Inequalities in physical comorbidity: a longitudinal comparative cohort study of people with severe mental illness in the UK Telephone-Delivered Physical Activity Intervention for Individuals With Serious Mental Illness Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries. Smoking Cessation Intervention for severe Mental Ill Health Trial (SCIMITAR): a pilot randomised control trial of the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation service. Impact of a nurse-led intervention to improve screening for cardiovascular risk factors in people with severe mental illnesses. Phase-two cluster randomised feasibility trial of community mental health teams Effects of a Multifaceted Psychiatric Intervention Targeted for the Complex Medically Ill: A Randomized Controlled Trial Behavioral interventions for antipsychotic medication-associated obesity: a randomized, controlled clinical trial. Recognition of Co-Occurring Medical Conditions Among Patients With Serious Mental Illness Intervention to promote physical health in staff within mental health facilities and the impact on patients’ physical health Community-Level HIV Prevention for Persons with Severe Mental Illness Living in Supportive Housing Programs The impact of a stage-matched intervention to promote exercise behavior in participants with type 2 diabetes. Improving the physical health of long-term psychiatric inpatients Pharmacist-Led Group Medical Appointments for the Management of Type 2 Diabetes with Comorbid Depression in Older Adults Does treatment of subsyndromal depression improve depression-related and diabetes-related outcomes? A randomised controlled comparison of psychoeducation, physical exercise and enhanced treatment as usual HIV risk reduction for the seriously mentally ill: pilot investigation and call for research. Physical health—a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff Comorbidity of depression and diabetes: an application of biopsychosocial model
Objectives Little is known about the prevalence of comorbidity rates in people with severe mental illness ( SMI ) in UK primary care . We calculated the prevalence of SMI by UK country , English region and deprivation quintile , antipsychotic and antidepressant medication prescription rates for people with SMI , and prevalence rates of common comorbidities in people with SMI compared with people without SMI . Design Retrospective cohort study from 2000 to 2012 . Setting 627 general practice s contributing to the Clinical Practice Research Data link , a UK primary care data base . Participants Each identified case ( 346 551 ) was matched for age , sex and general practice with 5 r and omly selected control cases ( 1 732 755 ) with no diagnosis of SMI in each yearly time point . Outcome measures Prevalence rates were calculated for 16 conditions . Results SMI rates were highest in Scotl and and in more deprived areas . Rates increased in Engl and , Wales and Northern Irel and over time , with the largest increase in Northern Irel and ( 0.48 % in 2000/2001 to 0.69 % in 2011/2012 ) . Annual prevalence rates of all conditions were higher in people with SMI compared with those without SMI . The discrepancy between the prevalence of those with and without SMI increased over time for most conditions . A greater increase in the mean number of additional conditions was observed in the SMI population over the study period ( 0.6 in 2000/2001 to 1.0 in 2011/2012 ) compared with those without SMI ( 0.5 in 2000/2001 to 0.6 in 2011/2012 ) . For both groups , most conditions were more prevalent in more deprived areas , whereas for the SMI group conditions such as hypothyroidism , chronic kidney disease and cancer were more prevalent in more affluent areas . Conclusions Our findings highlight the health inequalities faced by people with SMI . The provision of appropriate timely health prevention , promotion and monitoring activities to reduce these health inequalities are needed , especially in deprived areas BACKGROUND : Obesity is prevalent in individuals with serious mental illness ( SMI ) . OBJECTIVE : The purpose of this study is to examine the feasibility of a telephone-delivered physical activity ( PA ) intervention for out patients with serious mental illness to maintain PA and to explore the preliminary efficacy of the intervention on health status . DESIGN : This study used a r and omized experimental design . The treatment group received pedometers and eight weekly phone calls ; the control group received written information regarding PA . Descriptive statistics were used to analyze data collected at baseline and 8 weeks . RESULTS : Twenty-two subjects with SMI ( mean age = 44.09 ± 7.6 years ; 54.5 % were male ) were recruited and 16 subjects completed the study in 8 weeks .  PA ( z = −2.37 , p = .02 ) increased in the treatment group ( n = 8) whereas the control group ( n = 8) maintained baseline PA level ( z = −1.61 , p = .11 ) . Health outcomes were not changed ( ps > .05 ) . CONCLUSION : Telephone-delivered intervention is feasible and has the potential to improve PA  in individuals with SMI The explicit inclusion of mental health within the Sustainable Development Goals is a welcome development , borne out of powerful advocacy using public health , economic and human rights arguments . As funding comes on line for scale-up of evidence -based mental health care by task-sharing with primary care , it is time to take stock about care for people affected by severe mental illness ( SMI ) . The existing evidence base for task shared care for SMI provides an imperative to get started , but is skewed towards relatively more affluent and urban population s in middle-income countries where specialist mental health professionals provide most of the care . R and omised , controlled trials and rigorous implementation research on task shared service models are underway which will go some way to improving underst and ing of the quality , safety , effectiveness and acceptability of more widely generalisable care for people with SMI . A sub-group of people with SMI have more complex and long-term needs for care , with a high risk of homelessness , imprisonment and human rights violations as family and social supports become overwhelmed . Case studies from non-governmental organisations provide examples of holistic approaches to rehabilitation , recovery and empowerment of people with SMI , but rigorous comparative studies are needed to identify the most efficient , effective and scalable approaches to care . Health system constraints are emerging as the over-riding barriers to successful task-sharing , highlighting a need to develop and evaluate chronic care models for people with SMI that succeed in reducing premature mortality , improving wellbeing and achieving better social outcomes . Addressing these evidence gaps is essential if task-sharing mental health care is going to deliver on its promise of promoting recovery for the full range of people affected by SMI BACKGROUND There is a high prevalence of smoking among people who experience severe mental ill health ( SMI ) . Helping people with disorders such as bipolar illness and schizophrenia to quit smoking would help improve their health , increase longevity and also reduce health inequalities . Around half of people with SMI who smoke express an interest in cutting down or quitting smoking . There is limited evidence that smoking cessation can be achieved for people with SMI . Those with SMI rarely access routine NHS smoking cessation services . This suggests the need to develop and evaluate a behavioural support and medication package tailored to the needs of people with SMI . OBJECTIVE The objective in this project was to conduct a pilot trial to establish acceptability of the intervention and to ensure the feasibility of recruitment , r and omisation and follow-up . We also sought preliminary estimates of effect size in order to design a fully powered trial of clinical effectiveness and cost-effectiveness . The pilot should inform a fully powered trial to compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation ( BSC ) intervention with usual general practitioner ( GP ) care for people with SMI . DESIGN A pilot pragmatic two-arm individually r and omised controlled trial ( RCT ) . Simple r and omisation was used following a computer-generated r and om number sequence . Participants and practitioners were not blinded to allocation . SETTING Primary care and secondary care mental health services in Engl and . PARTICIPANTS Smokers aged > 18 years with a severe mental illness who would like to cut down or quit smoking . INTERVENTIONS A BSC intervention delivered by mental health specialists trained to deliver evidence -supported smoking cessation interventions compared with usual GP care . MAIN OUTCOME MEASURES The primary outcome was carbon monoxide-verified smoking cessation at 12 months . Smoking-related secondary outcomes were reduction of number of cigarettes smoked , Fagerstrom test of nicotine dependence and motivation to quit ( MTQ ) . Other secondary outcomes were Patient Health Question naire-9 items and Short Form Question naire-12 items to assess whether there were improvements or deterioration in mental health and quality of life . We also measured body mass index to assess whether or not smoking cessation was associated with weight gain . These were measured at 1 , 6 and 12 months post r and omisation . RESULTS The trial recruited 97 people aged 19 - 73 years who smoked between 5 and 60 cigarettes per day ( mean 25 cigarettes ) . Participants were recruited from four mental health trusts and 45 GP surgeries . Forty-six people were r and omised to the BSC intervention and 51 people were r and omised to usual GP care . The odds of quitting at 12 months was higher in the BSC intervention ( 36 % vs. 23 % ) but did not reach statistical significance ( odds ratio 2.9 ; 95 % confidence interval 0.8 % to 10.5 % ) . At 3 and 6 months there was no evidence of difference in self-reported smoking cessation . There was a non-significant reduction in the number of cigarettes smoked and nicotine dependence . MTQ and number of quit attempts all increased in the BSC group compared with usual care . There was no difference in terms of quality of life at any time point , but there was evidence of an increase in depression scores at 12 months for the BSC group . There were no serious adverse events thought likely to be related to the trial interventions . The pilot economic analysis demonstrated that it was feasible to carry out a full economic analysis . CONCLUSIONS It was possible to recruit people with SMI from primary and secondary care to a trial of a smoking cessation intervention based around behavioural support and medication . The overall direction of effect was a positive trend in relation to biochemically verified smoking cessation and it was feasible to obtain follow-up in a substantial proportion of participants . A definitive trial of a bespoke cessation intervention has been prioritised by the National Institute for Health Research ( NIHR ) and the SCIMITAR pilot trial forms a template for a fully powered RCT to examine clinical effectiveness and cost-effectiveness . TRIAL REGISTRATION Current Controlled Trials IS RCT N79497236 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment , Vol . 19 , No. 25 . See the NIHR Journals Library website for further project information Background People with severe mental illnesses ( SMI ) are at increased risk of cardiovascular disease ( CVD ) . Clinical guidelines recommend regular screening for CVD risk factors . We evaluated a nurse led intervention to improve screening rates across the primary - secondary care interface . Methods Six community mental health teams ( CMHTs ) were r and omised to receive either the nurse led intervention plus education pack ( n = 3 ) or education pack only ( n = 3 ) . Intervention ( 6 months ) : The nurse promoted CVD screening in primary care and then in CMHTs . Patients who remained unscreened were offered screening by the nurse . After the intervention participants with SMI were recruited from each CMHT to collect outcome data . Main outcome : Numbers screened during the six months , confirmed in General Practice notes . Results All six CMHTs approached agreed to r and omisation . 121 people with SMI participated in outcome interviews during two waves of recruitment ( intervention arm n = 59 , control arm n = 62 ) . Participants from both arms of the trial had similar demographic profiles and rates of previous CVD screening in the previous year , with less than 20 % having been screened for each risk factor . After the trial , CVD screening had increased in both arms but participants from the intervention arm were significantly more likely to have received screening for blood pressure ( 96 % vs 68 % ; adjusted Odds Ratio ( OR ) 13.6 ; 95 % CI : 3.5 - 38.4 ) , cholesterol ( 66.7 % vs 26.9 % , OR 6.1 ; 3.2 - 11.5 ) , glucose ( 66.7 % vs 36.5 % OR 4.4 ; 2.7 - 7.1 ) , BMI ( 92.5 % vs 65.2 % OR 6.5 ; 2.1 - 19.6 ) , and smoking status ( 88.2 % vs 57.8 % OR 5.5 ; 3.2 - 9.5 ) and have a 10 year CVD risk score calculated ( 38.2 % vs 10.9 % ) OR 5.2 1.8 - 15.3 ) . Within the intervention arm approximately half the screening was performed in general practice and half by the trial nurse . Conclusions The nurse-led intervention was superior , result ing in an absolute increase of approximately 30 % more people with SMI receiving screening for each CVD risk factor . The feasibility of the trial was confirmed in terms of CMHT recruitment and the intervention , but the response rate for outcome collection was disappointing ; possibly a result of the cluster design . The trial was not large or long enough to detect changes in risk factors . Trial Registration International St and ard R and omised Controlled Trial Registration Number ( IS RCT RN ) 58625025 Background : This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED , an instrument to assess case complexity . Methods : Of 885 rheumatology in patients and diabetes out patients who were assessed for eligibility , 247 were identified as complex ( INTERMED score > 20 ) and r and omized to the intervention ( n = 125 , 84 rheumatology and 41 diabetes patients ) or care as usual ( n = 122 , 78 rheumatology and 44 diabetes patients ) . For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and /or of referral to a liaison psychiatrist , followed by advice to the treating physician or organization of a multidisciplinary case conference . Baseline and follow-up at months 3 , 6 , 9 and 12 measured prevalence of major depression ( Mini-International Neuropsychiatric Interview ) , depressive symptoms ( Center for Epidemiological Studies Depression Rating Scale ) , physical and mental health ( SF-36 ) , quality of life ( EuroQol ) , health care utilization and HbA1c levels ( diabetic patients ) . Results : Prevalence of major depression was reduced from 61 % ( T0 ) to 28 % ( T4 ) in the intervention group and remained stable in care as usual ( 57 % at T0 to 50 % at T4 ) . Compared to care as usual , significant improvement over time was observed in the intervention group with regard to depressive symptoms ( F = 11.9 ; p = 0.001 ) , perception of physical ( F = 5.7 ; p = 0.018 ) and mental health ( F = 3.9 ; p = 0.047 ) and quality of life ( F = 21.8 ; p < 0.001 ) . Effects tended to be stronger in diabetes patients , in patients with baseline major depression and in patients with moderate INTERMED scores . Finally , hospital admissions occurred less often in the intervention group , reaching statistical significance for the period between 6 and 9 months of follow-up ( p = 0.02 ) . Conclusions : The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes OBJECTIVE To demonstrate the effectiveness of a Diabetes Prevention Program-inspired 12-month behavioral intervention for patients with severe mental illness ( SMI ) and medication-associated obesity . METHOD This r and omized , controlled , parallel , superiority study screened 225 volunteers from November 2005 to August 2008 at the VA Greater Los Angeles Healthcare System . 122 out patients with DSM-IV-diagnosed SMI taking antipsychotic medications who had ≥ 7 % weight gain or body mass index ( BMI ) > 25 were r and omized by computer-generated number to Lifestyle Balance treatment intervention  ( n = 60 ) or usual care control  ( n = 62 ) groups . Clinical raters were masked to r and omization . Treatment intervention included weekly classes and individual counseling for 8 weeks , food and exercise diaries , rewards , caregiver consultations , and monthly booster classes and counseling for 1 year . Controls received self-help material s and visited at equivalent intervals without formal classes or counseling . Outcomes were changes in anthropometric measurements , psychiatric symptoms , health knowledge , and glucose , hemoglobin A1c , and lipid levels . RESULTS Our intention-to-treat analysis found significant differences in predicted trajectory of mean weight change between the groups over 12 months ( P < .01 ) , with treatment participants expected to lose an average 4.6 kg , while control participants would gain an average 0.6 kg . BMI and body fat percentage followed the same pattern . Both groups demonstrated statistically significant improvements in health knowledge quiz scores over time ( P = .006 ) , without significant difference between groups . CONCLUSIONS Treatment was more effective than usual care control in treating medication-associated obesity , independent of SMI diagnosis , antipsychotic medication , and knowledge gained , suggesting that behavioral interventions are effective in SMI patients . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00344500 We determined whether patients with serious mental illness ( SMI ) were less likely than non-SMI to self-report having a medical condition that was recorded in their medical record . We included all patients from the VA National Psychosis Registry diagnosed with SMI and a r and om sample of non-SMI patients in fiscal year 1999 who completed the Large Health Survey of Veteran Enrollees ( N = 35,837 ) . Among patients with diagnoses for any of 11 conditions recorded in administrative data , we evaluated whether patients reported having that same condition in the survey , using multivariable logistic regression and generalized estimating equations . Among patients diagnosed with a given condition , those with SMI were less likely to report being told by providers that they had seven of the 11 conditions examined : heart disease ( OR = 0.68 , p < 0.001 ) , arthritis ( OR = 0.79 , p < 0.001 ) , cancer ( OR = 0.69 , p < 0.001 ) , diabetes ( OR = 0.79 , p < 0.001 ) , back pain ( OR = 0.81 , p < 0.001 ) , congestive heart failure ( OR = 0.71 , p < 0.001 ) , and hypertension ( OR = 0.77 , p < 0.001 ) . Patients with SMI were less aware of co-occurring medical conditions Background : Patients with severe mental illnesses have an increased physical morbidity and premature mortality on account of somatic diseases . Patients with mental illness are nursed and cared for by the staff , who may acts as role models for the patients . Aims : The study tested the efficacy of an intervention programme for improving physical health in staff working in long-term psychiatric treatment facilities . Furthermore , the paper measured the association between staff 's changes in physical health and the patients ’ changes in physical health . Methods : The study was a cluster r and omized controlled 12-month intervention study , and the intervention was active awareness on physical health . Results : In the intervention group the staff reduced their waist circumference by 2.3 cm ( 95 % CI : 0.3–4.4 ) when controlling for gender , age and cigarette consumption . In the control group , the staff changed their waist circumference by − 2.1 cm ( 95 % CI : − 5.6–1.5 ) . The staff in the intervention group experienced a significant reduction in diastolic blood pressure of − 5.9 mmHg ( 95 % CI : − 9.5 to − 2.3 , p = 0.009 ) . The study indicated an association between the staff average change in each facility and the individual patient 's changes in health parameters ( body mass index , total body fat and quality of life ) . Conclusion : The staff in the intervention group showed a significant reduction of waist circumference , while staff in the control group showed a non-significant increase . Furthermore , a significant reduction in the diastolic blood pressure was seen . Indications that staff acted as positive role models for the patients ’ physical health were seen SUMMARY Individuals with severe mental illness ( SMI ) are at risk for HIV/AIDS . Despite the availability of supportive community programs for those with SMI , there have been no published evaluations of community-level HIV prevention trials among this population . A pilot intervention trial was conducted to determine the feasibility of such an intervention in supportive housing programs ( SHPs ) . A multi-component community-level trial was implemented in two SHPs with a total of 28 residents . Participants completed assessment s at three time points : prior to the intervention ( baseline ) , following skills training ( post- assessment ) , and following the 4-month community intervention ( follow-up ) . Results demonstrated significant improvements in psychosocial risk factors at both post— and follow-up assessment s , with indications of sexual behavior change at follow-up . The community-level intervention appeared to reduce the risk of HIV among persons with SMI living in SHPs , and supports the importance of conducting larger scale intervention trials This study was design ed to develop and evaluate a stage-matched intervention ( SMI ) in Korean participants with type 2 Diabetes . The SMI was based on main constructs derived from the Transtheoretical Model match to the individual 's stages of readiness for exercise behavior . The SMI was developed according to the results of the content validity tested by an expert group ( n = 9 ) . A control group pre- and post-test design was used for evaluating the impact of the SMI : the intervention group ( n = 22 ) participated in the SMI for 3 months , while the control group ( n = 23 ) received usual educational advice . The intervention group , compared to the control group , showed significant improvements in stages of change for exercise behavior ( p < 0.001 ) , physical activity levels ( p < 0.001 ) , and reductions in FBS ( p < 0.05 ) and HbA(1)c ( p < 0.05 ) . This study yielded evidence for the beneficial impact of the SMI in participants with type 2 Diabetes Background : Patients with psychiatric illness have increased somatic morbidity and increased mortality . Knowledge of how to integrate the prevention and care of somatic illness into the treatment of psychiatric patients is required . The aims of this study were to investigate whether an intervention programme to improve physical health is effective . Methods : An extension of the European Network for Promoting the Health of Residents in Psychiatric and Social Care Institutions ( HELPS ) project further developed as a 12-month controlled cluster-r and omized intervention study in the Danish centre . Waist circumference was a proxy of unhealthy body fat in view of the increased risk of cardiovascular diseases and type 2 diabetes . Results :  Waist circumference was 108 cm for men and 108 cm for women . Controlled for cluster r and omization , sex , age , and body fat , the intervention group showed a small , but not significant , reduction in waist circumference , while participants in the control group showed a significant increase in waist circumference . Conclusions : The intervention had a positive effect on the physical health of the patients measured by a reduction in the increase of waist circumference Background : : Depression is associated with poor glycemic control , increased number of microvascular and macrovascular complications , functional impairment , mortality , and 4.5 times higher total health care costs in patients with diabetes .  Shared medical appointments ( SMAs ) may be an effective method to attain national guideline recommendations for glycemic control in diabetes for patients with depression through peer support , counseling , problem solving , and improved access to care . Objective : To test the efficacy as assessed by attainment of a hemoglobin A1c ( A1C ) < 7 % of pharmacistted group SMA visits , Veterans Affairs Multidisciplinary Education in Diabetes and Intervention for Cardiac Risk Reduction in Depression ( VA-MEDIC-D ) , in patients with type 2 diabetes mellitus . Methods : This was a r and omized controlled trial of VA-MEDIC-D added to st and ard care versus st and ard care alone in depressed patients with diabetes with A1C > 6.5 % .  VA-MEDIC-D consisted of 4 once-weekly , 2-hour sessions followed by 5 monthly 90-minute group sessions . Each SMA session consisted of multidisciplinary education and pharmacist-led behavioral and pharmacologic interventions for diabetes , lipids , smoking , and blood pressure . No pharmacologic interventions for depression were provided . The change in the proportion of participants who achieved an A1C < 7 % at 6 months was compared . Results : Compared to st and ard care ( n = 44 ) , a lower proportion of patients in VA-MEDIC-D ( n = 44 ) had systolic blood pressure ( SBP ) < 130 mm Hg at baseline , but were similar in other cardiovascular risk factors and psychiatric comorbidity . The change in the proportion of participants achieving an A1C < 7 % was greater in the VA-MEDIC-D arm than in the st and ard care arm ( 29.6 % vs 11.9 % ) , with odds ratio 3.6 ( 95 % CI 1.1 to 12.3 ) . VA-MEDIC-D participants also achieved significant reductions in SBP , low-density lipoprotein cholesterol , and non – high-density lipoprotein ( HDL ) cholesterol from baseline , whereas significant reductions were attained only in non – HDL cholesterol with st and ard care . There was no significant change in depressive symptoms for either arm . Conclusions : Pharmacist-led group SMA visits are efficacious in attainment of glycemic control in patients with diabetes and depression without change in depression symptoms Background Elevated depressive symptoms that do not reach criteria for a clinical diagnosis of depression are highly prevalent in persons with diabetes . This study was aim ed at determining the efficacy of psychoeducation and physical exercise compared with enhanced treatment as usual on 1-year changes in depressive symptoms , diabetes distress and self-management , and quality of life and metabolic control in type 2 diabetes patients with subsyndromal depression . Methods Adult type 2 diabetes patients who screened positively for depression and expressed a need for professional help with mood-related issues were eligible . Exclusion criteria were clinical depression , current psychiatric treatment and advanced diabetes complications . Out of 365 eligible patients 209 consented to either 6 weekly sessions of psychoeducation ( A ) and physical exercise ( B ) , or to enhanced treatment as usual ( C ) . Computer-generated sequences for block r and omisation stratified by gender were used . Depressive symptoms ( primary outcome ) and diabetes distress , diabetes self-care , metabolic control and health-related quality of life ( secondary outcomes ) were analysed at 6-month and 12-month follow-up using repeated- measures ANOVAs . Results Out of the 74 patients r and omised into group A , 66 into B and 69 into group C , 203 completed the interventions , and 179 patients with all 3 assessment s were analysed  . Depressive symptoms in participants from the psychoeducational , physical exercise and the enhanced treatment as usual groups improved equally from baseline to 12-month follow-up ( time versus time x group effect ; F = 12.51 , p < 0.001 , η2 = 0.07 and F = 0.609 , p = 0.656 , η2 = 0.007 respectively ) , as did diabetes distress and quality of life ( all p < 0.001 ) , diabetes self-care ( p < 0.001 to < 0.05 ) , triglycerides , and total cholesterol and LDL-cholesterol ( p < 0.001 ) . Conclusions The employed interventions had comparable positive effects on 12-month psychological and diabetes-related outcomes suggesting that even minimal intervention addressing patients ’ diabetes-related problems and concerns had favourable clinical implication s and might be sufficient to treat subsyndromal depression . Further investigation is warranted to clarify possible mechanisms of improvement . Trial registration Current Controlled Trials IS RCT N05673017The message on assigning the above mentioned IS RCT N was received on 11 August Research indicates that people with serious mental illnesses ( SMI ; e.g. , schizophrenia , schizoaffective disorder , bipolar disorder ) are at enhanced risk for infection with the human immunodeficiency virus ( HIV ) . To decrease this risk , we piloted a six-session HIV-risk reduction intervention for two single-gender groups ( nine women , eight men ; M age = 39.8 years ) of SMI out patients . The intervention and assessment were based on the  Information-Motivation-Behavioral Skills model of HIV-preventive behavior ( Fisher & Fisher , 1992 , Psychological Bulletin , 111 , 455 - 474 ) and employed activities design ed specifically for people with a SMI . Data were collected at pre- and post- interventions and at a one-month follow-up . Results indicated that this brief intervention result ed in enhanced HIV-related knowledge , and trends toward enhanced skill at condom use negotiation and condom use self-efficacy . Overall , a modest decrease in risk behavior among participants was observed . Thus , this pilot investigation revealed that HIV-related risk of the SMI can be reduced through traditional behavioral skills and education methods . Future research employing control groups , more intensive interventions , and baseline screening for high risk is encouraged The objective was to explore the impact on physical health of a lifestyle programme among persons with psychiatric disabilities , and their caregivers . Their satisfaction with the intervention was also assessed . Somatic comorbidity and an increased mortality related to the lifestyle among persons with psychiatric disabilities are well known . Few r and omized controlled trials have been aim ed specifically at lifestyle issues among persons with a psychiatric disability . This trial includes clients with psychiatric disabilities living in supported housing and their staff . Forty-one persons with a DSM-?V diagnosis of severe mental illness from psychiatric disability from 10 supported housing facilities and 41 of their caregivers participated in this 12-month study during 2005–2006 in Sweden . The supported housing facilities with residents and staff were r and omly assigned to either a health intervention programme or a control programme with an aesthetic content . The presence of metabolic syndrome and changes in the mean of physiological parameters such as Hba1c , P-glucose , P-insulin , lipids , blood pressure , physical working capacity , body mass index , Heart Score were investigated and participants ’ satisfaction assessed . There was a significant reduction in the mean of metabolic syndrome criteria in the intervention group compared with the control group at the follow-up . The participants expressed satisfaction with the programme . The results indicate that health interventions on lifestyle issues when involving carers are appreciated , feasible and could be successful in reducing some health-related risk factors among persons with psychiatric disabilities Background Type 2 diabetes ( T2D ) is one of the most psychologically dem and ing chronic medical illness in adult . Comorbidity between diabetes and depression is quite common , but most studies were based on developed country sample . Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients . Therefore , the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors . Methods Institution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic , Black Lion General Specialized Hospital in Ethiopia . Patients were selected using systematic r and om sampling technique . Depressive symptoms score , which constructed from a vali date d nine-item Patient Health Question naire ( PHQ-9 ) , was an outcome variable . Finally , significant associated factors were identified using multiple linear regression analysis with backward elimination procedure . Statistical Package for Social Science ( SPSS ) version 22.0 ( IBM SPSS Corp. ) was used to perform all analysis . Results Total of 264 patient data was analyzed with 95.7 % response rate . Patients mean ( SD ) current age and age at diagnosis was 55.9 ( 10.9 ) and 43.9 ( 10.9 ) years , respectively . Patients waist circumference ( mean ± SD ) was 98.9 ± 11.1  cm . The average PHQ-9 score was 4.9 ( SD 4.1 ) and fasting blood glucose was 166.4 ( SD 73.2 ) . Marital status ( divorced ) , occupation ( housewife ) , diabetic complication ( nephropathy ) , negative life event in the last six months , and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates . Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score . Conclusion Biopsychosocial variables including marital status , negative life event in the last 6 months , occupation , diabetic complication , and poor social support significantly increase average depressive symptoms score . Evidence -based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms
Discussion The proposed core outcome set will provide clear guidance about what outcomes should be measured , as a minimum , in trials of interventions for people with coexisting type-2 diabetes and SMI , and improve future synthesis of trial evidence in this area .
Background People with diabetes and comorbid severe mental illness ( SMI ) form a growing population at risk of increased mortality and morbidity compared to those with diabetes or SMI alone .
There is increasing interest in interventions that target diabetes in SMI in order to help to improve physical health and reduce the associated health inequalities .
However , there is a lack of consensus about which outcomes are important for this comorbid population , with trials differing in their focus on physical and mental health .
A core outcome set , which includes outcomes across both conditions that are relevant to patients and other key stakeholders , is needed .