What was the research about?
People with serious mental illness, or SMI, such as bipolar disorder or schizophrenia often also have long-term physical health problems. Mental health centers may be able to help people with SMI get wellness services and improve their health.
In this study, the research team looked at whether a peer-led program with wellness coaching helped people with SMI improve their physical and mental health. The six-month program included three months of biweekly group classes. Classes focused on topics such as ways to take charge of one’s own health. Patients also received wellness coaching at the same time as the classes and for three months afterward.
The research team compared the program with usual care at a mental health center. Usual care included health screenings, access to mental and physical health services in one place, help managing care from nurses, and peer support.
What were the results?
Compared with people receiving usual care, people in the peer-led program
- Had fewer visits to the emergency room for mental health problems
- Drank less alcohol
- Had better general wellness, such as emotional and financial wellness
- Gave more input to doctors about their care
- Were more satisfied with their care
People in the peer-led program and those who received usual care didn’t differ in other ways, such as joining in social activities or having better mobility.
Who was in the study?
The study included 74 people with SMI whose health had recently gotten worse. All people in the study received care at a mental health center in Connecticut. Of these, 46 percent were black, 36 percent were white, 4 percent were American Indian/Alaska Native, 4 percent were more than one race, and 10 percent were another race. The average age was 49, and 64 percent were men.
What did the research team do?
The research team enrolled 37 people in the peer-led program. The team compared people in the program with 37 people receiving usual care at the center. People in both groups were similar in age, gender, and mental and physical health.
People in both groups completed a survey at the beginning of the study and six months later. The survey asked about wellness and satisfaction with care. The research team also looked at people’s health records.
People with SMI, family members, and healthcare providers worked as part of the research team during the study.
What were the limits of the study?
The number of people in the study was small. Of the 74 people, 24 didn’t finish the surveys. Also, some people’s health records didn’t include all data needed for the study. Results may differ if more people finished the surveys or if the data were complete. The research team didn’t assign people by chance to receive peer-led support or usual care. People in the program may have been different from patients who received usual care in ways that the research team doesn’t know.
Future research could test the peer-led program with more people.
How can people use the results?
Health clinics can use the results of the study when looking for ways to help improve health for people with SMI.
To compare a pilot peer-led program plus usual care with usual care alone for people with serious mental illness (SMI) on a variety of wellness outcomes, including service use and quality of life
|Population||74 patients with SMI whose health had deteriorated since enrollment in a co-located primary care and community mental health center|
|Outcomes||Self-reported service use, such as number of ED visits; recovery indicators, such as alcohol use; general wellness, including physical, social, and intellectual wellness; satisfaction with health care, such as treatment plan input and treatment satisfaction; quality of life, such as satisfaction with living situation; well-being, such as participation in social activities and physical mobility; internalized stigma of mental illness; and religious methods of coping|
|Timeframe||6-month follow-up for study outcomes|
This quasi-experimental study examined whether a six-month pilot peer-led program with wellness coaching and a holistic health group curriculum plus usual care improved physical and mental health outcomes for people with SMI more than usual care alone. The program included three months of peer-led group classes covering topics such as personal wellness, mental health stigma, and self-management strategies. Patients also received personalized wellness coaching on the same topics at the same time as the classes and for three months afterward. Usual care included co-location of primary care and mental health services, care coordination, access to peer health navigators, and routine screening for health indicators, such as body mass index and blood pressure.
The study included 74 people with SMI whose health indicators had deteriorated since enrollment at a co-located primary care and community mental health center in Connecticut. Of these patients, 46% were black, 36% were white, 4% were American Indian/Alaska Native, 4% were more than one race, and 10% were another race. The average patient age was 49, and 64% were male.
Researchers compared outcomes for the 37 people with SMI who agreed to participate in the program with 37 people with SMI who received only usual care. Participants in both groups were matched on a number of characteristics, including demographics and mental health diagnosis. Participants completed a brief questionnaire at the start and end of the program. Researchers also reviewed administrative data to assess study outcomes.
Using a community-based participatory research approach, patients with SMI, family members, and healthcare providers were co-researchers throughout the study. Participation included developing tools and running analyses.
Compared with participants who received usual care, participants in the program showed improvement in specific outcomes related to physical and mental health, including
- Fewer psychiatric or substance abuse emergency department (ED) visits (p=0.04)
- Greater decreases in alcohol use (p=0.007)
- Greater improvements in general wellness (p=0.04)
- More treatment plan input (p=0.03)
- Greater treatment satisfaction (p=0.02)
For the remaining study outcomes, the two groups did not differ significantly.
The sample was small. Of the 74 participants, 24 did not complete the study. Also, some data on health outcomes and service use were missing. Findings may differ if more participants completed the study or if data were complete. In addition, the study used a comparison group, which may have yielded more confounding variables than a randomized controlled trial.
Conclusions and Relevance
The results of this study suggest that a peer-led intervention that includes wellness coaching may improve some outcomes for people with SMI.
Future Research Needs
Future research could test the intervention using a randomized study design with a larger number of participants.
Final Research Report
View this project's final research report.
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Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- Reviewers asked for a stronger justification for the study design and the choice of outcomes measured. For example, they found it puzzling as to why the researchers chose to follow up on those patients who did not improve in the first part of the study, rather than follow up on those who improved. The researchers revised the report to explain that patients who had not shown improvement were at the highest risk for increased illness, morbidity, and mortality. The researchers designed the pilot intervention especially for patients who did not report improvement using the available services at the wellness center.
- Reviewers asked for a more coherent presentation and synthesis of the findings in Aim 1 because it was not clear which outcomes were most important and merited further study. The researchers restructured the presentation of findings for Aim 1 to clarify.
- Reviewers asked for greater recognition of the limitations introduced in the stakeholder-driven approach for selecting a control group that is unrepresentative in its motivation. The researchers added to their discussion of the limitations introduced by self-selection and using propensity-matched controls. They acknowledged that participants may not be representative of other people with serious mental illness who may be less motivated to address their physical health needs.
- Reviewers expressed concern about missing data, such as the loss of some control subjects to follow-up. The researchers provided details on how much data was missing and they handled missing data in linear mixed models.
Conflict of Interest Disclosures
Study Registration Information
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