Risk and Protective Factors in Relation to Early Mortality Among People With Serious Mental Illness: Perspectives of Peer Support Specialists and Service Users

Objective: Individuals with serious mental illness (SMI) experience a 10-25-year reduced life expectancy when compared to the general population that is due, in part, to poor health behaviors. Yet, in spite of the development of health promotion and self-management interventions designed for people with SMI to promote health behavior change, the mortality gap has increased, suggesting that relevant factors are not being addressed. The objective of the present study was to explore potential contributors to early mortality among individuals with SMI by drawing from the lived experience of certified peer support specialists and service users (SUs). Method: Face-to-face semistructured interviews were conducted with a convenience sample of SU participants (n = 17) and certified peer specialists (n = 15). Qualitative data were analyzed using a grounded-theory approach. Results: We identified a final set of 27 codes relating to five overarching themes that relate to both risk factors and protective factors for early death: social connectedness (24.1% of coded items), treatment (21.3%), coping (21.3%), physical health and wellness (18.5%), and resilience and mental health (14.8%). Conclusions and Implications for Practice: Findings add to the literature supporting the powerful role of social processes in shaping health in people with SMI beyond social determinants of health (SDOH; e.g., income, employment) and health behavior change. Interventions that reduce loneliness and isolation in combination with addressing more conventional SDOH may have the most potential to reduce early mortality in people with SMI. Impact and Implications Individuals with serious mental illness (SMI) die earlier than those without. We interviewed certified peer support specialists and service users to explore potential reasons for this mortality gap. They most frequently identified social connectedness as relevant to mortality, as well as treatment, coping, physical health/wellness, and resilience/mental health. Interventions that promote social connectedness in conjunction with health behaviors may be most effective for preventing early death among people with SMI.