MENTAL HEALTH
MENTAL HEALTH ISSUES IN PATIENTS WITH HEART DISEASE
Dr. Reaz Mahmud Huda
MENTAL HEALTH ISSUES IN PATIENTS WITH HEART DISEASE
Dr. Reaz Mahmud Huda
Mental health involves how we think, feel, act, and make choices. Mental health disorders can be short-term or long-term and may interfere with a person’s mood, behaviour, thinking, and ability to relate to others. Impact of trauma, depression, anxiety, and stress on one’s body, including stress on one’s heart is evident in biomedical literature. Mental health is associated with risk factors for heart disease before a diagnosis of a mental health disorder and during treatment. These effects can arise both directly, through biological pathways, and indirectly, through risky health behaviours1 – as we find in patients attending out-patients department or private consultation chamber of the physicians.
People experiencing depression, anxiety, stress, and even PTSD over a long period of time may experience certain physiologic effects on the body, such as increased cardiac reactivity such as increased heart rate and blood pressure, reduced blood flow to the heart, and heightened levels of cortiso.1-3 Over time, these physiologic effects may result in different forms of heart disease. In contrast, mental health disorders such as depression, anxiety, and PTSD may develop after cardiac events, including heart failure, stroke, and heart attack.1,2 These disorders can be brought on after an acute heart disease event from factors including pain, fear of death or disability, and financial problems associated with the event.3
Besides, mental health disorders such as anxiety and depression may increase the chance of adopting behaviours such as smoking, inactive lifestyle, or failure to take prescribed medications.2 This is because people experiencing a mental health disorder may have fewer healthy coping strategies for stressful situations, making it difficult for them to make healthy lifestyle choices to reduce their risk for heart disease.2 Hence, mental health and wellbeing should be addressed while treating heart disease patients.
Interrelation between heart disease and mental disorders (Photo Courtesy: CDC, USA).
Health care professionals, individuals, and researchers can take to promote heart disease prevention and support mental health for patients with heart disease. Below are some possible actions that may help:3,4
1
Setting up multidisciplinary teams that include both heart disease and mental health professionals in a health care institution e.g. NICVD, BSMMU, or in medical colleges.
2
For cardiac physicians or surgeons, talking to patients about the relationship between mental health and heart disease and incorporating mental health screening and treatment (through referral) into care surrounding a major heart disease event and chronic disease.
3
Involving individuals and their family members in communication and decision-making regarding treatment following a heart disease event.
4
For researchers, addressing the role of social determinants of health and health disparities in improving the intersection between mental health and heart health outcomes as well as identify more biological links and impact of mental health on the prevention and treatment of heart disease and its risk factors.
References:
1.Chaddha A, Robinson EA, Kline-Rogers E, Alexandris-Souphis T, Rubenfire M. Mental health and cardiovascular disease. Am J Med. 2016;129(11):1145-8.
2.Abed MA, Kloub MI, Moser DK. Anxiety and adverse health outcomes among cardiac patients: a biobehavioral model. J Cardiovasc Nurs. 2014;29(4):354-63.
3.Kubzansky LD, Huffman JC, Boehm JK, et al. Positive psychological well-being and cardiovascular disease: JACC Health Promotion Series. J Am Coll Cardiol. 2018;72(12):1382-96.
4.World Health Organization (WHO). WHO Guidelines: Management of physical health conditions in adults with severe mental disorders. Geneva: WHO; 2018.
Dr. Reaz Mahmud Huda, MBBS, FCPS (Medicine), FCPS (Cardiology)
Assistant Professor,
Department of Cardiology,
National Institute of Cardiovascular Diseases (NICVD),
Dhaka, Bangladesh
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