Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services

Abstract

People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%–96%) and lowest for nutrition (17%, 95% CI:1%–35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence. PROSPERO registration: CRD42016049889.

Preventive care for physical activity and fruit and vegetable consumption: a survey of family carer expectations of health service delivery for people with a mental health condition

“…The results are also consistent with research reporting that people with a mental health condition would find it acceptable to be provided with support to change health risk behaviours from the services they access [28,49,61,[87][88][89]. Such findings highlight the need for health and community services to adhere to existing policies and increase the provision of care for these health risk behaviours to people with a mental health condition given the reported sub-optimal provision of preventive care to date [63].…”

“…Internationally and in Australia, guidelines and policies acknowledge the need to provide care to all health service clients who may be at risk for inadequate physical activity and/or fruit and vegetable consumption, [51][52][53] with additional guidelines and policies existing specifically for clients with a mental health condition [54,55]. Despite the existence of these guidelines and policies, the reported effectiveness of the provision of preventive care and lifestyle interventions in mental health services to improve such health risk behaviours, [56][57][58][59][60] and the reported interest of mental health service clients in receiving support to improve these behaviours, [49,61] sub-optimal care for health risk behaviours from general practitioners [62] and community and inpatient mental health services is consistently reported [63]. For instance, a recent a meta-analysis of 26 studies found sub-optimal provision of care (less than 80% of clients in receipt of care) to address inadequate nutrition generally and physical activity across all elements of care (e.g.…”

“…For instance, a recent a meta-analysis of 26 studies found sub-optimal provision of care (less than 80% of clients in receipt of care) to address inadequate nutrition generally and physical activity across all elements of care (e.g. asking/assessing, advising, assisting, and arranging referral) in community, inpatient, and other mental health services [63]. A number of factors have been implicated as barriers to the provision of preventive care in mental health settings including: clinician attitudes and beliefs about their client's capability or interest in changing [64,65]; as well as the risk behaviours of the clinician, where clinicians who are at risk for a particular behaviour themselves may be less likely to provide care to their client for that behaviour [66].…”

Systematic review of interventions to increase the provision of care for chronic disease risk behaviours in mental health settings: review protocol

“…mental health service, psychosocial support service, community mental health), (b) the four risk behaviours (tobacco smoking, poor nutrition, physical inactivity and harmful alcohol consumption), and (c) the study type (intervention or implementation studies). Search filters will be included for mental health service types and risk behaviours that were used in other, similar systematic reviews [ 52 , 53 ]. Search terms for study type (interventions and implementation studies) will be adapted from a glossary for dissemination and implementation research [ 54 ] and similar systematic reviews [ 55 ].…”

Patient receipt of smoking cessation care in four Australian acute psychiatric facilities

“…A systematic search of studies published between 2006 and 2016 found 19 studies reporting the prevalence of smoking cessation care provision/receipt in acute inpatient psychiatric facilities (Bailey et al 2016). The majority (79%) of studies were undertaken prior to or during 2010, with such studies consistently suggesting care provision was sub-optimal (Sarna et al 2009;Stockings et al 2015;Williams et al 2015).…”