Is there an association between perceived social support and cardiovascular health behaviours in people with severe ment
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ORIGINAL PAPER
Is there an association between perceived social support and cardiovascular health behaviours in people with severe mental illnesses? Alexandra Burton1 · Kate Walters2 · Louise Marston2 · David Osborn1 Received: 14 September 2019 / Accepted: 2 May 2020 © The Author(s) 2020
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. Keywords Severe mental illness · Cardiovascular disease · Social support · Primary care
Introduction People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder are at an increased risk of cardiovascular disease (CVD) and die up to 20 years earlier than the general population [1]. The mortality gap between * Alexandra Burton [email protected] 1
Division of Psychiatry, University College London, Maple House, 6th floor, 149 Tottenham Court Road, London W1T 7NF, UK
Department of Primary Care and Population Health, University College London, UCL Medical School (Royal Free Campus), Upper Third Floor, Rowland Hill Street, London NW3 2PF, UK
2
people with SMI and the general population is widening [2]. Factors which may be responsible for this health inequality include increased smoking rates, poor diet and sedentary lifestyles [
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