People who experience serious mental illness, particularly schizophrenia, have a premature mortality rate two to three times higher than the general population. Researchers estimate that cardiovascular disease (CVD) accounts for 40 to 50 per cent of this excess mortality. However, people diagnosed with serious mental illness are not currently mentioned in New Zealand clinical guidance for assessing and managing cardiovascular risk.
National mental health workforce development centre Te Pou o te Whaakaro Nui (Te Pou), in partnership with the Wise Group and University of Otago - Wellington, undertook a national and international evidence review during 2015. This review was part of a wider review to inform the guidance provided to primary care on CVD risk assessment and management being managed by the Heart Foundation [NZ Doctor, 5 August 2016].
The aims of the mental health section of the review were to identify the relative increase in CVD risk associated with serious mental illness, and the recommended assessment and management of CVD and CVD risk in people with serious mental illness.
Speaking on behalf of the research team, Helen Lockett from the Wise Group said the causal pathways to increased CVD mortality for people with serious mental health are complex but what is clear is that mental illness is a significant comorbidity for CVD.
Professor Rod Jackson, Auckland University epidemiologist said the research findings indicate that people presenting to their GP with a history of mental illness should be prioritised for CVD risk assessment and proactively offered support to manage CVD risk.
“As with several other high CVD risk population groups it would also be appropriate to consider initiating screening at a younger age than in the general population,” Prof Jackson said.
The Royal New Zealand College of General Practitioners is aware of the evidence review and the feedback and response from the College has been very positive and supportive.
Dr Tim Malloy, College President said the review findings fit with GPs’ core philosophy to treat the whole patient.
“A GP will always look at other health risks, like CVD, while treating the patient for what they came for. GPs are the first point of contact in the health system, and are well placed to make early connections like mental illness being a possible risk factor for CVD.
“GPs can also engage with the patient’s support network who can help the patient to have a healthier lifestyle,” Dr Malloy said.
The key findings of the evidence review are:
• People who experience serious mental illness have a greater relative risk of CVD than the general population, even after controlling for other risk factors such as smoking, diabetes, ethnicity, age.
• The increased CVD risk is present at an earlier age than in the general population.
• Current CVD risk assessment tools are likely to underestimate the risk for this population.
• There are inequities in assessment and management of CVD risk and CVD for people diagnosed with serious mental illness.
A full summary of the review can be found on Te Pou’s website.
Background to the evidence review
Te Pou responded to a request for suggestions from the Ministry of Health in January 2015, recommending the evidence on mental illness and CVD be reviewed as part of the process to update the primary care guidelines. This recommendation was based on international evidence and Dr Ruth Cunningham’s 2014 research on CVD risk among New Zealanders with serious mental illness. The Ministry agreed to include this in the evidence that would feed into their review of the guidelines.
Te Pou, Wise Group, University of Otago, Wellington, Heart Foundation and the Royal New Zealand College of General Practitioners are all part of the Equally Well collaborative – a group of more than 70 New Zealand organisations working together to improve physical health outcomes for people with serious mental health and addiction problems.