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Helping People with Serious Mental Illness Live Healthier Lives

“We focused on helping our participants lose weight, but we also found that participants felt better about themselves overall.”  Gail Daumit, MD, MHS, Principal Investigator, ACHIEVE

In 2015 an estimated 9.8 million adults in the U.S. aged 18 or older – 4.0% of all U.S. adults -- suffered from a serious mental illness (SMI) during the previous year.[i]  SMI, which includes schizophrenia and bipolar disorder, is defined as a mental disorder with serious functional impairment which substantially interferes with or limits one or more major life activities. Gail Daumit, MD, MHS, is a general internist and epidemiologist/health services researcher dedicated to improving the physical health of those with SMI and decreasing premature mortality in this population, whose members die on average 10-15 years earlier than those without SMI, primarily due to cardiovascular disease (CVD).

Dr. Daumit is currently leading three NIH-funded randomized clinical trials to address CVD risk factors in adults and youth with SMI, including overweight and obesity, diabetes, hypertension, hyperlipidemia, and tobacco smoking.

About eighty percent of people with SMI are overweight or obese, and about half smoke cigarettes.  Physical inactivity and unhealthy diets are common, and medications, which are often necessary for mental health treatment, can cause weight gain through increased appetite leading to high caloric intake. Yet those with SMI, particularly schizophrenia, often have impairments in memory and executive function that complicate learning and adopting new behaviors such as healthy eating, regular exercise, and smoking cessation.

Building on the success of their ACHIEVE study -- the ground-breaking, 10-site behavioral weight loss intervention trial that demonstrated that adults with serious mental illness can make substantial lifestyle changes and achieve weight loss (average 7.0 lbs.), despite their unique challenges – Dr. Daumit and her colleagues have embarked on three multi-site trials: 1) TRIUMPH, an 18-month tobacco smoking cessation program integrating exercise and weight counseling; 2)  IDEAL, a broader CVD risk-reduction program, also 18 months’ duration; and 3) CHAMPION, a 12-month healthy weight intervention program for youth ages 8 to 18 with serious emotional disturbance.

Dr. Daumit is working to enhance dissemination and implementation of evidence-based preventive health interventions like ACHIEVE into community mental health settings, and studying models of integrated behavioral health and medical care including Maryland’s Healthy Home program.  Her work uses descriptive epidemiology, health services research, clinical trials, and implementation research methods to address vulnerabilities in this population.

Dr. Daumit is using lessons she learned as Principal Investigator for ACHIEVE, which received the 2014 Trial of the Year Award from the Society for Clinical Trials. One lesson is to meet the participants where they are: namely, at community psychiatric rehabilitation centers and clinics, the setting of all three of the current trials, allowing for a familiar and encouraging environment. Perhaps the least familiar aspect ahead is the inclusion of young people, but Dr. Daumit remarks, “There is a window of opportunity to intervene in youth with mental illness to prevent development of CVD risk factors-- if we can have an impact in this group, we can hopefully break the cascade of risk factors leading to premature CVD in adults with serious mental illness.”