Physical and Mental Health: The Link

There is a bidirectional relationship between mental and physical illnesses. This means that:

• Physical illness can both cause and exacerbate mental illness
• Mental illness can both cause and exacerbate physical illness

Example Illnesses:

Mental Illnesses that increase risk of physical illness:

• Schizophrenia: A diagnosis of schizophrenia significantly increases the risk of premature mortality, with men dying 20 years earlier and women dying 15 years earlier compared to the general population[1]. This is often due to commonly comorbid physical illnesses such as diabetes, obesity, and hypertension[2][3][4].
• Bipolar Disorder: As with schizophrenia, a bipolar diagnosis increases the risk of obesity, diabetes, and metabolic syndrome[5][6]. This relationship between bipolar disorder and cardiovascular disease appears to be bi-directional, where individuals with bipolar disorder often display poor choices in terms of healthy living- with low rates of exercise, high calorie diets and subsequent increased risk of type II diabetes and obesity. However, there is also evidence that specific cardiometabolic conditions (such as obesity) heighten risk of depressive disorders and are associated with longer and more severe episodes of mood disorder and shorter periods of symptom remission[7].The life expectancy for those with bipolar is reduced by approximately ten years for men and eleven years for women[8].

Physical Illnesses that increase risk of mental illness:

• Diabetes: People living with diabetes are more likely to have an anxiety disorder. In addition, they are 2-3 times more likely to have depression than the general population[9]. Comorbid diabetes and depression have been shown to impact on blood sugar control, rates of diabetic complications, medication adherence rates and mortality[10].
• HIV/AIDS: HIV is a global health problem and is estimated to affect approximately 33.2 million people. Self-stigmatisation and depression are common co-morbid difficulties that may occur after a diagnosis of HIV. A recent systematic review found rates of depression in those with HIV to be 22% for people living in Europe[11]. Depressive symptoms in patients living with HIV have been related to more rapid decline in CD4 cells and faster HIV viral load increase, progression to AIDS and increased mortality[12]. Depression is also associated with non-adherence to antiretroviral medication, which again can impact on long-term outcomes[13]

The Repercussions for Services:

Integrating Mental and Physical Care

Research has found that the increased risk of physical illness and mortality for those with mental illness is often due to inequalities in treatment access and standard of care[14]. To reduce these inequalities, minimise the risk of premature morbidity and tackle the causality between certain mental and physical illnesses, research suggests that mental and physical care should be integrated. Doing this can help create a more holistic approach and provide early intervention before health deteriorates.

Key steps in this process are:

• Screening for comorbid mental and physical illness in primary care
• Ensuring those with longstanding physical illnesses are looked after mentally
• People with serious mental illnesses should attend an annual physical health check, either in primary or community care.
• Encourage healthier lifestyles in those with a diagnosed illness, to improve physical and mental health and reduce vulnerability to comorbid illnesses

References

[1] Laursen, T. M., Wahlbeck, K., H?llgren, J., Westman, J., ?sby, U., Alinaghizadeh, H., Gissler, M., & Nordentoft, M. (2013). Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries.?PloS one,?8(6), e67133. https://doi.org/10.1371/journal.pone.0067133

[2] Suvisaari, J., Kein?nen, J., Eskelinen, S., & Mantere, O. (2016). Diabetes and schizophrenia.?Current Diabetes Reports,?16(2), 1-10.

[3] Manu, P., Dima, L., Shulman, M., Vancampfort, D., De Hert, M., & Correll, C. U. (2015). Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management.?Acta Psychiatrica Scandinavica,?132(2), 97-108.

[4] Liao, C. H., Chang, C. S., Wei, W. C., Chang, S. N., Liao, C. C., Lane, H. Y., & Sung, F. C. (2011). Schizophrenia patients at higher risk of diabetes, hypertension and hyperlipidemia: a population-based study.?Schizophrenia research,?126(1-3), 110-116.

[5] Fagiolini, A., Chengappa, K. N., Soreca, I., & Chang, J. (2008). Bipolar disorder and the metabolic syndrome.?CNS drugs,?22(8), 655-669.

[6] McElroy, S. L., & Keck, P. E. (2012). Obesity in bipolar disorder: an overview.?Current psychiatry reports,?14(6), 650-658.

[7] McElroy, S. L., & Keck, P. E. (2012). Obesity in bipolar disorder: an overview.?Current psychiatry reports,?14(6), 650-658.

[8] Chang, C. K., Hayes, R. D., Perera, G., Broadbent, M. T., Fernandes, A. C., Lee, W. E., Hotopf, M., & Stewart, R. (2011). Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London.?PloS one,?6(5), e19590. https://doi.org/10.1371/journal.pone.0019590

[9] Roy, T., & Lloyd, C. E. (2012). Epidemiology of depression and diabetes: a systematic review.?Journal of affective disorders,?142, S8-S21.

[10] Smith, K. J., Béland, M., Clyde, M., Gariépy, G., Pagé, V., Badawi, G., ... & Schmitz, N. (2013). Association of diabetes with anxiety: a systematic review and meta-analysis.?Journal of psychosomatic research,?74(2), 89-99.

[11] Rezaei, S., Ahmadi, S., Rahmati, J., Hosseinifard, H., Dehnad, A., Aryankhesal, A., ... & Ghashghaee, A. (2019). Global prevalence of depression in HIV/AIDS: a systematic review and meta-analysis.?BMJ supportive & palliative care,?9(4), 404-412.

[12] Arseniou, S., Arvaniti, A., & Samakouri, M. (2014). HIV infection and depression.?Psychiatry and clinical neurosciences,?68(2), 96-109.

[13] Gonzalez, J. S., Batchelder, A. W., Psaros, C., & Safren, S. A. (2011). Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis.?Journal of acquired immune deficiency syndromes (1999),?58(2).

[14] Druss, B. G., Bradford, W. D., Rosenheck, R. A., Radford, M. J., & Krumholz, H. M. (2001). Quality of medical care and excess mortality in older patients with mental disorders.?Archives of general psychiatry,?58(6), 565–572. https://doi.org/10.1001/archpsyc.58.6.565