Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders.

Persons with severe mental disorders (SMDs) experience dramatically reduced life expectancy compared with the general population. We consider the role of digital technologies for addressing this serious public health concern. In this clinical review, we apply the multilevel risk model recently introduced by the WHO to conceptualise how digital technology can support efforts to reduce excess mortality risk at the individual, health system and social determinants of health levels. In particular, digital technologies show promise for targeting preventable physical health conditions in persons with SMDs. However, evidence on the use of these technologies for addressing early mortality risk factors is lacking. At the individual level, digital interventions show promise for managing mental health symptoms, promoting healthy lifestyle behaviours and targeting substance use concerns. At the health system level, digital interventions can support care coordination, clinician training, screening and monitoring health indices and shared decision-making. At the social determinants of health level, digital interventions can facilitate opportunities to engage peers for illness self-management and health promotion and for delivering and/or augmenting supported employment programmes. The time is ripe to capitalise on early evidence to support future development, testing and delivery of effective digital efforts targeting risk factors that contribute to shorter life expectancy in persons with SMDs. Key challenges and opportunities for future research include increasing user engagement, involving users during development and testing of digital interventions, carefully considering risks/harms and rigorously evaluating effectiveness and costs to support the scalability and sustainability of promising digital approaches. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.