Doctors Don’t Bother with Lifestyle Counseling for Mentally Ill Patients

Whether it’s depression or bipolar disorder or schizophrenia, people with mental illness often get medical treatment that perceives them less as whole persons than as a single body part.

According to a survey recently published in the journal Diabetes Educator, more than half of patients who had symptoms of mental illness, and almost 1 in 3 who also had diabetes, said their health-care providers had never discussed reducing their consumption of dietary fat, or engaging in regular exercise.

Although that advice would apply to a lot of people with a wide range of health issues, it’s also important for the mentally ill, because, according to the University of Illinois researchers who conducted the study, they have significantly higher rates of cardiovascular disease, diabetes, hypertension (high blood pressure) and high cholesterol. Those disorders often can be alleviated with lifestyle modifications.

The researchers also said the mentally ill are at increased risk of premature death.

Data for the study came from the Medical Expenditure Panel Survey (U.S. Department of Health and Human Services) that interviewed a nationally representative sample of participants several times over a two-year period about their health and use of medical services.

Symptoms of mental illness were identified by scores on the Kessler Psychological Distress Scale. Known as the K6, it’s a screening tool practitioners use to predict serious mental illness.

Participants in the study ranged in age from 18 to 70. Of those with symptoms of serious psychological problems, more than 15.6 in 100 also had diabetes; only about 8 in 100 without these symptoms had the endocrine disorder.

Rates for all clinical conditions that raise the risk of diabetes generally were higher among subjects who had symptoms of mental illness than among those who didn’t.

  • More than 7 in 10 with mental illness had body mass indexes (BMI) higher than 25 (BMI above 25 is deemed overweight; 30 denotes obesity) versus about 6.5 in 10 of their peers.
  • More than 4 in 10 had significantly higher rates of hypertension versus about 2.6 in 10 peers.
  • More than 4 in 10 had hyperlipidemia (elevated blood fat level) versus about 3 in 10 peers.
  • Almost 3 in 10 had cardiovascular disease versus about 15 in 100 peers.

The study also found that people with symptoms of psychological distress who had not been diagnosed with diabetes before the study had an average of more than three diabetes risk factors, compared with their counterparts, who averaged 2.4 risk factors.

So, clearly, this is a medical population in need of intervention about how to moderate its nonmental disease or how to head it off altogether with behavioral changes. But the likelihood of these people getting such help increased only in accordance with their number of risk factors.

That’s short-sighted, because diabetes is one condition that can be managed much better through lifestyle the earlier you address it.

The American Diabetes Association recommends that health-care providers counsel all patients with diabetes or at high risk of diabetes about physical activity and healthy dietary choices.

Because people with mental illness tend to utilize outpatient, inpatient and emergency services at much higher rates than the general population, said lead researcher Xiaoling Xiang in a university news release, clinicians should use these additional opportunities to educate patients about the benefits of a healthful diet and physical activity.

Diabetes isn’t the only problem that tends to be ignored in patients being treated for mental issues. A couple of years ago we wrote about how psychiatric patients tend to be ignored in emergency departments.

Just because people struggle with mental problems doesn’t mean they aren’t capable of helping themselves, and it’s patronizing to ignore their ability to do so.

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