Life expectancy for persons with serious mental illness (SMI) is 25 to 30 years shorter than the general population with much early death attributable to cardiovascular disease (CVD). At the same time, racial disparities in CVD risk and mortality are pervasive in the general population. Yet, despite health disparities between SMI and non-SMI and African Americans and Whites, we know almost nothing about potential racial differences in the epidemiology of CVD risk among persons with SMI. Exacerbating this problem is the absence of information related to participation in clinical research - we know very little about persons with SMI in studies to reduce CVD risk, much less potential differences by race. This proposed competitive revision will utilize the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE) (R01MH080964), a multi-site behavioral weight loss randomized clinical trial, as a platform to examine potential disparities between African Americans and Whites with SMI in CVD risk, clinical trial involvement, mediators and outcomes. The analyses proposed are new and distinct from the trial's original aims. We propose the following Specific Aims: 1) To determine if African Americans with SMI and Whites with SMI differ in CVD risk factors, estimated 10-year CVD risk and potential mediating factors;2) To determine if rates for African Americans with SMI differ from Whites with SMI in study interest (signing screening consent) and enrollment (signing randomization consent);3) To determine if African Americans with SMI differ from Whites with SMI in intervention participation or trial outcomes;and 4) To evaluate CVD risk factors, estimated 10-year CVD risk, trial enrollment, intervention participation and outcomes in African Americans and Whites with and without SMI enrolled in two concurrent behavioral weight loss clinical trials.
Specific Aim 4 will compare baseline and trial data of SMI participants in ACHIEVE with data from a concurrent practice-based weight loss trial, POWER, that enrolled a biracial population without SMI. This proposal has several strengths. First, ACHIEVE provides extensive data on CVD risk factors and potential mediating socioeconomic, environmental and clinical factors. Second, ACHIEVE collects data on weight for all consumers at psychiatric rehabilitation sites regardless if they are study participants, providing an unusual opportunity to describe the target population of persons with SMI and study interest by race. Third, the POWER Trial provides a unique comparison to a weight loss trial in non-SMI including sharing several investigators, interventionists, core intervention theory and data collection protocols with ACHIEVE. Given these features, this proposal is highly responsive to NOT-MH-10-021 """"""""Targeted Research on Mental Health Disparities"""""""", as it builds efficiently and creatively on currently funded work. Results should greatly enhance our understanding of racial differences in CVD risk and trial involvement among persons with SMI, thereby providing guidance to policy makers on whether special targeted efforts are needed in this high-risk group.
Racial disparities in cardiovascular disease are widespread in the general population, and persons with serious mental illness (SMI) also suffer from high burdens of cardiovascular disease and early mortality compared to those without SMI. Yet, among persons with SMI, we know little about potential racial disparities in cardiovascular disease risk or involvement in clinical trials to decrease cardiovascular disease risk;being a racial minority and having an SMI may be reflected in even greater heath disparities. The proposed analyses of race, cardiovascular disease risk and potential mediators in an ongoing behavioral weight loss clinical trial in persons with SMI will provide important information to greatly enhance our understanding of racial differences in cardiovascular risk and clinical trial participation in persons with SMI, and provide guidance for future interventions.
