Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 12/2020

Open Access 01-12-2020 | Care | Original Paper

Is there an association between perceived social support and cardiovascular health behaviours in people with severe mental illnesses?

Authors: Alexandra Burton, Kate Walters, Louise Marston, David Osborn

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 12/2020

Login to get access

Abstract

Purpose

People with severe mental illnesses (SMI) have an increased risk of cardiovascular disease (CVD). Research in the general population suggests that social support may protect against increased CVD morbidity and mortality; however, this may not apply to those with SMI. We aimed to explore the association between perceived social support and attendance at primary care nurse CVD risk reduction clinic appointments and CVD risk-reducing behaviours in an SMI population with elevated CVD risk factors.

Methods

We used longitudinal and cross-sectional data from a randomised controlled trial on 326 adults with SMI recruited via 76 general practices in England. Multilevel regression analysis estimated the effect of perceived social support on attendance at CVD risk reduction clinic appointments over 6 months, and adherence to CVD medication, physical activity, diet, smoking and alcohol use at baseline, adjusted by age, sex, ethnicity, deprivation, psychiatric diagnosis and employment.

Results

Perceived social support predicted greater appointment attendance in unadjusted (IRR = 1.005; 1.000–1.010; p = 0.05) but not adjusted analysis (IRR = 1.003; 0.998–1.009; p = 0.25). Perceived social support was associated with greater adherence to medication; for each 1% increase in social support, there was a 4.2% increase in medication adherence (OR = 1.042; 1.015–1.070; p = 0.002). No association was found between greater perceived social support and greater physical activity, lower sedentary behaviour, healthier diet, lower alcohol use or being a non-smoker.

Conclusions

Social support may be an important facilitator for CVD medication adherence and is potentially important for primary care appointment attendance; however, alternative strategies might be needed to help people with SMI engage in physical activity, healthier diets and to reduce their smoking and alcohol use.
Footnotes
1
The MMAS (8-item) content, name, and trademarks are protected by US copyright and trademark laws. Permission for use of the scale and its coding is required. A license agreement is available from Donald E Morisky, 14,725 NE 20th St Bellevue, WA 98,007, USA; dmorisky@gmail.com.
 
Literature
1.
Osborn D, Levy G, Nazareth I, Petersen I, Islam A, King MB (2007) Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the united kingdoms general practice research database. Arch Gen Psychiatry 64(2):242–249PubMedCrossRef
2.
Hayes JF, Marston L, Walters K, King MB, Osborn DPJ (2018) Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014. Br J Psychiatry 211(3):175–181CrossRef
3.
Filik R, Sipos A, Kehoe PG, Burns T, Cooper SJ, Stevens H et al (2006) The cardiovascular and respiratory health of people with schizophrenia. Acta Psychiatr Scand 113(4):298–305PubMedCrossRef
4.
McCreadie R (2002) Use of drugs, alcohol and tobacco by people with schizophrenia: case–control study. Br J Psychiatry 181(4):321–325PubMedCrossRef
5.
Schizophrenia and diabetes 2003 expert consensus meeting (2004) Dublin, 3-4 October 2003: consensus summary. Br J Psychiatry 184(47):s112–s114
6.
Correll CU, Robinson DG, Schooler NR, Brunette MF, Mueser KT, Rosenheck RA et al (2014) Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the raise-etp study. JAMA Psychiatry 71(12):1350–1363PubMedCrossRef
7.
Hardy S, Hinks P, Gray R (2013) Screening for cardiovascular risk in patients with severe mental illness in primary care: a comparison with patients with diabetes. J Mental Health 22(1):42–50CrossRef
8.
Osborn D, Baio G, Walters K, Petersen I, Limburg H, Raine R et al (2011) Inequalities in the provision of cardiovascular screening to people with severe mental illnesses in primary care. Schizophr Res 129(2):104–110PubMedCrossRef
9.
10.
World Health Organization (2018) Management of physical health conditions in adults with severe mental disorders. World Health Organization, Geneva
11.
Royal College of Psychiatrists (2014) Report of the second round of the National Audit of Schizophrenia (NAS). Healthcare Quality Improvement Partnership, London
12.
13.
Wheeler A, Beltrame J, Tucker G, Air T, Ling L-H, Schrader G (2012) Depression and 5-year mortality in patients with acute myocardial infarction: analysis of the IDACC database. Aust N Z J Psychiatry 46(7):669–675PubMedCrossRef
14.
Loprinzi PD, Ford MA (2018) Effects of social support network size on mortality risk: considerations by diabetes status. Diabetes Spectr 31(2):189–192PubMedPubMedCentralCrossRef
15.
Yang YC, Boen C, Mullan HK (2015) Social relationships and hypertension in late life: evidence from a nationally representative longitudinal study of older adults. J Aging Health 27(3):403–431PubMedCrossRef
16.
Cohen S, Wills TA (1985) Stress, social support, and the buffering hypothesis. Psychol Bull 98(2):310–357PubMedCrossRef
17.
18.
Cohen AN, Hammen C, Henry RM, Daley SE (2004) Effects of stress and social support on recurrence in bipolar disorder. J Affect Disord 82(1):143–147PubMedCrossRef
19.
San L, Bernardo M, Gómez A, Martínez P, González B, Peña M (2013) Socio-demographic, clinical and treatment characteristics of relapsing schizophrenic patients. Nord J Psychiatry 67(1):22–29PubMedCrossRef
20.
Rabinovitch M, Cassidy C, Schmitz N, Ridha J, Malla A (2013) The influence of perceived social support on medication adherence in first-episode psychosis. Can J Psychiatry 58(1):59–65PubMedCrossRef
21.
Magura S, Rosenblum A, Fong C (2011) Factors associated with medication adherence among psychiatric outpatients at substance abuse risk. Open Addict J 4:58–64PubMedPubMedCentralCrossRef
22.
Fogarty M, Happell B (2005) Exploring the benefits of an exercise program for people with schizophrenia: a qualitative study. Issues Mental Health Nurs 26(3):341–351CrossRef
23.
Firth J, Carney R, Jerome L, Elliott R, French P, Yung AR (2016) The effects and determinants of exercise participation in first-episode psychosis: a qualitative study. BMC Psychiatry 16:36PubMedPubMedCentralCrossRef
24.
Bassilios B, Judd F, Pattison P (2014) Why don’t people diagnosed with schizophrenia spectrum disorders (SSDs) get enough exercise? Australas Psychiatry 22(1):71–77PubMedCrossRef
25.
Heffner JL, Watson NL, McClure JB, Anthenelli RM, Hohl S, Bricker JB (2018) “I smoke like this to suppress these issues that are flaws of my character”: challenges and facilitators of cessation among smokers with bipolar disorder. J Dual Diagn 14(1):32–39PubMedPubMedCentralCrossRef
26.
Aschbrenner KA, Naslund JA, Gill L, Hughes T, O’Malley AJ, Bartels SJ et al (2017) Qualitative analysis of social network influences on quitting smoking among individuals with serious mental illness J Mental. Health 28(5):475–481
27.
Daumit GLMDMHS, Goldberg RWP, Anthony C, Dickerson FP, Brown CHP, Kreyenbuhl JPP et al (2005) Physical activity patterns in adults with severe mental illness. J Nerv Mental Dis 193(10):641–646CrossRef
28.
Leas L, Mccabe M (2007) Health behaviors among individuals with schizophrenia and depression. J Health Psychol 12(4):563–579PubMedCrossRef
29.
Arbour-Nicitopoulos KP, Duncan MJ, Remington G, Cairney J, Faulkner GE (2017) The utility of the health action process approach model for predicting physical activity intentions and behavior in schizophrenia. Front Psychiatry 8:135PubMedPubMedCentralCrossRef
30.
Ferron J, Brunette M, He X, Xie X, McHugo G, Drake R (2011) Course of smoking and quit attempts among clients with co-occurring severe mental illness and substance use disorders. Psychiatr Serv 62(4):353–359PubMedCrossRef
31.
Brunette MF, Ferron JC, Aschbrenner KA, Pratt SI, Geiger P, Kosydar S (2019) Attitudes about smoking cessation treatment, intention to quit, and cessation treatment utilization among young adult smokers with severe mental illnesses. Addict Behav 89:248–255PubMedCrossRef
32.
Schofield N, Quinn J, Haddock G, Barrowclough C (2001) Schizophrenia and substance misuse problems: a comparison between patients with and without significant carer contact. Soc Psychiatry Psychiatr Epidemiol 36(11):523–528PubMedCrossRef
33.
34.
Osborn D, Burton A, Walters K, Nazareth I, Heinkel S, Atkins L et al (2016) Evaluating the clinical and cost effectiveness of a behaviour change intervention for lowering cardiovascular disease risk for people with severe mental illnesses in primary care (PRIMROSE study): study protocol for a cluster randomised controlled trial. Trials 17(1):80PubMedPubMedCentralCrossRef
35.
Osborn D, Burton A, Hunter R, Marston L, Atkins L, Barnes T et al (2018) Clinical and cost-effectiveness of an intervention for reducing cholesterol and cardiovascular risk for people with severe mental illness in English primary care: a cluster randomised controlled trial. Lancet Psychiatry 5(2):145–154PubMedCrossRef
36.
37.
Berkman L, Glass T (2000) Social integration, social networks, social support and health. In: Berkman LF, Kawachi I (eds) Social epidemiology. Oxford University Press, New York, pp 158–162
38.
Fulginiti A, Brekke JS (2015) Escape from discrepancy: self-esteem and quality of life as predictors of current suicidal ideation among individuals with schizophrenia. Community Ment Health J 51(6):654–662PubMedCrossRef
39.
Morisky DE, Ang A, Krousel-Wood M, Ward HJ (2008) Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich, Conn) 10(5):348–354CrossRef
40.
Morisky DE, DiMatteo MR (2011) Improving the measurement of self-reported medication nonadherence: response to authors. J Clin Epidemiol 64(3):255–263PubMedCrossRef
41.
Berlowitz DR, Foy CG, Kazis LE, Bolin LP, Conroy MB, Fitzpatrick P et al (2017) Effect of intensive blood-pressure treatment on patient-reported outcomes. N Engl J Med 377(8):733–744PubMedPubMedCentralCrossRef
42.
Huang YM, Shiyanbola OO, Smith PD (2018) Association of health literacy and medication self-efficacy with medication adherence and diabetes control. Patient Preference Adher 12:793–802CrossRef
43.
Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE et al (2003) International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395PubMedCrossRef
44.
Faulkner G, Cohn T, Remington G (2006) Validation of a physical activity assessment tool for individuals with schizophrenia. Schizophr Res 82(2):225–231PubMedCrossRef
45.
Duncan MJ, Arbour-Nicitopoulos K, Subramanieapillai M, Remington G, Faulkner G (2017) Revisiting the International Physical Activity Questionnaire (IPAQ): assessing physical activity among individuals with schizophrenia. Schizophr Res 179:2–7PubMedCrossRef
46.
Roe L, Strong C, Whiteside C, Neil A, Mant D (1994) Dietary intervention in primary care: validity of the dine method for diet assessment. Fam Pract 11(4):375–381PubMedCrossRef
47.
Little P, Barnett J, Margetts B, Kinmonth AL, Gabbay J, Thompson R et al (1999) The validity of dietary assessment in general practice. J Epidemiol Community Health 53(3):165–172PubMedPubMedCentralCrossRef
48.
Osborn D, Nazareth I, King MB (2007) Physical activity, dietary habits and Coronary Heart Disease risk factor knowledge amongst people with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 42(10):787–793PubMedCrossRef
49.
Saunders JB, Aasland OG, Babor TF, De La Fuente JR, Grant M (1993) Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88(6):791–804PubMedCrossRef
50.
Dawe S, Seinen A, Kavanagh D (2000) An examination of the utility of the AUDIT in people with schizophrenia. J Stud Alcohol 61(5):744–750PubMedCrossRef
51.
Maisto SA, Carey MP, Carey KB, Gordon CM, Gleason JR (2000) Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychol Assess 12(2):186–192PubMedCrossRef
52.
StataCorp (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp LP
53.
Thorup A, Petersen L, Jeppesen P, Ohlenschlaeger J, Christensen T, Krarup G et al (2006) Social network among young adults with first-episode schizophrenia spectrum disorders: results from the Danish OPUS trial. Soc Psychiatry Psychiatr Epidemiol 41(10):761–770PubMedCrossRef
54.
Aschbrenner KAP, Mueser KTP, Bartels SJMDMS, Pratt SIP (2013) Perceived social support for diet and exercise among persons with serious mental illness enrolled in a healthy lifestyle intervention. Psychiatr Rehabil J 36(2):65–71PubMedPubMedCentralCrossRef
55.
Smyth N, Siriwardhana C, Hotopf M, Hatch SL (2015) Social networks, social support and psychiatric symptoms: social determinants and associations within a multicultural community population. Soc Psychiatry Psychiatr Epidemiol 50(7):1111–1120PubMedCrossRef
56.
Vancampfort D, Firth J, Schuch F, Rosenbaum S, De Hert M, Mugisha J et al (2016) Physical activity and sedentary behavior in people with bipolar disorder: a systematic review and meta-analysis. J Affect Disord 201:145–152PubMedCrossRef
57.
Aschbrenner KA, Naslund JA, Gill L, Bartels SJ, O'Malley AJ, Brunette MF (2017) Preferences for smoking cessation support from family and friends among adults with serious mental illness. Psychiatr Q 88(4):701–710PubMedPubMedCentralCrossRef
58.
Brunette MF, Feiron JC, Aschbrenner K, Colctti D, Devitt T, Greene MA et al (2017) Characteristics and predictors of intention to use cessation treatment among smokers with schizophrenia: young adults compared to older adults. J Subst Abuse Alcohol 5(1):1055
59.
Scheurer D, Choudhry N, Swanton KA, Matlin O, Shrank W (2012) Association between different types of social support and medication adherence. Am J Manag Care 18(12):e461–467PubMed
60.
Aschbrenner KA, Ferron JC, Mueser KT, Bartels SJ, Brunette MF (2015) Social predictors of cessation treatment use among smokers with serious mental illness. Addict Behav 41:169–174PubMedCrossRef
61.
Gunzler DD, Morris N, Dalton JE, McCormick R, Dawson NV, Thomas C et al (2017) Clinic appointment attendance in adults with serious mental illness and diabetes. Am J Health Behav 41(6):810–821PubMedPubMedCentralCrossRef
62.
Murray J, Fenton G, Honey S, Bara AC, Hill KM, House A (2013) A qualitative synthesis of factors influencing maintenance of lifestyle behaviour change in individuals with high cardiovascular risk. BMC Cardiovasc Disord 13(1):1–11CrossRef
63.
Croezen S, Picavet HSJ, Haveman-Nies A, Verschuren WMM, de Groot LCPGM, van't Veer P (2012) Do positive or negative experiences of social support relate to current and future health? Results from the doetinchem cohort study. BMC Pub Health 12:65CrossRef
64.
Pieroth R, Rigassio Radler D, Guenther PM, Brewster PJ, Marcus A (2017) The relationship between social support and diet quality in middle-aged and older adults in the United States. J Acad Nutr Diet 117(8):1272–1278PubMedCrossRef
65.
Holt RI, Hind D, Gossage-Worrall R, Bradburn MJ, Saxon D, McCrone P et al (2018) Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT. Health Technol Assess 22(65):1–160PubMedPubMedCentralCrossRef
66.
Druss BG, von Esenwein SA, Glick GE, Deubler E, Lally C, Ward MC et al (2017) Randomized trial of an integrated behavioral health home: the health outcomes management and evaluation (HOME) study. Am J Psychiatry 174(3):246–255PubMedCrossRef
Metadata
Title
Is there an association between perceived social support and cardiovascular health behaviours in people with severe mental illnesses?
Authors
Alexandra Burton
Kate Walters
Louise Marston
David Osborn
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Keyword
Care
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 12/2020
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-020-01879-9

Other articles of this Issue 12/2020

Social Psychiatry and Psychiatric Epidemiology 12/2020 Go to the issue

Original Paper

Mortality by diseases and medical conditions in the offspring of parents with severe mental illness

Original Paper

The effect of gender on the long-term course and outcome of schizophrenia in rural Ethiopia: a population-based cohort

Original Paper

Schizophrenia, social support, caregiving burden and household poverty in rural China

Original Paper

Employment functioning in people with severe mental illnesses living in urban vs. rural areas in India

Original Paper

The impact of employment on recovery among individuals who are homeless with severe mental illness in the Vancouver At Home/Chez Soi trial

Original Paper

Fidelity and IPS: does quality of implementation predict vocational outcomes over time for organizations treating persons with severe mental illness in the Netherlands?