No health without mental health
World Mental Health Day on 10 October raises public awareness about mental health issues. The Day promotes more open discussion of mental disorders, and investments in prevention and treatment services. The treatment gap for mental, neurological and substance use disorders is formidable especially in poor resource countries.
Physical and mental health are intertwined and the relationship between these illnesses and human productivity and mortality are close. There is need to deal with mental health problems of people with severe or chronic physical illnesses and care of physical health problems of persons with severe mental illnesses or substance abuse through a continued and integrated care.
The theme for this year is a continuation of the one on integration of physical and mental health from last year, with a specific focus on the relationship of mental health with chronic physical illnesses. World Federation of Mental Health is developing a program – the Great Push for Mental Health – to ensure that mental health is given priority in all countries and the need for mental health to be tied to the Millennium Development Goals.
MENTAL HEALTH AND CHRONIC PHYSICAL ILLNESSES: THE NEED FOR CONTINUED AND INTEGRATED CARE
This year the WFMH is highlighting the global concern of undiagnosed mental and emotional disorders in people coping with chronic illnesses and the need for health professionals to provide more integrated or collaborative systems of care. There is underlining of the intimate and bi-directional relationship between mental illnesses and chronic physical illnesses including diabetes, cancer, heart disease, respiratory diseases, and obesity.
Diabetes and depression
Heart disease and depression
- Estimates indicate that one in four persons with diabetes suffers from depressive symptoms. The odds of developing depression and the rate of depression are doubled for people who have diabetes.
- Depression increases the risk of mortality in people with diabetes by 30 percent.
- Based on global prevalence estimates of diabetes done in 2000, 43 million people with diabetes have symptoms of depression.
- The economic burden of diabetes alone is significant. When depression is present with diabetes, there is an additional increase in health care costs by 50-75 percent.
- People who have both diabetes and depression have more severe symptoms of both diseases, higher rates of work disability and use more medical services than those who have diabetes alone.
- Studies suggest that depression increases the risk of developing type-2 diabetes by more than 20 percent in young adults.
- Depression can lead to poor lifestyle decisions such as unhealthy eating, less exercise, smoking, alcohol abuse, and weight gain. All these are risk factors for diabetes and make it more difficult to control sugar levels.
- The interaction between diabetes and depression is not well understood. However, whether a cause or an effect, the combination of diabetes and depression can be deadly. Interactions between diabetes and depression make each illness more difficult to control.
Cancer and mental illness
- Depression is present in 1 of 5 outpatients with coronary heart disease and in 1 of 3 outpatients with congestive heart failure, yet the majority of such cases are not recognized or appropriately treated.
- Major depressive disorder is a risk factor in the development of incident coronary heart disease events in healthy patients and for adverse cardiovascular outcomes in patients with established heart disease. For people with heart disease, depression can increase the risk of an adverse cardiac event such as a heart attack or blood clots. For people who do not have heart disease, depression can also increase the risk of a heart attack and development of coronary artery disease.
- Up to 15 percent of patients with cardiovascular disease and up to 20 percent of patients who have undergone coronary bypass graft surgery experience major depression.
- In one landmark study, the continued presence of depression after recovery increased the risk of death (mortality) to 17 percent within 6 months after a heart attack (versus 3 percent mortality in heart attack patients who didn‘t have depression).
- Negative lifestyle habits associated with depression – such as smoking, excessive alcohol consumption, lack of exercise, poor diet and lack of social support – interfere with the treatment for heart disease.
- Depression has been proven to be such a risk factor in cardiac disease that the American Heart Association (AHA) has recommended that all cardiac patients be screened for depression.
- Patients with depression after myocardial infarction, especially those with prior episodes, should be both carefully watched and aggressively treated because they are at an elevated cardiac risk and less likely to improve spontaneously.
Respiratory diseases and mental illnesses
- Approximately half of all patients with terminal or advanced cancer suffer with poor mental health. Specifically, depression, anxiety, and adjustment disorders plague people with advanced or terminal cancer. While half of terminally ill or advanced cancer patients suffer from depression, anxiety, and/or an adjustment disorder, less than half of cancer patients receive treatment for their mental health.
- Death rates are as much as 25% higher in cancer patients who felt depressed and 39% higher in cancer patients who received a diagnosis of depression.
- Depression is a disabling illness that affects about 15% to 25% of cancer patients. It affects men and women with cancer equally.
- The relationship between cancer and depression is complex. Depression may be triggered by the diagnosis of cancer, other issues related to the cancer and its treatment, or the impact of the cancer on a person's life. However, depression may occur by chance or be related to other difficult events, either in the past or in the present, which have nothing to do with cancer, such as the loss of a loved one.
- Cancers, especially breast cancer and lung cancer, are the second most common cause of death in people with schizophrenia, whose risk for cancer death is 50% higher than that of the general population. Possible explanations for these findings include a delay in diagnosis due to patients paying less attention to symptoms; the difficulty for schizophrenic patients to benefit from optimum treatment; and less compliance with treatment, the authors speculate.
- Adequate recognition and treatment of depression in patients with cancer can enhance quality of life and help patients and families make the best use of their remaining time together. Since patients are often reluctant to describe their depressive symptoms, caregivers need to know how depression can be recognised.
Obesity and mental illnesses
- Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death, affecting approximately 11.4 million people in the United States and millions more across the world.
- Twenty percent of patients with asthma and COPD suffer from major depression and/or anxiety (generalized anxiety, panic and phobia), a prevalence rate that is substantively greater than that in the general population.
- Depression and anxiety are associated with worsening of consumer/patient-reported respiratory symptoms and decreased lung function.
- Panic disorder, panic attacks, general anxiety disorders (GAD) and phobias appear to be the anxiety disorders most strongly associated with asthma.
- Depression makes it more difficult to adhere to treatment regimens for patients with respiratory disease.
- Research studies report increased cigarette smoking among individuals with COPD who also have anxiety disorders. Smoking is particularly problematic in youth with asthma, leading to higher symptom burden and treatment resistance.
- Depression has been found to hinder life-style adaptations that are necessary for increasing survival rates and optimizing the quality of life for individuals suffering with respiratory disease.
- Studies suggest that psychopharmacological and/or psychosocial interventions might improve asthma control.
- There is no simple association between obesity and depression and/or anxiety.
- Depression and anxiety are associated with unhealthy behaviors, such as poor diet, physical inactivity and sedentary lifestyle, tobacco use, and heavy alcohol consumption. Many of these unhealthy behaviors are linked to an increased potential for obesity.
- Obesity and depression share similar symptoms such as sleep problems, sedentary behavior and poorly controlled food intake; but for the most part are treated as separate health problems, often leading to poor treatment outcomes. Individuals with current depression or chronic depression are 60% more likely to be obese than those with no history of depression.
- Individuals with a chronic history of anxiety are 30% more likely to be obese than those who have not had a diagnosis of anxiety. The Centers for Disease Control and Prevention (CDC) reports that obesity is associated with serious chronic illnesses such as coronary heart disease, stroke and osteoarthritis, making effective treatment for obesity all the more important.
- Obesity has been associated with an increased lifetime risk for major depression and panic disorder, particularly among females.
- Some research studies indicate that obesity in adolescence may lead to depression in adulthood, while other studies indicate that depression in adolescence leads to obesity in adulthood.
SOURCE: World Federation for Mental Health
Monday, 11 October 2010