Where mental and physical health meet
Our understanding of the importance of mental health has improved dramatically, and this is definitely a good thing. But physical health matters too, and the two are inextricably linked...
For individuals with a mental health condition, seeking support can be challenge in itself. But hopefully, when they do, these days it is likely that the systems to provide the help that they need will be in place. But, what's also really important is that, while we recognise mental health as its own separate issue, we must remember that mental wellbeing is also bound up with physical health, and forgetting this can be dangerous.
The United Kingdom’s ageing population is clearly placing challenges on the NHS. With increased life expectancy comes increased risk of developing chronic disease, such as cancer and heart disease. Physical symptoms of illnesses like these often represent only part of a patient’s battle, and the psychological impacts can be equally severe. For example, depression has been reported in a significant proportion of individuals with varying types of cancer, and the stigma and uncertainty that still unfortunately surrounds a formal mental health diagnosis means there are likely to be cases that go undiagnosed. This may well worsen if patients lack strong support networks. As the elderly frequently experience loneliness, they are particularly vulnerable, and restoration of physical health can often represent only part of the healing process.
But can the opposite also occur? Can certain mental health conditions end up impacting a patient’s physical health? For some psychiatric diagnoses, the physical dangers are well documented, such as risks of amenorrhoea (loss of menstrual periods) and osteoporosis (thinning bones) later in life following suffering from a restrictive eating disorder. When we recognise the risks, we can do something about them; anorexia patients can be prescribed medication to restore bone density, for example. But gaps in our knowledge, and people with undiagnosed mental health disorders, mean that this is not always the case.
In the last few decades, experimental and clinical data has been gathered to show that the immune system can show impaired function in individuals with depression. There are lots of possible explanations for this. It may reflect another underlying factor such as stress, which can both precipitate depression and compromise immunity. If this is the case, we can see that the same factors can influence mental and physical health. Alternatively, this association may be to do with interactions between molecules called cytokines, involved in our immune responses, and the transmitters that help to regulate mood. In the current COVID-19 pandemic, mental health in countries all around the globe has suffered – but what is equally concerning is the possibility that those who were already struggling with their mental health before the pandemic may be at risk of suffering poorer outcomes if they are infected, due to possible weaker immunity.
Another example of how closely linked mental and physical health can be arises when we look at the cardiovascular system – specifically, at high blood pressure or hypertension. Hypertension is one of the most common diseases globally. It can lead to serious complications in the heart, circulatory system and kidneys, which can severely compromise an individual’s quality of life. Whilst the causes are complex, there has been recent evidence to suggest that anxiety may be a significant risk factor. This is understandable – anxiety is a state of stress, and in these situations, the human body tries to maximise cardiac output to increase blood supply to organs such as our muscles. The negative effects of this can include high blood pressure. Given the prevalence of anxiety (especially in young adults), with many cases likely going undiagnosed, there is cause for concern that poor mental health induced by current stresses could lead to severely damaging physical disease in the long term. Supporting individuals suffering with their mental health is not only important for their current wellbeing but may also safeguard the health of our population in the future.
Every person’s health is specific and unique to them. Reactions to both a disease and its treatment vary hugely from individual to individual. Assuming that resolution of someone’s initial physical symptoms will magically see them ‘cured’ can be dangerous and on the other hand, we are learning more and more about just how diverse the effects of mental illness can be. To try to stay healthy, we ultimately need to prioritise both our mental and physical wellbeing.