Developing an intersectional screening approach for cardiovascular disease in severe mental Illness; a mixed-methods study.

Project Description

Cardiovascular disease (CVD) is the leading cause of premature death in people with severe mental illness (SMI), with mortality rates more than twice those of the general population and rising (1). Women and people from Black and ethnic minority backgrounds experience the greatest burden (2), yet their CVD risks remain poorly characterised and epidemiological evidence is limited, particularly in UK populations (3). Current screening relies on general population tools such as QRISK3, which recognises SMI as a single risk factor but fails to account for the combined effects of sex, ethnicity, socioeconomic deprivation, antipsychotic use, and lifestyle. This creates blind spots in risk stratification and intervention (1,3), leading to systematic under-prediction of risk in those most affected. UK data on how these intersectional factors interact remain scarce, despite national priorities calling for equity-focused action (4,5). Without robust intersectional evidence and tailored screening pathways, high-risk subgroups remain unidentified and opportunities for prevention are lost.
This doctoral programme will evaluate and adapt existing CVD risk assessment approaches to improve screening equity for people with SMI.

In SMI populations:

1. Systematic Review: Map global evidence on CVD risk and assess the performance of current screening tools.

2. Epidemiological Analysis (CPRD): Examine how sex, ethnicity, deprivation and antipsychotic use influence CVD risk and the accuracy of QRISK3 in UK primary care.

3. Qualitative Study: Explore barriers, facilitators and acceptability of enhanced screening with service users, carers and clinicians.

4. Co-design Workshops: Develop a culturally sensitive, intersectionality informed screening pathway or decision-support guide for routine practice