and cholesterol screening, and diabetes prevention.

For example, under the heading "smoking," the 2 facts are that are listed are: smokers have a 15-times increased risk for lung cancer; and, on average, smokers die 10 years earlier than nonsmokers.

The action plan for smoking states that 1 in 6 people successfully stop smoking using nicotine replacement therapy.

Under the heading "diabetes prevention," the 2 facts that are cited are: men who smoke 40 cigarettes a day are 45% more likely to develop diabetes than nonsmokers; and people older than 45 years of age or with a waist circumference greater than 94 cm for men or 80 cm for women, a family history of diabetes, or a history of high blood pressure or heart disease are at greater risk.

The action plan for diabetes prevention states that 4 in 5 cases of type 2 diabetes in people younger than 65 years of age can be prevented by weight management, exercise, and a healthy diet.

The facts and action plan represent a generic "one size fits all" strategy for risk-factor management.

The physician notes, on the passport, goals that have been jointly agreed upon by the physician and patient.

The passport serves as the patient's record, which he/she can share with his/her healthcare professionals and update as needed.

The HEALTH passport has been validated in diabetic inpatients, with data showing that the incidence of type 2 diabetes can be reduced by 58% through effective lifestyle management.

Mr. Megson presented a comparison of the results of questionnaires completed by 50 psychiatric inpatients and by 100 general medical inpatients in an earlier study.

In an analysis by Mr. Megson and his team, patients from the "old age" psychiatric ward and patients younger than 16 years of age were excluded. A broad range of psychiatric conditions was represented in the sample, including mania, schizophrenia, and personality disorders.

Passport Boosts Motivation

Results showed that 88% of psychiatric inpatients were at high risk of developing chronic diseases, compared with only 37% of general inpatients in the earlier study. In addition, 2.1 times as many psychiatric inpatients as general inpatients were at high risk for diabetes. Also, 4.2 times as many psychiatric inpatients reported that they smoked cigarettes.

Psychiatric inpatients also reported that they were motivated to monitor their blood pressure routinely, decrease their alcohol and drug intake, and increase their exercise.

The investigators calculated that if patients achieved their lifestyle goals, the incidence of alcohol and drug abuse would be reduced by 50%, physical inactivity would be decreased by 55%, obesity would be reduced by 44%, and smoking would be reduced by 41%.

Psychiatric inpatients reported that the main obstacle to living a healthier lifestyle was their enjoyment of unhealthy behaviors (42%). For general medical patients, the key obstacle was a lack of time (36%).

Mr. Megson said that the psychiatric inpatients in this study will be followed to determine how many of them implemented their goals.

Mr. Megson has disclosed no relevant financial relationships.

24th European College of Neuropsychopharmacology (ECNP) Congress: Abstract P.8.a.003. Presented September 6, 2011.