Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial

Overview

Journal Psychiatr Serv

Specialty Psychiatry

Date 2018 Feb 2

PMID 29385952

Citations 31

Authors

Benjamin G Druss

Manasvini Singh

Silke A von Esenwein

Gretl E Glick

Stephanie Tapscott

Sherry Jenkins Tucker

Cathy A Lally

Evelina W Sterling

Affiliations

Soon will be listed here.

Abstract

Objective: Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population.

Methods: This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months.

Results: At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant.

Conclusions: The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.

Citing Articles

Facing the paradox of professionalizing peer roles in MH services: how addressing self-disclosure with self-determination theory might help.

Moran G Epidemiol Psychiatr Sci. 2025; 34():e1.

PMID: 39801361 PMC: 11735117. DOI: 10.1017/S2045796024000751.

What is known about persons with co-occurring problems' experiences with supported housing, recovery, and health promotion? A scoping review.

Hammervold U, Gytri S, Storm M, Lid T, Sagvaag H BMC Health Serv Res. 2024; 24(1):1366.

PMID: 39516887 PMC: 11549848. DOI: 10.1186/s12913-024-11736-z.

Mental health of individuals at increased suicide risk after hospital discharge and initial findings on the usefulness of a suicide prevention project in Central Switzerland.

Werdin S, Fink G, Rajkumar S, Durrer M, Gurtner C, Harbauer G Front Psychiatry. 2024; 15:1432336.

PMID: 39345920 PMC: 11427254. DOI: 10.3389/fpsyt.2024.1432336.

Feasibility, acceptability and preliminary evaluation of a user co-facilitated psychoeducational programme: a feasibility proof-of-concept randomised control trial.

Skliarova T, Lara-Cabrera M, Hafstad H, Havnen A, Saether S, Salvesen O BMC Psychiatry. 2024; 24(1):615.

PMID: 39285365 PMC: 11403850. DOI: 10.1186/s12888-024-06015-4.

Challenges in the evaluation of suicide prevention measures and quality of suicide data in Germany, Austria, and Switzerland: findings from qualitative expert interviews.

Werdin S, Wyss K BMC Public Health. 2024; 24(1):2209.

PMID: 39138493 PMC: 11323587. DOI: 10.1186/s12889-024-19726-w.

References

Kilbourne A, Barbaresso M, Lai Z, Nord K, Bramlet M, Goodrich D . Improving Physical Health in Patients With Chronic Mental Disorders: Twelve-Month Results From a Randomized Controlled Collaborative Care Trial. J Clin Psychiatry. 2016; 78(1):129-137. PMC: 5272777. DOI: 10.4088/JCP.15m10301. View

Corrigan P, Giffort D, Rashid F, Leary M, Okeke I . Recovery as a psychological construct. Community Ment Health J. 1999; 35(3):231-9. DOI: 10.1023/a:1018741302682. View

Swarbrick M, Murphy A, Zechner M, Spagnolo A, Gill K . Wellness coaching: a new role for peers. Psychiatr Rehabil J. 2011; 34(4):328-31. DOI: 10.2975/34.4.2011.328.331. View

Krapek K, King K, Warren S, George K, Caputo D, Mihelich K . Medication adherence and associated hemoglobin A1c in type 2 diabetes. Ann Pharmacother. 2004; 38(9):1357-62. DOI: 10.1345/aph.1D612. View

Lorig K, Ritter P, Pifer C, Werner P . Effectiveness of the chronic disease self-management program for persons with a serious mental illness: a translation study. Community Ment Health J. 2013; 50(1):96-103. DOI: 10.1007/s10597-013-9615-5. View

Tunis S, Croghan T, Heilman D, Johnstone B, Obenchain R . Reliability, validity, and application of the medical outcomes study 36-item short-form health survey (SF-36) in schizophrenic patients treated with olanzapine versus haloperidol. Med Care. 1999; 37(7):678-91. DOI: 10.1097/00005650-199907000-00008. View

Goldberg R, Dickerson F, Lucksted A, Brown C, Weber E, Tenhula W . Living well: an intervention to improve self-management of medical illness for individuals with serious mental illness. Psychiatr Serv. 2012; 64(1):51-7. PMC: 8666111. DOI: 10.1176/appi.ps.201200034. View

Feaster D, Mikulich-Gilbertson S, Brincks A . Modeling site effects in the design and analysis of multi-site trials. Am J Drug Alcohol Abuse. 2011; 37(5):383-91. PMC: 3281513. DOI: 10.3109/00952990.2011.600386. View

Kring A, Barch D . The motivation and pleasure dimension of negative symptoms: neural substrates and behavioral outputs. Eur Neuropsychopharmacol. 2014; 24(5):725-36. PMC: 4020953. DOI: 10.1016/j.euroneuro.2013.06.007. View

10.

Kelly E, Fenwick K, Barr N, Cohen H, Brekke J . A systematic review of self-management health care models for individuals with serious mental illnesses. Psychiatr Serv. 2014; 65(11):1300-10. PMC: 4433309. DOI: 10.1176/appi.ps.201300502. View

11.

Liu N, Daumit G, Dua T, Aquila R, Charlson F, Cuijpers P . Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry. 2017; 16(1):30-40. PMC: 5269481. DOI: 10.1002/wps.20384. View

12.

Druss B, Zhao L, von Esenwein S, Bona J, Fricks L, Jenkins-Tucker S . The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophr Res. 2010; 118(1-3):264-70. PMC: 2856811. DOI: 10.1016/j.schres.2010.01.026. View

13.

Walker E, McGee R, Druss B . Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015; 72(4):334-41. PMC: 4461039. DOI: 10.1001/jamapsychiatry.2014.2502. View

14.

Lorig K . Action planning: a call to action. J Am Board Fam Med. 2006; 19(3):324-5. DOI: 10.3122/jabfm.19.3.324. View

15.

Olfson M, Gerhard T, Huang C, Crystal S, Stroup T . Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry. 2015; 72(12):1172-81. DOI: 10.1001/jamapsychiatry.2015.1737. View

16.

Salyers M, Bosworth H, Swanson J, Osher F . Reliability and validity of the SF-12 health survey among people with severe mental illness. Med Care. 2000; 38(11):1141-50. DOI: 10.1097/00005650-200011000-00008. View

17.

McNaught M, Caputi P, Oades L, Deane F . Testing the validity of the Recovery Assessment Scale using an Australian sample. Aust N Z J Psychiatry. 2007; 41(5):450-7. DOI: 10.1080/00048670701264792. View

18.

Davidson L, Bellamy C, Guy K, Miller R . Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry. 2012; 11(2):123-8. PMC: 3363389. DOI: 10.1016/j.wpsyc.2012.05.009. View

19.

Walker E, Druss B . A Public Health Perspective on Mental and Medical Comorbidity. JAMA. 2016; 316(10):1104-5. PMC: 5987544. DOI: 10.1001/jama.2016.10486. View

20.

Schinnar A, Rothbard A, Kanter R, Jung Y . An empirical literature review of definitions of severe and persistent mental illness. Am J Psychiatry. 1990; 147(12):1602-8. DOI: 10.1176/ajp.147.12.1602. View