Cardiovascular disease and mental health

US reminder on mental health burden

Improving Medical and Psychiatric Outcomes Among Individuals With Bipolar Disorder: A Randomized Controlled Trial

Back to table of contents Previous article Next article Professional NewsFull AccessUntreated Chronic Illness Blamed for High MortalityRich DalyRich DalySearch for more papers by this authorPublished Online:15 Aug 2008https://doi.org/10.1176/pn.43.16.0007Contrary to what may be a popular belief, a person with serious mental illness is more likely to die of a heart attack or complications from diabetes than by suicide.Misperceptions about the health care needs of people with mental illness extend even to health care professionals, which may be one of the reasons such patients are dying prematurely—25 to 30 years earlier than other Americans, according to federal health statistics. This gap in life expectancy is an increase from the 10- to 15-year mortality difference in the early 1990s between individuals with mental illness and others.To reverse this trend, advocates for people with mental illness recently called for federal intervention, including improving the tracking of these individuals' physical and mental health; removing obstacles to their receiving quality, integrated physical and mental health care; and encouraging primary care providers to work in close proximity in the same facility with mental health clinicians to improve provision of that care.“We have to get past the point of psychiatrists saying 'I don't do that internal medicine stuff,' and internists saying 'I don't want to take all of the time that people with mental illness need,'” said Joe Parks, M.D., medical director of psychiatric services for the Missouri Department of Mental Health.Parks and other mental health experts briefed congressional staff in June on the need for federal efforts to reverse the declining life expectancy for people with serious mental illness. The briefing was organized by the Senate Mental Health Caucus.It was Park's 2007 report that identified the lower life expectancy of people with serious mental illness compared with the general population and that dispelled the “suicide” stereotype behind the early deaths. Early deaths, Parks said, were largely due to untreated or undertreated nonmental chronic health conditions. Among the leading preventable medical conditions driving the increased morbidity and mortality in this population were metabolic disorders, cardiovascular disease, and diabetes mellitus.Park's research also found a high prevalence of modifiable risk factors, including obesity and smoking. Cigarette use, he noted, is so widespread among people with serious mental illness that they now smoke about 44 percent of all cigarettes sold in the United States. “We really need to focus on smoking because it is a big opportunity” to prevent disease and death, Parks said.The prevalence of risk factors among people with serious mental illness is exacerbated by poor health care access among this population and by the stigma they face—even from medical professionals, according to a consensus of the literature.Similar health disparities exist even in populations with broad access to health care, such as veterans, said Barbara Mauer, a health care consultant in Seattle. Mauer, who has studied the issue, blamed both the negative attitudes of health care providers toward mental illness and a failure to educate patients to seek both needed mental and primary health care.Research studies designed to address disparities between mental health care and general health care have found health improvements when nurse case managers coordinate both mental and physical care for each patient, while educating and giving patients new skills to better manage their own illnesses.Analysis of one nurse case manager pilot program found that medical problems were newly detected by staff in one-third of participating patients taken to a mental health facility for evaluation and treatment. At the same time, there was an increase in disease-prevention health care provided to these patients.Another pilot program approached the challenge of split—and therefore fragmented—mental and general health care from the behavioral health care side by placing nurse practitioners in mental health clinics. In one such program in Massachusetts, the nurse practitioners ensured that the mental health patients also received general health care services.A Colorado pilot program that is addressing health care providers' negative attitudes toward mental illness and improving access to care has found some success. The integrated care program in Summit County combined the staffs of a community health center and a mental health clinic to create “care teams” of general and mental health care providers within a facility that had previously emphasized general health care. The program provided training for the mental health staff in the common physical health care needs of people with mental illness and educated the general health care providers on signs that patients may also need mental health and substance abuse treatment.Among the biggest impacts of the program was the improved communication it encouraged between two traditionally separate organizations, to the extent that both were comfortable referring patients and seeking additional information from the other side of the program.“It's important to share our knowledge and share our ignorance,” said Helen Royal, a nurse in the program.Advocates at the congressional briefing said the federal government can encourage such pilot programs by including funds for them in their established grant programs.Also, the Community Mental Health Services Improvement Act (S 2182 and HR 5176) would create a new grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) to fund the co-location of primary care services within mental health organizations. The legislation, which would provide $50 million in grants for the first year of a five-year program, was included in draft legislation to reauthorize SAMHSA, but that legislation has stalled for the year.Supporters are optimistic that the grant program will be revived in Congress next year, along with efforts to require insurers to cover smoking cessation and obesity treatment programs.The text of S 2182 and HR 5176 can be accessed at<http://thomas.loc.gov> by searching on the bill numbers. ▪ ISSUES NewArchived

As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.

The central place of psychiatry in health care worldwide.

The CoLaus study is a large population based cross sectional study in over 6000 subjects aged 35-75 years living in Lausanne, Switzerland. Its main goals are to obtain information on (1)The prevalence of cardiovascular risk factors and diseases in the population of Lausanne, (2)New biologic and genetic determinants of isolated and clusters of cardiovascular risk factors. Recruitment was done from 2003 to 2006 to obtain a representative sample of subjects. The participation rate was 42%. The participants were extensively phenotyped by administering a questionnaire on personal and family history of cardiovascular risk factors & personal medical history, a basic physical exam for cardiovascular risk factors, mental status examination and biological markers in blood and urine. Plasma, serum, whole blood and urine were stored at -80oC and all Caucasian subjects were genotyped with database in Lausanne. Starting in 2004, over 3600 CoLaus participants underwent an extensive psychiatric phenotypization (PsyCoLaus). This extensive phenotype should allow us to better understand the known association between cardiovascular diseases and mental health. In May 2009 follow-up of the entire CoLaus population was started to prospectively assess the association between cardiovascular diseases, cardiovascular risk factors and mental disorders. Data were collected to know the course of the conditions related to cardiovascular diseases or mental disorders observed at baseline, the incidence of such conditions during the follow-up and the evaluation of candidate variables which could be either mediators of a causal relationship or shared factors underlying the association between mental disorders and cardiovascular diseases. Several sub-studies were also started like: (1)AngioLaus – a case control study in which 500 participants underwent detailed cardiovascular pheno-typing including intima-media thickness in the carotid arteries, pulse-wave velocity, central arterial pressure and endothelial function before and during reactive hyperaemia. (2)HERCULES - to study the prevalence of hypertension using 24-hour ambulatory blood pressure measurement, to assess renal function using 24-hour urine collection (creatinine clearance, micro-albuminuria) and to expand understanding of genetic variants associated with hypertension and renal function within the CoLaus study. (3)OsteoLaus - to compare risk models to discriminate osteoporotic fractures, to better understand the association of osteoporosis, cardiovascular diseases & mental health and to determine the genetic determinants of osteoporosis. (4)HypnoLaus - to determine the prevalence of sleep disorders in the general population, to assess the genetic basis of sleep and its disorders and for better characterization of a potential link between cardiovascular disease risk factors and mental health. Each subject had reversible anonymised unique identification barcode and samples in the bio-bank were identified with barcodes. The data are stored in an Oracle database updated with Epi-data software. A scientific advisory board consisting of external scientists evaluate the progression of the project. The participant motivation is being sustained with regular newsletters and interactive website. The project had received funding from GlaxoSmithKline initially and is currently supported by the Swiss National Science Foundation. There have been over 100 publications with more than 3000 citations so far from the project.

Black people in the United States (U.S.) are dying at disproportionate rates from the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) virus, which causes Coronavirus Disease 2019 (COVID-19). Age-adjusted COVID-19 mortality rates for Black people are 2.8 times higher than White people (Prevention & (CDC). 2020). Black people are at higher risk for COVID-19 due to social factors, (i.e., structural racism and its manifestations including mortgage redlining, employment discrimination, healthcare provider bias, etc.), the politicization of COVID-19, and poor access to testing facilities (Poteat, Millett, Nelson, & Beyrer, 2020; Williams & Cooper, 2020).

Integrated Care

Background: Cardiovascular diseases (CVD) are major causes of death in Japan, and controlling the risk factors for CVD is an important public health task. Lifestyle factors, for example, diet and stress, have impacts on risk factors such as hypertension and hyperlipidemia. Deterioration of mental health is related to CVD pathogenesis. Aim: We investigated the relationships between levels of mental health, 4-year changes in lifestyle, and CVD risk factors among Japanese workers, using the SF-36 (Japanese version), which is a comprehensive scale measuring health-related quality of life. We hypothesized that workers’ mental health levels would influence 4-year changes in their lifestyles and CVD risk factors. Methods: Data from the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study, which were collected by examination and administration of the SF-36, were used. The relationships between mental health levels at baseline, lifestyle chan- ges, and cardiovascular risk factors were longitudinally analyzed. Subjects with total SF-36 scores ≥65 were classified as the “Good Mental Health Group,” and those with total scores <65 were classified as the “Poor Mental Health Group.” Results: Multiple logistic regression analyses showed that, as compared to people who had poor mental health, those who had good mental health at baseline had a significantly higher probability of good maintenance of improvements in body mass index, (OR = 1.20, 95% CI: 1.03 - 1.39), blood pressure (OR = 1.20, 95% CI: 1.01 - 1.43), total cholesterol (OR = 1.07, 95% CI: 0.86 - 1.33) and HDL cholesterol (OR = 1.26, 95% CI: 1.07 - 1.47). Conclusion: Japanese workers with good mental health tend to improve or maintain good lifestyle conditions and minimize CVD risk factors, while those with poor mental health generally have difficulty improving their lifestyles and lowering their CVD risk.

Background: Depression is highly prevalent in cardiac populations. While depression can lead to a range of clinical and psychological impairments, its impact on vocational, mental and physical health functioning remains under-researched in this population. Also unclear is whether targeted treatment can improve these outcomes. Combining depression management with a Coronary Heart Disease (CHD) secondary prevention program using a flexible mode of delivery could facilitate access to treatment, improving these patient outcomes and minimising the burden of this co-morbidity. The purpose of this thesis was to assess the impact of depression on mental, physical and vocational functioning in those with cardiovascular disease (CVD), and determine whether targeted treatment can improve these outcomes. Methods: Australian population-based data were used to assess the burden of, and interaction between, major depressive disorder (MDD) and CVD on vocational and health related quality of life (HRQOL) outcomes. Further, a novel systematic review was conducted to determine the predictive role of depression on return to work (RTW) after a cardiac event. In order to determine the effectiveness of depression treatment on mental and physical HRQOL outcomes of cardiac patients, a meta-analysis was conducted. Finally, data from a two-arm, 24-week randomised feasibility trial, with 6-month evaluation outcomes, were used to assess the effectiveness of a telephone-delivered, depression and lifestyle management program (‘MoodCare’) on mental and physical HRQOL and vocational functioning of depressed Acute Coronary Syndrome patients. Results: First, Australians with co-morbid MDD and CVD were least likely to be participating in the workforce (adj. Odds Ratio (OR): 0.4, 95% CI:0.3-0.6), and most likely to experience work functioning impairments (adj. OR:8.1, 95% CI:3.8-17.3) and absenteeism (adj. OR:3.0, 95% CI:1.4-6.6) when compared with individuals with one or neither condition. Second, depression predicted RTW after a cardiac event in over half of the 12 studies reviewed. Third, Australians with co-morbid MDD and CVD reported the greatest deficits in Assessment of Quality of Life (AQOL) utility scores (adj. Coefficient:-0.32, 95% CI:-0.40,-0.23) when compared with those with one or neither condition. Fourth, a meta-analysis demonstrated that depression treatment administered after a cardiac event significantly improved both mental and physical health functioning. Effect sizes were greatest for mental (standardised mean difference [SMD]=-0.29, 95% CI:-0.38,-0.20) versus physical HRQOL (SMD:-0.14, 95% CI:-0.24,-0.04). Finally, the MoodCare program yielded significant improvements in physical health functioning after 6-months (SF-12 mean difference=6.7; 95% CI:1.1, 12.3), compared with a control condition. Significant improvements in mental health functioning were also observed for those with a history of MDD. No intervention effects were observed for vocational outcomes. Conclusions: These findings confirm co-morbid depression and CVD as a significant public health issue. The benefits of treating depression in this population can go beyond psychological outcomes to improve HRQOL. These findings provide support for the use of a combined depression management and lifestyle program which is delivered over the telephone to improve key functioning outcomes of cardiac patients. Further research is required to determine the most effective way to impact vocational outcomes. Several clinically- and policy-relevant recommendations are discussed in light of these findings.

TO THE EDITOR: Cardiovascular disease (CVD) and mental disorders are the top two contributors to the total burden of disease in Indigenous Australians and make a substantial contribution to the excess morbidity and mortality in this group. There is increasing evidence that mental disorders are risk factors for, or consequences of, CVD. Awareness and better understanding of the intertwined relationship between mental disorders and CVD in Indigenous populations can provide opportunities for coordinated and seamless management of these conditions in health care systems. We investigated the association between mental disorders due to substance use and CVD in a remote Indigenous community in the Northern Territ ry. A cohort of 897 Aboriginal adults aged 20–74 years (85% of the community’s total adult population) was established throu h a population-based renal disease screening program in the community between 1992 and 1995. We followed up 784 participants, who were free of CVD at baseline, to 31 May 2005, using hospital and death records. The study was approved by the Behavioural and Social Sciences Ethical Review Committee of the University of Queensland. Substance use-related mental disorders were determined from participants’ hospital records, using International Classification of Diseases, ninth revision (ICD-9) codes 192, 291 and 303–305; and 10th revision (ICD10) codes F10–F19. Cases of CVD were identified by the first CVD event recorded in participants’ hospital and death records, using ICD-9 codes 390–459 and ICD-10 codes I00–I99. We used the Kaplan–Meier method to calculate cumulative CVD incidence rates for those with and without substance use-related mental disorders. CVD hazard ratios were estimated using Cox proportional hazards models. During a median follow-up period of 10 years, 177 of the 784 participants (23%) had clinically diagnosed mental disorders due to substance use (mainly alcohol: 140 participants), and 243 (31%) developed CVD. Incidence rates of CVD were 71 (95% CI, 58–87) and 27 (95% CI, 23–32) per 1000 person-years for those with and without substance use-related mental disorders, respectively (Box). Participants with substance use-related mental disorders were 2.6 (95% CI, 2.0–3.3) times more likely to develop CVD than those without. After adjusting for CVD risk factors measured at baseline (age, sex, body mass index, smoking status, alcohol use, blood pressure, serum cholesterol level, diabetes and albuminuria status), the association remained statistically significant, with an adjusted hazard ratio of 2.6 (95% CI, 1.9–3.5). Our findings confirm an association between substance use-related mental disorders and CVD in an Indigenous population, after adjusting for potential confounders. Traditional health care systems tend to separate services and treatment for mental disorders from those for physical health problems such as CVD. This separation is even more evident in remote Indigenous settings, where primary health care practitioners are already overwhelmed in providing general medical care to community members, with mental health services being delivered infrequently by visiting psychiatrists. The observed intertwined relationship between these two common conditions calls for integration of mental health services into routine primary health care, and enhanced collaboration between primary care practitioners, cardiologists and psychiatrists, in an effort to curb the huge burden imposed by these diseases. The emerging Aboriginal mental health worker program in the NT has the potential to be an effective service model to bridge the gap between mental health care and day-today primary health care. Dedicated financial resources and ongoing support for recruitment, training and retention of Aboriginal mental health workers will be required for sustained integration of mental health care with primary care in Indigenous communities.

Modest Gains Confer Large Impact: Achievement of Optimal Cardiovascular Health in the US Population

The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes. The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale. Mental and physical health outcomes were assessed by self-report and interviewer evaluation. Survival analysis and linear and logistic regressions were used to determine the risk for adverse mental and physical health outcomes posed by traumatic grief. Survival and regression analyses indicated that the presence of traumatic grief symptoms approximately 6 months after the death of the spouse predicted such negative health outcomes as cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits at 13- or 25-month follow-up. The results suggest that it may not be the stress of bereavement, per se, that puts individuals at risk for long-term mental and physical health impairments and adverse health behaviors. Rather, it appears that psychiatric sequelae such as traumatic grief are of critical importance in determining which bereaved individuals will be at risk for long-term dysfunction.

To examine the separate and joint associations of physical activity and levels of physical, mental, and social health with long-term all-cause and cardiovascular disease (CVD) mortality in older adults. A cohort of 4008 individuals representative of the non-institutionalized population of Spain aged 60years and older was analyzed. Information on physical activity was self-reported. Physical and mental health were assessed with the SF-36 questionnaire, and social health with a 4-item score on network structure and social engagement. Participants were categorized as being in a good, intermediate, or poor health according to tertiles of the score in each health dimension. Analyses were performed with Cox regression and adjusted for main confounders, including levels in the other two health dimensions. Over a median follow-up of 14 years, a total of 1811 deaths occurred, 674 due to CVD. Hazard ratios (95% confidence interval) for all-cause mortality were 1.35 (1.18-1.55), 1.18 (1.02-1.36), and 1.37 (1.18-1.58) for poor vs. good physical, mental, and social health, respectively (all p trend < 0.001). Being physically active was associated with a 28% (15-39%), 31% (19-42%), and 19% (5-31%) lower all-cause mortality in participants with poor physical, mental, and social health, respectively. In each health dimension, physically active individuals with poor health showed a similar or lower all-cause mortality than those who had intermediate or good health but were physically inactive. Results for CVD mortality were similar to those for all-cause death. Physical activity might attenuate the excess all-cause and CVD mortality associated with poor physical, mental, and social health.

Physical activity, especially routine walking, is an imperative factor for the prevention of strokes, mental illness, and cardiovascular diseases (CVDs). The NIH (National Institute of Health) has also acknowledged walking as the most important factor of the stroke rehabilitation program. Many research studies are presented by physicians and researchers in the literature that highlight the positive impacts of walking on human health (physical and mental). This paper has the objective of studying the impact of regular walking, especially on mental illness, CVDs, and strokes. The C-reactive protein (CRP), P-selectin protein, and homocysteine biomarkers are considered to decide the improvement in the health of an individual with respect to CVDs and strokes. The other parameters considered for the recommendations of physicians and healthcare experts for mental health are PSS (perceived stress score) and ESS (Epworth sleepiness score) that control mental illness. The values are measured for the participating subjects before participating in the walking activity and after the end of the walking schedule to see the impact on individuals. The overall mental and physical health of an individual contributes to the chances of occurrence of CVDs, mental illness, and strokes in individuals aged between 40 years and 55 years, as per the study presented in this paper. The results show that the PSS and ESS scores are improved after the walking activity. Eventually, it improved recovery from many kinds of mental illness and also reduced the chances of strokes. Similarly, the levels of the biomarkers that determine the chances of an individual having CVD or stroke also improved. Walking can impact our overall health in many ways, however, in this paper, the focus is given to ailments, such as strokes, CVDs, and mental illness. The results show that stress and improper sleepiness can impact mental health negatively. The research outcome is measured by adding walking in a routine life so that every individual can get rid of many physical and mental ailments. The results presented in the paper reveal that the 90-day walking program has created a good impact on the health of individuals by improving their physical and mental health.