Wellness Advice Often Lacking for Mentally Ill

A new study finds health care providers often fail to provide dietary and exercise advice to patients with diabetes, or to those who display symptoms of mental illness.

People with mental illness are often at high risk for diabetes as well as other “lifestyle” diseases.

During the investigation researchers discovered more than half of patients with symptoms of mental illness, and nearly one-third of those who also had diabetes, failed to receive appropriate health education.

The study has been published in the journal Diabetes Educator.

Although exercise and dietary recommendations have been a mainstay of diabetic care, researchers say those with mental illness can also benefit from a wellness lifestyle. Appropriate amounts of physical activity and healthy dietary choices can improve the quality of life and prevent debilitating health problems for diabetics and for those with mental illness.

Providers should not miss the opportunity to advise people with mental illness on health promotion and lifestyle changes, said researcher Xiaoling Xiang of the University of Illinois.

“It is important that providers counsel people in this population as early as possible about exercise and nutritional changes that reduce the risks associated with diabetes — before risk factors such as hypertension and high cholesterol manifest,” said Xiang, a doctoral candidate in social work.

People with mental illness have significantly higher rates of health problems such as cardiovascular disease, diabetes, hypertension, and high cholesterol that could be prevented or alleviated with lifestyle modifications.

They are also at increased risk of premature death, according to the study.

In the current study, participants ranged from 18 to 70 years old. The prevalence of diabetes was 15.6 percent among people in the data sample who had symptoms of serious psychological distress, compared with 7.9 percent of their peers.

Rates for all of the clinical conditions that predispose patients to diabetes were significantly higher among participants with symptoms of mental illness than among their counterparts.

More than 70 percent of those with mental illness had body mass indexes above 25, compared with 64.3 percent of their peers. They also had significantly higher rates of hypertension (42.1 percent, compared with 25.6 percent), hyperlipidemia (42 percent, versus 30.6 percent), and cardiovascular disease (29.7 percent, versus 14.7 percent).

People with symptoms of psychological distress who had not been diagnosed with diabetes at the time of the study had an average of more than three diabetes risk factors, compared with their counterparts, who averaged 2.4 risk factors.

The likelihood of patients receiving lifestyle counseling increased in accordance with their number of risk factors, however. While only 10.4 percent of patients who had no diabetes risk factors said they had received dietary advice from their health care providers, more than 65 percent of people with five or more risk factors had received dietary counseling.

“Given the elevated risk for diabetes among individuals with symptoms of psychological distress, even greater numbers of clinicians in the study sample should have been providing lifestyle counseling,” Xiang said.

“However, the increase in the rates of diabetes and diabetes risk factors seems to have outpaced the increase in the rates of provider advice for this population.”

Because people with mental illness tend to utilize outpatient, inpatient, and emergency services at much higher rates than the general population, clinicians have increased opportunities to educate patients about the benefits of a healthy diet and physical activity, Xiang said.

Researchers used data from the U.S. Dept. of Health and Human Services’ Medical Expenditure Panel Survey. This survey interviews a nationally representative sample of participants multiple times over a two-year period about their health and use of medical services.

Subjects in the data sample who had symptoms of mental illness had scored 13 or higher on the six-item Kessler Psychological Distress Scale, also called the K6, a screening tool that has been shown to be strongly predictive of serious mental illness.

Source: University of Illinois