Burton, Alexandra; (2020) Social support and cardiovascular disease risk reducing behaviours for people with severe mental illnesses in primary care. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background People with severe mental illness (SMI) have an increased risk of cardiovascular disease (CVD). Research in the general population suggests that social support may protect against CVD morbidity and mortality, however little is known about social support and cardiovascular health in people with SMI. Objectives For people with SMI: 1. Assess the effectiveness of CVD risk-reducing interventions that involve supportive others 2. Develop and integrate a social support strategy into a CVD risk-reducing intervention in primary care 3. Explore the relationship between social support and cardiovascular health behaviours 4. Describe how existing social support was explored within initial appointments in a CVD risk reducing intervention in primary care. Methods Systematic review, longitudinal and cross-sectional observational study and qualitative thematic analysis of intervention appointments. Results Few studies were identified on effective interventions that used existing support networks to improve cardiovascular health in people with SMI. Recommendations for involving supportive others in CVD risk reduction were identified from focus groups, workshops and UK clinical guidelines These included exploring how to involve supportive others, respecting confidentiality and identifying strategies for those without social support. Higher social support predicted significantly greater appointment attendance in unadjusted but not adjusted analyses and greater medication adherence. There was no association between higher perceived social support and greater physical activity, healthier diet, lower alcohol use or being a non-smoker. Social support was explored in first appointments, with most participants identifying a supportive other. Reasons to involve others included companionship, positive feedback and health improvements for supportive others and participants. Some participants described family or friends as negative influences on their health. Conclusions Perceived social support may be an important facilitator for adherence to CVD medications, but there was limited evidence for an association between perceived social support and other CVD health behaviours in people with SMI. Harnessing positive social relationships within interventions should be considered as a strategy for encouraging uptake of CVD health behaviours in people with SMI. Further work is needed to develop interventions that increase social support and improve health outcomes for people with SMI who have limited social contacts.

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