Results Summary

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.

Final Research Report

View this project's final research report.

Peer-Review Summary

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

Project Information

Chyrell Bellamy, PhD, MSW
Yale University
$2,135,847
10.25302/03.2020.IH.13047294
Increasing Healthcare Choices and Improving Health Outcomes Among Persons with Serious Mental Illness

Key Dates

September 2013
October 2018
2013
2018

Study Registration Information

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Last updated: November 30, 2022