Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services

Abstract

People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%-96%) and lowest for nutrition (17%, 95% CI:1%-35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence. PROSPERO registration: CRD42016049889.

Keywords: Alcohol; Care provision; Mental health services; Nutrition; Physical activity; Smoking.

Fig. 1

PRISMA study flow diagram of studies published from 2006 to 2017.

Fig. 2

Forest plots of the overall client and audit reported highest estimates of smoking cessation care provision by care element: a) ask/assess, b) advise, c) assist, and d) arrange. Note: Error-bars represent 95% confidence intervals; included studies published from 2006 to 2017. At times, 95% confidence intervals exceed the boundaries of the proportion (between 0 and 1), as the random effects binomial proportion interval (Wald interval) assumes a normal distribution.