Evaluation of interventions to improve somatic health in severe mental illness: A conceptual framework

Background: The somatic health status of people with severe mental illness (SMI) compared to the general population is lower and has decreased over the last decades. This reduced somatic health status has a multiple interlinked background with several potentially reversible components. Interventions that aim to improve somatic health in persons with severe mental illness are not uniformly evaluated. Aims of the Study: A conceptual framework was developed to appraise the current evaluation methods. Methods: Our conceptual framework includes pathways to reduced somatic health as well as the influences of specific mechanisms on these pathways. A critical appraisal was performed on the currently used evaluation measures on their representativeness for the different constructs. Results: Insufficient disease states influencing somatic health are currently evaluated to fully evaluate the effect of interventions. A critical appraisal on the currently used evaluation measures assessing effect and mechanism showed that only part of the currently used measures was representative for the constructs of the conceptual framework. Discussion and Limitations: Our study is the first to present to present an appraisal of the currently used evaluation methods of ISH-interventions based on a conceptual framework. Although, we have attempted to give a good overview, it is of course only possible to assess the most important causes and diseases in patients with SMI. Moreover, we found no systematic reviews for the appraisal of all evidence on the quality of certain instruments. Implications for Healthcare Provision and Use and Health Policies: In clinical settings information of individual patients' risk factors can be related to possible diseases states he/she can develop and which should be prevented. In research it can be used to look for confounders based on the other influences on specific disease states. Implications for Further Research: There is a great need to improve the somatic health of patients with severe mental illness. Therefore, the development of suitable instruments to properly evaluate the characteristics of interventions to improve somatic health deserve highest priority.