Supporting Mental Health in People with Cardiovascular Disease

Having good health is not just about the absence of physical disease or infirmity-but also the necessity to have good social and mental wellbeing (World Health Organization, 1948).Sadly, mental ill health is a global problem affecting many people, including a significant number with cardiovascular disease.In 2017, nearly 800 million people were living with a mental health disorder and, proportionately, it affects slightly more females than males (11.9% vs 9.3%) (Dattani et al, 2021).Almost one in three people are affected by a mental health condition at some point in their lifetime (Nochaiwong et al, 2021).This places a huge burden on those it affects; one in five people are living with a disability caused by the mental ill health (Dattani et al, 2021).There is growing evidence that mental health conditions are closely linked with cardiovascular disease.This is multifaceted.Firstly, there is already substantial evidence that people who have a cardiac event (e.g.myocardial infarction, coronary intervention) have a higher incidence of anxiety and depression afterwards when compared with the wider population (Jha et al, 2019).Also, those with atrial fibrillation and heart failure have somewhere between a two-and fivefold increased risk of suffering anxiety and depression (Dregan et al, 2020).These mental health conditions can develop after an acute event and often stem from feelings such as fear (e.g. of dying, of recurring pain), vulnerability, sadness, hopelessness and a sense of losing control over one's health and wellbeing.Experiencing depression or anxiety after a cardiac event increases patients' risk of having a subsequent event or even of premature death (Murphy et al, 2020).Indeed, there is a risk that patients can develop post-traumatic stress disorder (PTSD) following an acute cardiac event and this not only has an impact upon a person's quality of life by causing significant suffering, it also affects morbidity and mortality (Jacquet-Smailovic et al, 2021).It is essential then to ensure early identif ci ation and treatment are available.Another way that cardiovascular disease and mental health conditions are connected is that when people experience anxiety, stress, depression and/or PTSD, it causes particular physiological changes in the body (e.g. increase in heart rate/blood pressure, a reduction in coronary blood flow and an increase in cortisol).If a person experiences a mental health condition over a period of time, the physiological features can increase the risk of heart and metabolic disease (Bremner et al, 2018;Jacob et al, 2018).Again, early identification and intervention, if required, are beneficial to lessening risk.Additionally, it is known that those who are affected by a mental health condition are more likely to adopt lifestyle behaviours that increase their risk of developing cardiovascular disease.For instance, they are more likely to smoke tobacco, not take the recommended amount of exercise or physical activity, and they may adopt a diet high in sugar and fats (Abed et al, 2014).With all of this in mind, it seems that the connection between mental health and cardiovascular disease is signif ci ant.Worryingly, the COVID-19 pandemic has increased the prevalence of mental health disorders even further.Currently, in the general population, 28% of people now have depression, 27% have anxiety, 37% are experiencing stress and 50%, psychological distress (Nochaiwong et al, 2021).The prevalence differs across the world and seems to relate to the restrictions imposed to reduce the spread of the virus and the associated consequences of these (e.g.unemployment, loneliness, social isolation) (Bucciarelli et al, 2022).Data for those with established cardiovascular disease are less clear with regards to whether the prevalence of mental health disorders has also increased in this population during the pandemic.Unfortunately, COVID-19, cardiovascular disease and mental health conditions seem to deleteriously affect each other and this increases patients' risk of worsening health (Bucciarelli et al, 2022).Providing adequate and effective support and treatment for anyone affected by a mental health issue is a huge concern for healthcare providers.Worryingly, more than 75% of people with a mental health problem do not seek help for it and are therefore missing out on vital support and treatment (Subramanian et al, 2019). How can we recognise mental health conditions?People naturally experience challenges in their lives and it is normal at times for anyone to feel down, worried or anxious.However, if these feelings do not go away, it may be a mental health condition that could benefit from support and treatment.It is essential to recognise and identify the symptoms associated with mental health conditions to allow early diagnosis and intervention where required.Symptoms include: