AI Insight
This scoping review examined interventions delivered in primary care settings, particularly general practice, to reduce cardiovascular disease risk among patients with severe mental illness such as schizophrenia, bipolar disorder, and major depression. Following a systematic search of four databases, only 10 relevant studies published between 2015 and July 2025 were identified, indicating a substantial gap in the evidence base. Identified intervention types included tailored behavioural change programs, the patient-centred medical home model, clinical decision tools, and provider education, with promising features including staff training, collaborative care structures, and peer support.
Why it matters
People with severe mental illness experience disproportionately higher rates of cardiovascular morbidity and mortality, making the identification of effective primary care interventions a pressing public health priority. The findings highlight the need for further randomised controlled trials to establish the clinical effectiveness and cost-efficiency of such interventions in real-world general practice settings.
by Aswath Krishna Muthuraman, Nandakumar Ravichandran, Niamh Murphy, John Broughan, Eleni Niarchou, Brian O’Donoghue, Joseph Gallagher, Kenneth McDonald, Janis Morrissey, Walter Cullen
Background
People with severe mental illness (SMI), including bipolar disorder, major depression, and schizophrenia, face significantly increased morbidity and mortality from cardiovascular disease (CVD). Common CVD risk factors in these populations comprise health behaviours such as smoking and poor diet, and physical factors, including diabetes mellitus, obesity and dyslipidaemia. Thus, there is a need to identify interventions to prevent CVD in SMI patients, for which general practice may be ideal for delivery. This scoping review aimed to explore the interventions to reduce CVD risk in patients with SMI in primary care, with a focus on general practice.
Methods
This scoping review was guided by Arksey and O’Malley’s six-step methodological framework, barring step six – consultation. A systematic search was performed across four electronic databases: PubMed, Embase, APA PsycINFO and CINAHL, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Narrative synthesis was conducted to identify key themes informed by the Popay et al. framework.
Results
A total of 10 studies were included in the final analysis. Five themes were identified, namely (1) Primary Care Interventions, (2) Intervention Implementation, (3) Collaborative or Intermediary Structures, (4) Barriers and Facilitators, and (5) Participant Experiences and Viewpoints. Identified intervention types included tailored behavioural change interventions, the patient centred medical home model, clinical tool use and provider education. Promising aspects of interventions included effective staff training, collaborative structures and peer support involvement. Challenges to implementation included patient mental health symptoms impacting ability to attend sessions, lack of knowledge and experience among staff of working with SMI patients, and resource constraints, including time and workload concerns.
Conclusion
This scoping review highlights a research gap regarding primary care interventions to reduce CVD risk in SMI patients, as only 10 relevant studies were identified published from 2015 to July 2025 in the English language. However, aspects of existing literature, such as promising intervention features, implementation barriers and feedback for consideration were also identified. Future research regarding this topic could address identified barriers and feedback points. Further randomised controlled trials assessing clinical-effectiveness and cost-efficiency of interventions in primary care settings may also be required.