{"id":6576,"date":"2016-04-01T10:57:56","date_gmt":"2016-04-01T14:57:56","guid":{"rendered":"http:\/\/geiselmed.dartmouth.edu\/news\/?p=6576"},"modified":"2016-04-13T13:32:07","modified_gmt":"2016-04-13T17:32:07","slug":"dartmouth-research-aims-to-reduce-cardiovascular-risk-for-people-with-mental-illness","status":"publish","type":"post","link":"https:\/\/geiselmed.dartmouth.edu\/news\/2016\/dartmouth-research-aims-to-reduce-cardiovascular-risk-for-people-with-mental-illness\/","title":{"rendered":"Dartmouth Research Aims to Reduce Cardiovascular Risk for People with Mental Illness"},"content":{"rendered":"

Only a few years ago, the thought of joining a fitness club was too frightening for Tara See to consider.<\/p>\n

\u201cMy anxiety level had reached a point where I barely left my house,\u201d says Tara, who was suffering from the effects of post-traumatic stress disorder (PTSD) from childhood trauma and depression, and poor physical health. \u201cWhen I had my own children, the anxiety became worse. It got to the point where I couldn\u2019t go to the store to get groceries; my husband had to do everything.\u201d<\/p>\n

Making Healthy Changes<\/h3>\n

With treatments and counseling from her community mental health center care team, and support from the Healthy Choices, Healthy Changes<\/em> program, Tara successfully joined a gym and changed her eating habits. She\u2019s lost 75 pounds over the past year, and now feels fit and strong. \u201cWhen you are too self-conscious to even leave your house, you have no life,\u201d says Tara. \u201cI know it\u2019s hard, but I tell people, just do it and don\u2019t look back.\u201d<\/p>\n

Mike Goodwin underwent a similar transformation after participating in the Healthy Choices, Healthy Changes<\/em> program. \u201cIt\u2019s been a great experience,\u201d says Mike, who has been diagnosed with bi-polar disorder and PTSD. \u201cI\u2019m happy to have a gym membership; I love to work out. I used to have problems with anger and went to anger management counseling, but I don\u2019t have to anymore. I can take out my frustration on my weights and it chills me out.\u201d<\/p>\n

Having a gym membership and participating in the Breathe Well, Live Well<\/em> program also helped him quit smoking. \u201cI was a long-time smoker and I\u2019d tried to quit before, cold turkey, but it didn\u2019t work. I didn\u2019t think I could do it, but I wanted to try,\u201d says Mike, who hasn\u2019t smoked now for almost two years. \u201cI think the keys were good treatment and support from my caseworker and my family, and being able to do these programs.\u201d<\/p>\n

Testing Wellness Incentives<\/h3>\n

Through their participation in Healthy Choices, Healthy Changes<\/em> and Breathe Well, Live Well<\/em>, Tara and Mike are part of a statewide research effort testing whether providing mentoring and financial incentives\u2014supporting exercise, improved nutrition, and smoking cessation\u2014can help clients of the New Hampshire\u00a0Community Mental Health Center system improve their cardiovascular health.<\/p>\n

The project, called the NH Medicaid Wellness Incentives Program (NH WIP), was funded by the Centers for Medicare and Medicaid Services, and coordinated through a partnership between the Bureau of Behavioral Health and investigators affiliated with the Health Promotion Research Center at Dartmouth<\/a> (HPRCD). Part of the Geisel School of Medicine, the HPRCD has received funding from the Centers for Disease Control (CDC) to conduct long-term follow-up evaluations of WIP project participants.<\/p>\n

\"Anna
Anna M. Adachi-Mejia, PhD<\/figcaption><\/figure>\n

\u201cWe\u2019re one of only 26 academic research institutions nationwide designated a Prevention Research Center by the CDC,\u201d explains Anna Adachi-Mejia, PhD, deputy director of the HPRCD.\u00a0 \u201cThe CDC and Prevention Research Center network work together to test and apply approaches that can improve the nation\u2019s health. At Dartmouth, our primary goal is to measurably decrease cardiovascular risk factors in our region by addressing two of the CDC\u2019s top public health priorities that they refer to as Winnable Battles\u2014obesity and smoking.\u201d<\/p>\n

Reducing Cardiovascular Risk<\/h3>\n

No group has more to gain from reducing their cardiovascular risk than those who suffer from serious mental illness. \u201cI refer to it as the most under-recognized health disparity in the nation,\u201d says\u00a0Steve Bartels, MD, MS, a professor of psychiatry and of community and family medicine at Dartmouth\u2019s Geisel School of Medicine, who directs and is the co-principal investigator of the HPRCD.<\/p>\n

\"Steve
Steve Bartels, MD, MS<\/figcaption><\/figure>\n

People with serious mental illness die about 25 years earlier than the rest of the population, largely due to cardiovascular disease, Bartels says. That\u2019s why he and his Dartmouth colleagues have been working for a number of years with the CDC and public health partners to test interventions that can make a difference in this high-risk population.<\/p>\n

That work began about 15 years ago with the evaluation of InSHAPE<\/em>, a wellness program for people with mental illness that was created by Ken Jue at a community mental health center in Keene, NH, after he noticed that many of his patients were dying from heart attacks in their mid-50s.\u00a0 The innovative program, which combined individual health coaching with community engagement, would eventually be expanded to include the state\u2019s 10 community mental health centers.<\/p>\n

\u201cWhat we found in the two randomized trials that we did, the first funded by the CDC and the second funded by the National Institute of Mental Health (NIH), was that InSHAPE<\/em> was associated with a reduction in cardiovascular risk in half of the individuals who participated\u2014that was astonishing,\u201d says Bartels, who followed that up with a NIH-funded implementation study in NH and found similar results.<\/p>\n

Building on InShape\u2019s Success<\/h3>\n
\"Sarah
Sarah I. Pratt, PhD<\/figcaption><\/figure>\n

The NH Medicaid WIP project builds upon and benefits from the infrastructure established by the InSHAPE<\/em> program, says Sarah Pratt, PhD, co-principal investigator on HPRCD\u2019s core research project. \u201cIt\u2019s giving us an opportunity to collect long-term, follow-up outcomes data (on 1,365 people who were overweight or obese and 1,400 smokers), which is very rare in this field,\u201d she says.<\/p>\n

In a randomized study, the WIP project will determine if using incentives like fitness trainers, gym memberships, Weight Watchers memberships, and smoking cessation programs can help people who are Medicaid beneficiaries and have mental health challenges make measurable health improvements.<\/p>\n

\u201cWe\u2019re still in the process of evaluating all of our data, so the overall results aren\u2019t available yet,\u201d says Pratt. \u201cBut it looks very promising\u2014we\u2019re seeing a lot of great success stories, where people like Tara and Mike have literally turned their lives around.\u201d<\/p>\n

Treating the Whole Patient<\/h3>\n

The next step, says Bartels, is to figure out how evidence-based health promotion interventions like InSHAPE can be implemented in mental health organizations, even though they haven\u2019t been part of their core services or funding. He\u2019s just secured another grant to study this in 48 mental health organizations across the country.<\/p>\n

\u201cOur challenge is to find out how we can change these organizations\u2014to not only focus on symptom resolution for people with psychiatric symptoms but also wellness as a central part of their mission,\u201d he says.<\/p>\n","protected":false},"excerpt":{"rendered":"

Geisel investigators at the Health Promotion Research Center at Dartmouth are leading a statewide effort to determine if offering financial incentives\u2014for fitness, weight loss, and smoking cessation programs\u2014can help people with mental illness reduce their high risk for cardiovascular disease.<\/p>\n","protected":false},"author":26,"featured_media":6584,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[14,1],"tags":[354,698,480,37,219,699,697],"class_list":["post-6576","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-improving-lives","category-news","tag-anna-adachi-mejia","tag-exercise","tag-healthy-eating","tag-mental-health","tag-smoking","tag-smoking-cessation","tag-steve-bartels","author-26"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-content\/uploads\/sites\/2\/2016\/03\/workout-shutterstock_109082192.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4r3h1-1I4","_links":{"self":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/6576","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/users\/26"}],"replies":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/comments?post=6576"}],"version-history":[{"count":12,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/6576\/revisions"}],"predecessor-version":[{"id":6643,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/6576\/revisions\/6643"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media\/6584"}],"wp:attachment":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media?parent=6576"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/categories?post=6576"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/tags?post=6576"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}