Mental health and prevention of cardiovascular disease in general practice: impacts and interventions

Abstract

General practice has an important role in screening for cardiovascular risk factors and providing appropriate interventions, including education, counseling and referral to address behavioural risk factors. The emotional outcomes of such interventions have not previously been measured. There is also limited evidence about the psychological impact of screening for cardiovascular risk factors and conflicting evidence about the mechanisms of association between mental health and health risk behaviours. This nested exploratory mixed methods study used questionnaires, record audit and participant interviews to investigate the relationship between mental health (using psychological distress as a non-specific measure) and the behavioural risk factors for cardiovascular disease in general practice patients who participated in a cluster randomised controlled trial of a complex general practice based intervention aiming to reduce vascular risk factors (HIPS trial). Four research questions were addressed: is there an association between psychological distress and behavioural risk factors; how does psychological distress influence maintaining or changing behavioural risk factors; what effect does changing behavioural risk factors have on psychological distress; and does the HIPS intervention impact on the participants’ psychological distress? The HIPS intervention, which addressed behavioural risk factors through screening and risk assessment in combination with education and support, did not have negative psychological consequences; and contributed to a small improvement in the mental health of the participants. This improvement was not mediated by a change in lifestyle behaviour or body mass index. However interview findings suggest there is a complex bi-directional association between distress and behaviour. A conceptual model articulating a new theory of the processes involved in behaviour change has been developed. It outlines the relationship between external stressors (stressful events), unhealthy behaviour and mood. Moderators and mediators of the relationships include personality, coping style, social support and beliefs and habits. The model could be used in the design of structured general practice based interventions addressing behavioural risk factors for cardiovascular disease; in the clinical setting to determine effective interventions for individual patients; or in a policy setting as the basis for clinical practice guidelines and regulations.