 Overview
Portfolio Snapshots, a product of the NIMH Division of Services and Intervention Research (DSIR), highlights recent NIMH investments in selected priority areas. We hope that these examples will guide you in submitting high-quality, targeted grant applications that complement the existing research grant portfolio.
NIMH DSIR supports research with high public health impact in two critical areas:
- studies to test prevention and treatment interventions that could substantially improve mental health outcomes in real world settings, and
- mental health services research to improve access, cost effectiveness, quality, and outcomes of care provided to diverse populations in multiple settings.
DSIR-supported research is intended to generate empirical knowledge that will improve mental health outcomes and functioning; enhance day-to-day clinical practice; increase the effectiveness of care systems; and inform the decisions of consumers, providers, and policy makers. The overarching goal of this research is to develop knowledge that, if applied, could substantially reduce the burden of mental disorders in the United States.
The October 2012 edition of Portfolio Snapshots highlights recently funded projects that address the well-documented disparity in physical health and longevity experienced by individuals with severe mental illness. Each project addresses important gaps in current knowledge, adds uniquely to the overall DSIR grant portfolio, and will provide information that can inform healthcare practice and policy decisions. Potential applicants for DSIR research grants should contact the relevant program officer to discuss emerging scientific opportunities in this and other areas of high priority.
Improving Health and Reducing Premature Mortality in People with Severe Mental Illness
 In the
United States alone, 11.4 million people have severe mental illness (SMI).
[1] These same people also carry a heavy physical disease burden. They die
prematurely—11-32 years earlier than people without SMI—from largely
preventable comorbid medical conditions, such as heart disease, cancer,
pulmonary disease, and stroke.[2]-[3] These comorbid conditions also tend
to occur earlier and more frequently in this population than in the general
population. [4] Moreover, rates of prevention, detection and treatment of
these conditions are lower among people with SMI, further adding to health
disparities between them and the general population. [5] Effective
approaches to these common conditions exist for the general population, but
there is a critical need for evidence-based methods that can bring these same
strategies to people with SMI. Here are three recently funded
studies that address this knowledge gap.
Understanding Disparities in Preventive Services for Patients with Mental Illness (1R01 MH096795; Principal Investigator: Carla Green, Ph.D., MPH)
People with SMI use preventive health care less frequently than the general population does, and strategies to address this disparity may reduce common medical conditions and premature mortality in this population. Electronic medical record data from 65,000 individuals with SMI enrolled in integrated health plans or safety-net clinics will be compared to those of more than 700,000 patients without SMI to identify modifiable provider, patient, organizational, and regulatory factors that impede or facilitate preventive health care service use. Clinician surveys and patient interviews will augment data derived from electronic medical records. The findings will inform the development of effective strategies for increasing use of preventive services among people with SMI.
A Peer-Led, Medical Disease Self-Management Program for Mental Health Consumers (1R01 MH090584; Principal Investigator: Benjamin Druss, MD, MPH)
People with SMI and other medical conditions face challenges in effectively managing complex health problems. In the general population, peer-led disease self-management interventions have been demonstrated to be feasible, effective, and scalable. Similarly effective self-management strategies for people with SMI and chronic medical conditions could significantly improve health outcomes. This multi-site randomized controlled trial (RCT) tests the effectiveness of the Health and Recovery Peer program, a manual-based disease self-management intervention, with adults who have SMI and one or more chronic medical conditions. If successful, this study will establish the first peer-led, evidence-based intervention for improving physical self-management in this vulnerable population.
Improving Outcomes for Individuals with Serious Mental Illness and Diabetes (1R01 MH085665; Principal Investigator: Martha Sajatovic, MD)
Diabetes is common among people with SMI and is a major source of premature mortality. Currently, no effective practical interventions exist that aim to improve self-management and health outcomes among people with both SMI and diabetes. The Targeted Training in Illness Management (TTIM) intervention, which utilizes nurse and peer educators, is designed to overcome the complexities associated with co-management of SMI and medical disorders. This RCT tests the effectiveness of TTIM in adults with both SMI and diabetes who are seen in safety-net primary care clinics. If successful, TTIM could be easily adapted to related medical conditions such as metabolic syndrome and obesity, and implemented broadly in primary care settings.
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NIMH recently hosted a meeting, Research to Improve Health and Longevity of People with Severe Mental Illness, that brought together leading extramural researchers, state administrators who are implementing innovative programs, advocates for people with SMI, and representatives from other NIH institutes. As a result of this meeting, NIMH issued a concept clearance to support research on service interventions that will demonstrably reduce the prevalence and magnitude of modifiable health risk factors related to shortened lifespan in people with SMI.
For more information, please contact Susan T. Azrin, Ph.D.
Future editions of Portfolio Snapshots will highlight additional high-priority research areas. Potential grant applicants should contact Program Officials early in the grant development process to explore how future studies can add unique value to the overall research portfolio.
[1] Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: SAMHSA, 2012.
[2] Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease. 2006; 3(2):1-14.
[3] Druss BG, Zhao L, Von Esenwein S, Moratto EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Medical Care. 2011; 49(6):599-604.
[4] Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: SAMHSA, 2012.
[5] Nasrallah HA, Meyer JM, Goff DC, McEvoy JP, Davis SM, Stroup TS, Lieberman JA. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: Data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research. 2006; 86(1-3):15-22.
Second photo courtesy of Centers for Disease Control and Prevention Public Health Image Library
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