When one out of three patients entered the University of Massachusetts Weight Center's behavioral weight-loss program with major depression, it didn't seem like a coincidence, says Sherry L. Pagoto, PhD, one of the center's clinical psychologists.
And when the depressed patients lost much less weight on the program that non-depressed patients, "We felt like we were failing them," Pagoto says, so she took more pointed action. She and her colleagues created a pilot behavioral activation intervention-with a report now in press for publication in Psychotherapy: Theory, Research, and Practice-targeting their depressive symptoms. They found that the treatment not only helped patients recover from depression but helped them lose weight as well. Pagoto is now leading a randomized clinical trial of this intervention targeting women with obesity and clinical depression.
Her efforts reflect a growing trend in which physicians, psychologists and psychiatrists collaborate to improve the health and wellness of people with mental illnesses. And this work couldn't come at a better time. A 2006 report from the National Association of State Mental Health Program Directors titled "Morbidity and Mortality in People with Serious Mental Illness" found that living with a serious mental illness may shorten one's lifespan by nearly 25 years.
Overall, the report found, people with serious mental disorders live less healthy lifestyles, in part because they are less likely to be financially secure or have access to quality care. They also have higher rates of such chronic illnesses as diabetes, heart ailments and respiratory diseases, as well as vulnerability to homelessness, unemployment and alcohol consumption.
Mental health professionals have long acknowledged that people with serious mental illnesses often die younger than those without one. The report highlights just how severe the mortality gap may be, says David Chambers, PhD, associate director of dissemination and implementation research at the National Institute of Mental Health (NIMH).
One crucial area for change lies in addressing the medical co-morbidities that disproportionately affect people with serious mental illnesses.
"There's overwhelming evidence that these people are dying from chronic illnesses that affect the general population-heart and lung disease, diabetes, obesity," says Ken Thompson, MD, chief medical officer of the Center for Mental Health Services (CMHS) with the Substance Abuse and Mental Health Services Administration (SAMHSA). "The difference is that they're dying much younger than everyone else."
'Inventing the neck'
Even before the report's release, NIMH, SAMHSA and other mental health agencies rallied around research proposals that respond to the widespread co-occurring medical conditions that often accompany serious mental illness, says Thompson.
"It's the equivalent of inventing the neck," he says. "We need to recognize that the head and body are connected to each other."
Clinical psychologist Janice A. Blalock, PhD, of the University of Texas M.D. Anderson Cancer Center, agrees. She's leading an NIMH-funded study that tests the effectiveness of combining cognitive behavioral therapy with a smoking-cessation program to treat smokers with depression. Often, depressed smokers use nicotine to self-medicate depressive symptoms, says Blalock, and giving up smoking leaves them without their most frequently used coping mechanism. She hopes an integrated effort to treat both depression and nicotine addiction may work better than treating the two issues separately.
"It's something that everyone believes-that depression interferes with being able to quit smoking," says Blalock. "But it's not been widely looked at."
In addition to more synchronized treatment from primary-care and mental health professionals, seriously mentally ill consumers should also be encouraged to play a more active role in managing their own care, says clinical and community psychologist Richard W. Goldberg, PhD, of the University of Maryland School of Medicine. Goldberg is putting together a curriculum that teaches people with schizophrenia how to manage their medication, eat better and exercise more, as well as how to communicate with their physicians and navigate through the medical system.
The program's most innovative component, says Goldberg, is the involvement of mental health consumers in both the development and delivery of the intervention. The program's reliance on consumer facilitation and mutual support reflects a growing trend toward emphasizing recovery-oriented services.
"It's not all about health professionals telling consumers what they need to do," he says. "It's also important to empower mental health consumers to develop and maintain self-management skills."
Campaigning for change
As efforts by psychologists like Blalock and Goldberg gain ground, work is also under way at the national level to promote awareness on behalf of seriously mentally ill people.
CMHS's Thompson, for one, is part of a newly formed federal work force promoting primary-care/mental health integration. They recently helped launch a "Ten in Ten" campaign, which aims to reduce early mortality of seriously mentally ill people by 10 years by 2018. The campaign will include a centralized Web resource providing information on wellness strategies for individuals, families, mental health and primary-care providers and the community, and the group will examine policies and practices to better support wellness-such as federal financing of health prevention services.
Hopefully, efforts such as these will bring attention to a neglected population, Thompson says.
"We need to put our minds together and come up with increasingly innovative programs that can make this 'Ten in Ten' goal possible," he says. "Or go even further, so that we end up not having a mortality gap at all."
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