Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.
Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.
Schizophr Res. 2023 May;255:1-8. doi: 10.1016/j.schres.2023.03.007. Epub 2023 Mar 16.
People with schizophrenia and other serious mental illnesses (SMI) represent a concerning health disparity population, with 10-30 fewer years of life compared to the general population, mainly from high rates of cardiovascular disease (CVD). Preventing CVD is possible with exercise and diet interventions, but only 50 % of participants in clinical trials achieve reduction in CVD risk. This study assessed whether cash incentives improved weight loss, cardiovascular endurance, and/or mortality risk when added to one of four healthy lifestyle programs (gym membership, Weight Watchers membership, the InSHAPE program, InSHAPE + Weight Watchers).
From 2012 to 2015, 1348 overweight or obese adults with SMI enrolled in a study using equipoise stratified randomization. Participants were randomly assigned to intervention, then to cash incentives, or not, for participation (gym and/or Weight Watchers), with baseline and quarterly assessments for 12 months. We examined effects of the interventions, key covariates, and incentives, using generalized linear models.
Main effects of randomization to receive cash incentives was not significant for any outcome; whereas total amount of incentives was significantly associated with all three primary outcomes (weight loss, cardiovascular endurance, mortality risk), mainly for participants in the InSHAPE+WW group who received additional cash incentives.
Incentives may be effective at preventing CVD and improving health outcomes for people with SMI, especially in the context of intensive support for healthy lifestyle behaviors. Policy changes are required to increase access to healthy lifestyle programming and more research is needed to establish the optimal amount of incentives for people with SMI.
ClinicalTrials.gov identifier: NCT02515981.
患有精神分裂症和其他严重精神疾病（SMI）的人是一个令人担忧的健康差异群体，与普通人群相比，他们的预期寿命减少了 10-30 年，主要原因是心血管疾病（CVD）的发病率较高。通过运动和饮食干预可以预防 CVD，但临床试验中只有 50%的参与者降低了 CVD 风险。本研究评估了在四种健康生活方式计划（健身房会员、Weight Watchers 会员、InSHAPE 计划、InSHAPE+Weight Watchers）中加入现金激励措施是否可以改善体重减轻、心血管耐力和/或死亡率风险。
2012 年至 2015 年，1348 名超重或肥胖的 SMI 患者参加了一项使用均衡分层随机化的研究。参与者随机分配到干预组，然后根据是否参与（健身房和/或 Weight Watchers）获得现金激励，基线和每季度评估 12 个月。我们使用广义线性模型检查了干预措施、关键协变量和激励措施的效果。
收到现金激励的随机分组的主要效果不显著；而总激励金额与所有三个主要结局（体重减轻、心血管耐力、死亡率风险）显著相关，主要与接受额外现金激励的 InSHAPE+WW 组的参与者相关。
激励措施可能对预防 SMI 患者的 CVD 和改善健康结果有效，尤其是在为健康生活方式行为提供强化支持的情况下。需要政策改变以增加获得健康生活方式计划的机会，并且需要更多的研究来确定 SMI 患者的最佳激励金额。
ClinicalTrials.gov 标识符：NCT02515981。
