Reducing the Mortality Gap in People with Severe Mental Disorders: the Role of Lifestyle Psychosocial Interventions

Patients with severe mental disorders (SMD), including major depression, bipolar disorder, schizophrenia and related spectrum disorders, have a reduced life expectancy of 10-25 year compared with the general population. This life expectancy gap is mainly due to the co-occurrence of many physical diseases, such as hypertension, coronary heart disease, stroke, chronic obstructive pulmonary disease, tuberculosis, hepatitis and HIV. Factors contributing to the reduced life expectancy can be grouped into three main categories: a) factors related to the patient; b) factors related to clinicians; and c) factors related to the health system. As regards the first group, patients with SMD often adopt unhealthy lifestyle behaviors, including heavy smoking, reduced physical activity, sedentary behaviors, poor diet and alcohol or drug abuse, and are reluctant to seek for physical care with GPs and other medical specialists. Increasing the levels of physical activity, improving the dietary patterns, and reducing the smoking habits of people with severe mental disorders represent a global health challenge and a public health priority. Until now, attempts made to reduce this mortality gap have acted at three different levels: health system level, physician level, and patient level. The third-level interventions include electronic alerts through smartphones and web-based platforms, intensive case management, promotion of healthy habits, complex psychosocial interventions. Several population-based studies have showed that lifestyle behaviors are amenable to change through the adoption of specific psychosocial interventions. However, most clinical guidelines, although emphasizing the importance of health monitoring and regular check-ups for patients with severe mental illnesses, do not make specific recommendations on the provision of lifestyle interventions. These lifestyle-oriented interventions, consisting of behavioral, educational, and psychological components, have been conducted mainly in research settings, and have shown a good impact on patients’ physical health. Despite this, their feasibility in routine settings has not been tested yet. It seems to be clinically and ethically relevant to develop, validate and carry out interventions to improve the lifestyle’s behaviors of patients with severe mental disorders, to reduce the presence of comorbidities and to improve their life expectancy. In this Research Topic we will summarize the available knowledge of the efficacy and effectiveness of psychosocial interventions aimed at improving healthy lifestyle behaviors and promoting the physical health of patients with severe mental disorders. Total number of articles: 19