Impact of Relaxation and Group Psycho-Education on Health Outcomes Using Integrated Care Models and Quality Improvement


The purpose of this Integrated Care Practice Change and Quality Improvement (ICPCQI) initiative was to evaluate the impact of wellness and relaxation and group psycho-education on health out-comes in an integrated care setting. Individuals diagnosed with mental illness and a co-occurring chronic medical condition participated in the ICPCQI initiatives which were run by peer support and wellness experts in an integrated care setting over the one-year project implementation period. Evaluation of outcome measures revealed an overall decline of 8.3% (p < 0.0001) and 7.3% (p < 0.0001) in the average systolic and diastolic blood pressure respectively. There was a 12.3% (p = 0.02) reduction on the average PHQ-9 scores. GAD-7 (p = 0.9) scores had a mean reduction of 1.5%. These preliminary results suggest that the evidence-based ICPCQI initiatives positively impact health outcomes among individuals with mental illness and chronic medical conditions.

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Okafor, M. , Ede, V. , Kinuthia, R. , Strotz, D. , Marchman, C. , Weeks, S. and Satcher, D. (2014) Impact of Relaxation and Group Psycho-Education on Health Outcomes Using Integrated Care Models and Quality Improvement. Open Journal of Preventive Medicine, 4, 887-896. doi: 10.4236/ojpm.2014.412100.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R. and Walters, E.E. (2005) Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.
[2] Kessler, R.C., Berglund, P., Demler, O., et al. (2003) The Epidemiology of Major Depressive Disorder: Results from the National Comorbidity Survey Replication (NCS-R). Journal of American Medical Association, 289, 3095-3105.
[3] Reeves, W.C. and Strine, T.W., Pratt, L.A., et al. (2011) Mental Illness Surveillance among Adults in the United States. MMWR Surveillance Summaries, 60, 1-29.
[4] Kessler, R.C., Heeringa, S., Lakoma, M.D., Petukhova, M., Rupp, A.E., Schoenbaum, M., et al. (2008) Individual and Societal Effects of Mental Disorders on Earnings in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 165, 703-711.
[5] Chapman, D.P., Perry, G.S. and Strine, T.W. (2005) The Vital Link between Chronic Disease and Depressive Disorders. Preventing Chronic Disease, 2, A14.
[6] Lichtman, J.H., Bigger Jr., J.T., Blumenthal, J.A., et al. (2008) Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association. Circulation, 118, 1768-1775.
[7] Keyser, D.J., Houtsinger, J.K., Watkins, K. and Pincus, H.A. (2008) Applying the Institute of Medicine Quality Chasm Framework to Improving Health Care for Mental and Substance Use Conditions. Psychiatrics Clinic of North America, 31, 43-56.
[8] Broadbent, E., Kydd, R., Sanders, D. and Vanderpyl, J. (2008) Unmet Needs and Treatment Seeking in High Users of Mental Health Services: Role of Illness Perceptions. Australian & New Zealand Journal of Psychiatry, 42, 147-153.
[9] Levinson, D., Karger, C.J. and Haklai, Z. (2008) Chronic Physical Conditions and Use of Health Services among Persons with Mental Disorders: Results from the Israel National Health Survey. General Hospital Psychiatry, 30, 226-232.
[10] Insel, T.R. (2008) Assessing the Economic Costs of Serious Mental Illness. American Journal of Psychiatry, 165, 663- 665.
[11] Mark, T.L., Levit, K.R., Buck, J.A., Coffey, R.M. and Vandivort-Warren, R. (2007) Mental Health Treatment Expenditure Trends, 1986-2003. Psychiatric Services, 58, 1041-1048.
[12] Gates, L.B. and Akabas, S.H. (2007) Developing Strategies to Integrate Peer Providers into the Staff of Mental Health Agencies. Administration and Policy in Mental Health and Mental Health Services Research, 34, 293-306.
[13] Chinman, M., Young, A.S., Hassell, J. and Davidson, L. (2006) Toward the Implementation of Mental Health Consumer Provider Services. Journal of Behavioral Health Services & Research, 33, 176-195.
[14] Mowbray, C.T., Moxley, D.P., Thrasher, S., Bybee, D. and Harris, S. (1996) Consumers as Community Support Providers: Issues Created by Role Innovation. Community Mental Health Journal, 32, 47-67.
[15] Paulson, R., Herinckx, H., Demmler, J., Clarke, G., Cutler, D. and Birecree, E. (1999) Comparing Practice Patterns of Consumer and Non-Consumer Mental Health Service Providers. Community Mental Health Journal, 35, 251-269.
[16] Donker, T., Griffiths, K.M., Cuijpers, P. and Christensen, H. (2009) Psychoeducation for Depression, Anxiety and Psychological Distress: A Meta-Analysis. BMC Medicine, 7, 79.
[17] DeMarco-Sinatra, J. (2000) Relaxation Training as a Holistic Nursing Intervention. Holistic Nursing Practice, 14, 30-39.
[18] Shah, L.B., Klainin-Yobas, P., Torres, S. and Kannusamy, P. (2014). Efficacy of Psychoeducation and Relaxation Interventions on Stress-Related Variables in People with Mental Disorders: A Literature Review. Archives of Psychiatric Nursing, 28, 94-101.
[19] Robinson, P.J. and Strosahl, K.D. (2009) Behavioral Health Consultation and Primary Care: Lessons Learned. Journal of Clinical Psychology in Medical Settings, 16, 58-71.
[20] Gabbay, R.A., Bailit, M.H., Mauger, D.T., Wagner, E.H. and Siminerio, L. (2011) Multipayer Patient-Centered Medical Home Implementation Guided by the Chronic Care Model. Joint Commission Journal on Quality and Patient Safety, 37, 265-273.
[21] The PDSA Cycle. The W.Edwards Deming Institute Web Site.
[22] Georgia Certified Peer Specialist Project. Georgia Certified Peer Specialist Project Web Site.
[23] Viron, M., Zioto, K., Schweitzer, J. and Levine, G. (2014) Behavioral Health Homes: An Opportunity to Address Healthcare Inequities in People with Serious Mental Illness. Asian Journal of Psychiatry, 10, 10-16.
[24] Unutzer, J., Katon, W., Williams Jr., J.W., Callahan, C.M., Harpole, L., Hunkeler, E.M., et al. (2001) Improving Primary Care for Depression in Late Life: The Design of a Multicenter Randomized Trial. Medical Care, 39, 785-799.
[25] Van Leeuwen, W.E., Unutzer, J., Lee, S. and Noel, P.H. (2009) Collaborative Depression Care for the Old-Old: Findings from the IMPACT Trial. American Journal of Geriatric Psychiatry, 17, 1040-1049.
[26] Laderman, M. and Mate, K. (2014) Integrating Behavioral Health into Primary Care. Healthcare Executive, 29, 74-77.
[27] Kuramoto, F. (2014) The Affordable Care Act and Integrated Care. Journal of Social Work in Disability & Rehabilitation, 13, 44-86.

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