Characteristics of Persons with SMI Receiving Integrated Primary and Behavioral Health Care Services: Interrelationships Among Social Support, Level of Functioning, and Health Status

Background: Persons with serious mental illness (SMI) require a disproportionate amount of health-related services. Treatment that integrates both primary and behavioral healthcare (PBHC) services reduces healthcare costs and negative health outcomes.  However, scant research has examined empirically relevant factors that influence the health status of relatively stable populations of persons with SMI in integrated PBHC programs.  The current study examined interrelationships among major variables of interest associated with health status, including social support, psychological and daily functioning, and health indicator data.

Methods:  Researchers collected data from the health records of persons with SMI (N=125) receiving integrated PBHC services at 3 community-based clinics. Social support was measured with the 4-item Social Connectedness Subscale of the Mental Health Statistics Improvement Program (SCS-MHSIP).  Psychological functioning was assessed with the K6, and daily functioning was measured with the 8-item Perception of Functioning subscale of the (PF) MHSIP. Health indicator data measured systolic and diastolic blood pressure (BP), body mass index (BMI), blood glucose, and blood lipids, which included high-density-lipoproteins (HDL), low-density-lipoproteins (LDL), triglycerides (TRI), and lipid total.  Health status was self-assessed with one MHSIP item asking participants to rate their overall health. First, bivariate analyses were conducted to examine zero-order correlations between major variables of interest. Ordinary least squares (OLS) regression was employed using a forced entry method to examine the predictive ability of significant health correlates on participants’ overall health status.

 Results:  The sample consisted of primarily middle-aged (M=45,SD=11.4, Range=19-69) White (60.8%) females (67.2%) who were diagnosed with a mood disorder (66.6%). Overall mean scores on the SCS-MHSIP and the PF-MHSIP were 15.2 (SD=3.2,Range=4-20,) and 27.4 (SD=5.5,Range=15-38), respectively, indicating relatively high levels of social support and daily functioning. The mean K6 score was 12.2 (SD=6.0,Range=0-24), indicating moderate levels of psychological distress. The mean systolic and diastolic BP scores were 133 (SD=18.5) and 82 (SD=11.6), respectively, both above recommended levels. The mean BMI score was 32.2 (SD=8.8), which corresponds to the low range of obesity. Mean blood glucose and lipoprotein levels were above normal: blood glucose=106.97(SD=56.07), lipid HDL=46(SD=13.8), lipid LDL=138(SD=70.3), lipid TRI=147(SD=100.7), and lipid lotal=200(SD=47.4). The overall mean health status score was 2.5 (SD=1.3, Range=1-7), indicating that participants perceived their overall health as below average. Based on the results of correlational analyses, the following predictors of health status were included in the regression model: diastolic BP (r=-.22), lipid TRI (r=.23), blood glucose (r=-.26), social support (r=23), psychological functioning (r=.-.23), and daily functioning (r=.41). The inclusion of all predictor variables in the equation explained approximately 26% of the variance in health status (R=.51,RSquare=.26). The model was significant, at F(6,97) = 5.54, p < .01. Among correlates, only daily functioning was a significant predictor of current health status (beta=.30, p<.05).

Implications: Results are consistent with those of previous studies undertaken with less stable populations of persons with SMI showing that daily functioning is a predictor of current health status.  Findings emphasize the diversity of persons with SMI, as well as underscore the importance of promoting wellness and health literacy in integrated PBHC settings.