Life Goals Behavioral Change to Improve Outcomes for Veterans With Serious Mental Illness
Condition: Bipolar Disorder; Schizophrenia; Major Depressive Disorder; Chronic Affective Disorders; Cardiovascular Disease Risk
MeSH terms: Cardiovascular Diseases; Schizophrenia; Depressive Disorder; Depressive Disorder, Major; Bipolar Disorder; Mood Disorders
Study type: Interventional

Summary: 
      Persons with serious mental illness are at increased risk of cardiovascular disease. The
      goals of this study are to test a treatment, Life Goals Collaborative Care to help promote
      health behavior change and to get feedback from patients and providers on what is needed to
      help better coordinate and physical and mental health care of these patients.
    

Detailed description: 
      Background: Persons with serious mental illness (SMI, including schizophrenia, bipolar
      disorder, or chronic affective disorders) experience a disproportionate burden of medical
      comorbidity, notably cardiovascular disease (CVD), leading to poor functioning and premature
      mortality. CVD risk factors in persons with SMI are attributable to unhealthy lifestyles
      exacerbated by mental health-related symptoms, medication side effects (e.g., weight gain),
      and the fragmentation of physical and mental health services.

      Objectives: The specific aims of this rapid response proposal pilot study are 1) to adopt and
      test the feasibility of an evidence-based psychosocial intervention (Life Goals Collaborative
      Care- or LGCC) designed to promote health behavioral change that was developed for bipolar
      disorder to a broader SMI patient population, and 2) to describe the implementation of LGCC
      and the barriers and facilitators of adoption to a more generalizable SMI patient population,
      and to vet the program to key VA stakeholders in order to inform a larger implementation
      study across different VHA settings.

      Methods: LGCC is a novel manual-based intervention that incorporates behavioral change
      strategies within a Chronic Care Model-based program. It is designed to reduce risk factors
      for cardiovascular disease (CVD), through improved control of psychiatric symptoms and
      increased positive health behaviors, as well as improved coordination of physical and mental
      health care. We will enroll 100 individuals diagnosed with a chronic mental disorder and CVD
      risk factor who are also receiving care within the VA Ann Arbor Healthcare System mental
      health clinics, of which 50 will be randomized to LGCC, and 50 randomized to receive usual
      care. LGCC consists of 1) 10 sessions focused on CVD risk reduction through behavioral change
      within the context of patients' psychiatric symptoms; 2) participant goal setting in diet and
      exercise; 3) customized ongoing motivational interviewing (MI)-based patient contacts with a
      health specialist for 6 months, in addition to 4) strategies to increase provider access and
      support for behavioral change and medical management. Outcomes will be assessed to determine
      whether effect sizes are comparable to previously published LGCC randomized controlled
      trials, and include mental and physical health-related quality of life and long-term
      (10-year) CVD risk based on the Framingham risk score assessed at 6 months. Additional mixed
      methods analyses of administrator, consumer and provider interviews to inform further
      adoption of LGCC will also be completed.

      Impact: Serious mental illness is associated with significant disability, decreased quality
      of life, and a decreased life span. VA patients with SMI die an average of 13-18 years
      earlier than age and gender matched individuals from the U.S. population, mostly from CVD.
      Interventions such as LGCC that combine individualized lifestyle coaching with Chronic Care
      Model principles may lead to the greatest impact on this public health crisis because they
      address multiple reasons for health disparities, and behavior change is reinforced through
      improved coordination and continuity of care. If effective, LGCC could be easily disseminated
      in VA practices and aligned with emerging VHA "T-21" initiatives around veteran-centered care
      (patient-centered medical home) and behavioral medicine programs that can ultimately improve
      outcomes for veterans with mental disorders.
    

Intervention name(s): Life Goals Collaborative Care
Intervention type(s): Behavioral
Intervention description(s): LGCC consists of 1) 10 sessions focused on CVD risk reduction through behavioral change within the context of patients' psychiatric symptoms; 2) participant goal setting in diet and exercise; 3) customized ongoing motivational interviewing (MI)-based patient contacts with a health specialist for 6 months, in addition to 4) strategies to increase provider access and support for behavioral change and medical management.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: chronic mental disorders; cardiovascular disease; behavior change