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Is mental health linked to cardiovascular disease?

Mental health issues are a prevalent issue among the Indian population – and the situation only continues to grow. As with many other health problems, mental health crises have only been exacerbated by the COVID-19 pandemic and the resultant isolation due to lockdown measures, bereavement, and loss of earnings due to unemployment.

An elderly Indian man at the retirement home. Illustration of mental health conditions among senior citizens. Image credit: rawpixel / 123rf
The COVID-19 outbreak has led to an increase in mental health conditions being reported, with concern for vulnerable populations such as senior citizens. Image credit: rawpixel / 123rf

A question which ought to be posited is the link between one’s mental health and their physical health. One question which bears asking is: can mental health issues be linked to cardiovascular disease (CVD)? The answer, according to research, is yes. According to a paper titled “Mental health and cardiovascular disease” in the American Journal of Medicine, “the prevalence of depression in patients with cardiovascular disease is threefold higher than that in the general population. Depression is underdiagnosed in the medical setting.”

Such potential for mental health issues to cause cardiovascular issues is not a new phenomenon. Even the type of mental health issue can create different issues for the health of the heart, according to Dr Ameya Udyavar, consultant cardiologist and electrophysiologist in Mumbai’s Hinduja hospital, who said

“As cardiologists we classify mental stress into two categories, acute and chronic. Acute stress refers to sudden shocks as a result of personal tragedy, accidents, deaths, etc., and that can lead to heart attacks and ballooning of the heart wherein the heart dilates, pumping goes down and the heart muscles become weak. Chronic stress involves stress in everyday life which builds up over a period of time. This includes anxiety over unemployment, exams, project deadlines, traffic jams, fights at home, etc. and can lead to hypertension, high blood pressure and high cholesterol.” 

Heart disease in India has been growing in prevalence at a significant rate in recent decades. As Health Issues India reported in 2019, “over the last 25 years, India has seen a fifty percent rise in heart disease cases according to doctors at the Meenakshi Mission Hospital and Research Centre. Heart disease accounted for 28.1 percent of all deaths in India in 2016, making this statement far from implausible.”

Mental health conditions may be playing a role in this rapid rise in heart disease cases. Despite a large segment of the population affected by some manner of mental health condition, mental health services account for just 0.16 percent of the government budget for health. In addition, there is an acute shortage of psychiatric professionals in the country. Data indicates that there are 0.3 psychiatrists, 0.12 psychologists and 0.07 social workers for every 100,000 Indians. 

Mental health has been further impacted by the COVID-19 pandemic. The Indian Psychiatry Society (IPS) said that a study in 2020 showed a twenty percent rise in mental health disorder cases, affecting at least one in five Indians. 

The reasons for the exacerbation of mental health issues are myriad. The life threatening aspect of COVID-19 for both the individual and their family members is just the start of these issues. The social isolation caused by lockdown measures is in itself a risk factor for developing cardiovascular disease. Untold stress and upheaval was also caused to millions of day workers as lockdown measures effectively rendered individuals jobless, and in many cases homeless, overnight.

The link between the two conditions, and the key matters that increased this susceptibility across the pandemic, are the emergence of risk factors. “Mental health issues create a playground where cardiovascular disease [comes] in,”  says Gitanjali Narayanan, associate professor of clinical psychology at NIMHANS in Bengaluru. This happens by not taking medications on time, avoiding social contact and other such aspects which automatically lead a person to develop risk factors for CVDs.” 

Due to the inability to access mental health services in India, few Indians will adequately manage the symptoms of mental illness. As such, issues such as social isolation, poor dietary habits, lack of exercise and motivation, and chronic stress become major risk factors in the development of cardiovascular disease, as well as other conditions.

The fact that the recent study found a threefold higher rate of mental health issues in patients with cardiovascular disease underlines the link between these conditions. Given the high rate of mental health issues in India, it is far past the time to begin acknowledging, and treating these conditions as the considerable public health issue that they represent.

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