General physical health care advice for people with serious mental illness

Tosh G, Clifton A, Bachner M

Published Online:

November 9, 2011

People with serious mental illness have worse physical health than the general population. This review looks at whether giving advice about general physical health has any effect on the physical health and quality of life of people with serious mental illness.

Abstract (click to read)

Background:

There is currently much focus on provision of general physical health advice to people with serious mental illness and there has been increasing pressure for services to take responsibility for providing this.

Objectives:

To assess the effects of general physical health advice as a means of reducing morbidity, mortality and improving or maintaining quality of life in people with serious mental illness.

Search strategy:

We searched the Cochrane Schizophrenia Group Trials Register (November 2009) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO.

Selection criteria:

All randomised clinical trials focusing on general physical health advice.

Data collection and analysis:

We extracted data independently. For binary outcomes we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses.

Main results:

For the comparison of physical healthcare advice versus standard care we identified five studies (total n = 884) of limited quality. For measures of quality of life one trial found no difference (n = 54, 1 RCT, MD Lehman scale 0.00 CI -0.67 to 0.67) but another did (n = 407, 1 RCT, MD Quality of Life Medical Outcomes Scale - mental component 3.7 CI 1.7 to 5.6). There was no difference between groups for the outcome of death (n = 407, 1 RCT, RR 1.3 CI 0.3 to 6.0), for the outcome of uptake of ill-health prevention services, one study found percentages significantly greater in the advice group (n = 363, 1 RCT, MD 36.9 CI 33.1 to 40.7). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 884, 5 RCTs, RR 1.18 CI 0.97 to 1.43). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal.

Authors' conclusions:

General physical health could lead to people with serious mental illness accessing more health services which, in turn, could mean they see longer term benefits such as reduced mortality or morbidity. On the other hand it is possible clinicians are expending much effort, time and financial expenditure on giving ineffective advice. This is an important area for good research reporting outcome of interest to carers and people with serious illnesses as well as researchers and fundholders.

This record should be cited as:

Tosh G, Clifton A, Bachner M. General physical health advice for people with serious mental illness. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008567. DOI: 10.1002/14651858.CD008567.pub2

Assessed as up to date:

May 5, 2010

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Primary Review Group:

Schizophrenia Group

Health topics:

Mental health > Effective practice/health systems

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

General physical health care advice for people with serious mental illness

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