Table 1

Multiple levels of risk factors for early mortality and the potential for digital interventions for individuals living with severe mental disorders*

Multiple levels of riskRisk factors for early mortalityRelevant examples of digital technology interventions from the literature
Level 1: Individual factors
  • Illness severity

  • Symptoms

  • Age of onset

  • Family history

  • Time since diagnosis

  • Lifestyle behaviours

  • Chronic medical conditions

  • Substance use

  • Motivation

  • Smartphone applications for management of mental health symptoms (eg, FOCUS, Actissist, PRIME)29 31 32

  • Telehealth programmes for psychiatric and medical instability22 23

  • Telephone-based wellness coaching for weight reduction and wellness promotion24

  • Wearable activity tracking devices for supporting behavioural weight loss interventions25

  • Web-based smoking cessation programme26

  • Smartphone-based smoking cessation apps27 28

Level 2: Health system factors
  • Lack of leadership

  • Inadequate financing

  • Poor quality and fragmented service delivery

  • Lack of care coordination

  • Limited workforce and staff capacity

  • Negative attitudes among health providers

  • Limited knowledge, skills or proficiency among providers

  • Effects of antipsychotic medications and other treatments

  • Health Technology Program to support delivery of evidence based mental health treatments, relapse prevention after a hospitalisation for psychosis and technology coach for care coordination38

  • Web-based platform for training clinicians in delivery of evidence-based treatments in community mental health settings36

  • Electronic screening tool for recording and monitoring metabolic syndrome indices including anthropometric measures such as weight, body mass index, blood pressure and waist circumference33

  • Electronic personal health record to allow patients with serious mental illness and comorbid medical conditions to access their own health information in community mental health centres35

  • CommonGround web application to support the clinical encounter in community mental health settings by facilitating goal setting and shared decision-making34

Level 3: Social determinants of health
  • Discriminatory policies

  • Low socioeconomic position

  • Poverty

  • Homelessness

  • Low health literacy

  • Societal stigma

  • Negative attitudes and discrimination

  • Poor environment

  • Impoverished or unsafe neighbourhoods

  • Limited access to social support

  • Few community resources

  • Peer-delivered and mobile technology supported integrated medical and psychiatric self-management intervention called PeerTECH for older adults with serious mental illness and medical comorbidity39

  • Mobile technology and popular social media combined with peer support as part of a lifestyle intervention for promoting weight loss and improved fitness by creating community of wellness to facilitate interactions and support among participants towards achieving lifestyle goals40 41

  • WorkingWell mobile app aimed at supporting employment and providing coping strategies for improving success in the work environment by focusing on key factors such as relationships, mental illness challenges, encouraging motivation and managing lifestyle and wellness concerns outside of work, such as sleeping and eating well45 46

  • *This table is adapted from the ‘Multilevel model of risk for excess mortality in persons with severe mental disorders’ described by Liu and colleagues (2017).1

  • †Recent relevant examples from the literature using digital technologies for addressing risk factors for early mortality among individuals living with severe mental disorders.