Equipping Social Workers to Better Serve Individuals with Serious Mental Illness: Recognizing Physical Health Risk Factors

Background/Purpose. Individuals with serious mental illness (SMI) are at significant risk of cardiovascular disease (CVD). Despite having regular behavioral health care appointments, this population is less likely to have a primary care provider to screen for cardiovascular conditions. Subsequently, CVD readily progresses to an emergent state that is both challenging to treat and stressful for individuals with SMI to manage.

Integrated health care is a predominant approach to treating interrelated physical and behavioral health disorders. In integrated settings, social workers serve vital roles through addressing behavioral health disorders, in addition to identifying physical health concerns and referring to primary care providers as needed. As such, social workers are in a position to facilitate referrals for cardiovascular screening, which can expedite diagnosis and treatment. In order for social workers to maximize their ability to promote whole health among this population, data is needed regarding which individuals with SMI are most at risk of foregoing critical health screenings. This study analyzed medical, lifestyle, and access factors that correlate with receipt of cardiovascular screening.

Methods. Data were drawn from the 2015 National Center for Health Statistics (NCHS) of 33,672 adults. Inclusion criteria included participants with SMI, which was assessed using the Kessler 6 (K6). The K6 evaluates psychological distress via symptom severity, as opposed to DSM-5 diagnostic criteria. The dependent variable was receipt of comprehensive cardiovascular screening. This computed variable had 3 screening response options: blood pressure only, blood pressure and cholesterol, and blood pressure, cholesterol, and glucose level. After accounting for missing data, the final sample size was 1,036. Listwise deletion was employed due to no independent variable having more than 5% missing data. Independent variables included medical risk factors, lifestyle risk factors, and access factors. Multinomial logistic regression was employed to determine the extent to which risk factors correlated with cardiovascular screening measures.

Results. The sample was mostly female (65.4%) with a mean age of 49.7 (SD = 16) years. Rates of medical risk factors were reported at 40.4% for obesity, 60.5% for cardiovascular disease, and 46.1% for metabolic conditions. Most participants reported alcohol use (54.9%) and being physically inactive (52.1%). Fewer respondents (31.5%) reported encountering access barriers. Regression results suggest increased age (OR = 1.04) and having a known metabolic history (OR = 4.05) were associated with receiving all screening measures. Additionally, participants with more outpatient health care visits (OR = 1.22) and those with a primary care provider (OR = 2.50)  had higher odds of receiving screenings.

Conclusions and Implications. Individuals with SMI are a vulnerable population with poorer health status. Within this population, those who are younger, lack a known cardiovascular history, are less engaged with services in general, and without a primary care provider are possibly at greater risk of not receiving comprehensive cardiovascular screening. These findings shed light on the importance of behavioral health specialists not only making referrals, but also using behavioral modification strategies to facilitate use of primary care services.