This year's theme for World Mental Health Day is a reminder that we psychiatrists must work closely with our colleagues not only in primary care but also in cardiology, endocrinology, oncology, and pulmonology.
The theme of the day, which is observed on Oct. 10, is “Mental Health and Chronic Physical Illnesses – The Need for Continued and Integrated Care.”
We know that mental health greatly affects the management of chronic physical illnesses. The four major chronic illnesses mentioned by the World Health Organization – cardiovascular problems, diabetes, cancer, and respiratory illnesses – are responsible for 60% of the world's deaths, and 80% of these deaths are happening among the world's poorest populations. “If nothing is done, experts estimate that we could witness another 388 million people die prematurely within the next 10 years,” authors of the 2010 report prepared by the World Federation for Mental Health (WFMH) wrote.
Not surprisingly, depression has the largest effect on worsening health, compared with other chronic illnesses. According to the report, depression is present in one of five outpatients with coronary heart disease and in one of three outpatients with heart failure, and most such cases go unrecognized. 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.
Major depression puts heart attack victims at great risk and appears to add to the patients' disability from heart disease. It can contribute to a worsening of symptoms as well as to poor adherence to cardiac treatment regimens.
Based on global prevalence estimates of diabetes that were done in 2003, 43 million people with diabetes have symptoms of depression. Furthermore, people who have diabetes and depression have more severe symptoms of both diseases and higher rates of work disability, and they use more medical services than do those who have diabetes alone.
According to the WFMH report, studies suggest that depression increases the risk of developing type 2 diabetes more than 20% in young adults. Depression can lead to poor lifestyle decisions, such as smoking, alcohol abuse, weight gain, unhealthy eating, and lack of exercise.
About half of all patients with terminal or advanced cancer suffer with poor mental health. Adequate recognition of depression is important to enhance quality of life.
Overall, 20% of patients with asthma and chronic obstructive pulmonary disease suffer from major depression and/or anxiety. Studies suggest that psychopharmacologic and/or psychosocial interventions might improve asthma control. Depression and anxiety are associated with unhealthy behaviors, such as poor diet, physical inactivity, sedentary lifestyle, tobacco use, and heavy alcohol consumption. Many of these factors lead to obesity. Obesity has been associated with an increased lifetime risk for major depression and panic disorder. It is suggested that primary care services need to improve ways of screening for depression that is associated with particular chronic illnesses like heart conditions or diabetes.
The American Psychological Association suggests the following 10 ways to build resilience:
▸ Make connections.
▸ Avoid seeing crises as insurmountable problems.
▸ Accept that change is a part of living.
▸ Move toward realistic goals.
▸ Take decisive actions.
▸ Look for opportunities for self-discovery.
▸ Nurture a positive self-view.
▸ Keep things in perspective.
▸ Maintain a hopeful outlook.
▸ Maintain self-care.
Above all, integrated health care is vitally important in order to address mental and physical health problems. Such problems will remain unresolved and complicated if either part is ignored. The important aspect is the collaborative part of psychiatrists, our physician colleagues such as family practitioners, and allied mental health professionals in achieving the goal of addressing and managing this issue.
This, of course, is the right approach if we are serious about addressing global morbidity and mortality. Hence, the theme advocated this year by the WFMH is quite appropriate.