Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about severe mental illness and summarizes recently published research reports or developments.

DATAPOINT of the month
  • One in four individuals with serious mental illness live in poverty
Twenty-four percent of the 11.3 million individuals with serious mental illness lived below the federal poverty line in 2018, according to results from the 2018 National Survey on Drug Use and Health, a survey conducted annually by the Substance Abuse and Mental Health Services Administration, released last month. There was a significant increase in the number of individuals with serious mental illness living in poverty from the previous year, when 22% or 2.5 million individuals lived on less than $12,140 a year.

RESEARCH of the month
  • Improving metabolic risk screening for individuals taking antipsychotic medications.

Despite the importance of antipsychotic medications in reducing adverse symptoms for people with severe mental illness, they sometimes come with side effects. One of the most serious side effects of these effective medications is cardiometabolic disease, such as high blood pressure or diabetes, both of which contribute to the lower life-expectancy experienced by individuals with severe mental illness compared to the general population. Therefore, screening for these illnesses in individuals taking antipsychotic medications is crucial.
A recently published systematic review of all studied interventions for metabolic risk screening in people taking antipsychotic medications found that although most of the interventions showed improvements in metabolic risk screening, many lacked the scientific rigor necessary to bridge the gap between research and incorporation into clinical practice. Even in the research settings, up to one-third of individuals taking antipsychotic medications were never screened for cardiometabolic risk. The authors write that strategies that focused on shifting provider culture to encourage screening were among the most promising approaches.
  • Using real-world functioning to assess treatments for schizophrenia
Schizophrenia can be extremely disabling to many individuals with the illness. Yet, much research into treatments for schizophrenia does not measure how the treatment affects real-world functioning in individuals. In addition, current assessments often depend on self-reporting, which is known to be unreliable due to the time between when the event occurred and when the individual is asked to recall it.
New research published this month in Schizophrenia Bulletin provides an alternative to such methods, utilizing a type of tool referred to as ecological momentary assessment (EMA). EMA is a data collection technique delivered through a smart phone that allows for real-time assessment of behaviors. The smart phone can signal an individual several times a day to respond to a brief questionnaire about their daily life and has already shown to be feasible and reliable for research into a variety of different factors in schizophrenia such as severity of hallucination symptoms or substance abuse.
The current study utilized the EMA technique to examine how this tool can be used to assess functioning in individuals with schizophrenia. The authors found that the brief surveys delivered to participants via their smart phone were accurate and reliable in measuring different types of real-world functioning, including social interactions, self-care, home-care, leisure, work, and educational functioning behaviors. The authors suggest that the results support the inclusion of EMA of real-world functioning as an outcome measure for future research in schizophrenia.

  • Research neglect of suicide prevention.
Ethical considerations around research into vulnerable populations is extremely important, justifying the risk versus the potential benefits and protecting the individual participant and society. However, a recently published JAMA Psychiatry viewpoint article argues that ethical considerations have negatively shaped attitudes on suicide research, limiting innovative research and resulting in major scientific neglect into this important issue.
There is a need for research into suicide prevention, as suicide rates have been steadily increasing in the United States over the past 20 years, according to the authors. Yet, research has shown that currently, there are no known risk factors for suicidal ideation that predict suicide with any accuracy. The authors argue that novel investigative approaches are necessary to reverse the societal injustice of the scientific neglect of suicide.

Elizabeth Sinclair
Director of Research
Treatment Advocacy Center