Healthy Minds, Healthy Hearts

Mental ill health is a global problem. In 2017, nearly 800 million people were living with a mental health disorder¹, and almost one in three people are affected at some point in their lifetime.² In comparison, Singapore sees a slightly smaller proportion of people affected by a mental health condition in their lifetime, with around one in seven people. However, its prevalence is increasing.³ The restrictions and lockdowns caused by the COVID-19 pandemic have also worsened the situation.² What is worrying is that more than 75% of people with mental health problems do not seek help and miss vital help and support.³

Being healthy is more than just having no physical disease or infirmity; you also need good social and mental well-being.⁴ Most people know what the main risk factors are for cardiovascular disease (CVD), but not everyone is aware that poor mental health can also affect your heart too. In fact, it works two ways.

The Head-Heart Connection

Several studies have found that mental health conditions such as anxiety and depression are prevalent in persons with CVD.^5,6 In the US, one in five patients admitted for an acute cardiac event met the diagnostic criteria for major depression and more than half exhibited significant levels of depressive symptoms.⁷ Locally, a study showed that 1 in 8 patients with Coronary Heart Disease (CHD) experienced higher levels of anxiety and 1 in 10 patients with CHD had higher levels of depression.⁸

Mental health conditions can develop after an acute cardiac event and often stem from fear (e.g. of dying or recurring pain), vulnerability, sadness, hopelessness, and a sense of loss of control over one’s health and well-being.⁹ This can impact the heart patient’s quality of life and can even cause Post Traumatic Stress Disorder (PTSD).¹⁰

Those who struggle with their mental health are also more likely to have CVD¹¹. When a person experiences anxiety, stress, depression and/or PTSD, it causes physical changes to the body, such as increased heart rate or blood pressure. If the mental health condition persists over a period, these changes to the body can increase the risk of heart disease.^{12, 13}

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 CVD. They are more likely to smoke tobacco, have sedentary lifestyles and may adopt a diet high in sugar and fats.¹⁴

Symptoms of Mental Ill Health

We all experience difficult or challenging times in our lives, so it is normal at times to feel down, worried or anxious. If these feelings do not go away, then it may be a mental health condition that could benefit from support and treatment. How can you recognise the symptoms, either in yourself or in others? The symptoms include:

• Low mood (feeling sad or empty)
• Loss of interest in things you used to enjoy
• Reduced concentration (or difficulty concentrating)
• Feelings of hopelessness/helplessness/worthlessness
• Changes to your sleep pattern (not being able to sleep or sleeping too much)
• Feeling anxious or worried all of the time
• Feeling fatigued
• Having severe panic or intense fear
• Suicidal thoughts

Seek Help

If you experience these symptoms for a prolonged period, do not ignore them but instead seek help and support not only from family and friends but also healthcare professionals. If you can, speak with your family or friends and share how you feel. Helping them understand how you are feeling means you do not have to avoid the issue, and they may be able to support you.

If you observe the symptoms in others, there are very practical ways to show them you care. For example, let them know that if they want to talk about it, they can. Try not to be judgemental and listen as the person may know what would help them. For some, your presence, a listening ear and perhaps even a hug is all that is needed.

Do not be tempted to use flippant comments such as ‘cheer up’ or ‘pull yourself together’ as these do not work and may worsen the situation. Others may need the help and support of a healthcare professional.

Ways of Treatment

If people are not able to manage their mental health problems themselves or with the help of loved ones, they should contact their family doctor or cardiac rehabilitation specialist.¹⁵

The healthcare professional will conduct an assessment to determine how the person’s mental health is affected.¹⁶ This may include a screening questionnaire where the person answers a series of questions that can help to guide the healthcare professional to make a diagnosis.

It can be difficult to figure out the actual cause of some symptoms, for example, lethargy, as this can be caused by the heart condition itself. In some cases, the medication a person has been prescribed could cause a symptom of the mental health condition. A one-off assessment may not be enough in these cases, and the healthcare professional may need to have several consultations until a diagnosis can be reached.

There are several ways in which mental health conditions can be treated.

• For a healthy mind as well as a healthy heart, exercise regularly. Exercise causes the release of endorphins, or ‘feel good hormones’ as they are often known, making a person feel happier and blocking feelings of pain.¹⁷ If possible, people should engage in things that make them happy and avoid or lessen the things that may be causing anxiety.
• Avoid taking on too much and break tasks into smaller, more manageable chunks. Completing the small pieces will give a sense of achievement.
• Having a mental health condition may also cause people to turn to unhealthy coping mechanisms such as bingeing on junk food, alcohol or smoking cigarettes. Try to avoid these things and slowly return to more healthy behaviours.
• Meditation, yoga or Tai Chi may also be helpful in relaxation and coping with the stresses of everyday life.¹⁷

Some people with certain mental health conditions may benefit from a form of psychological therapy (talking therapy). This will involve seeing a therapist to discuss the cause of the mental health problem and find ways to manage or cope with this. Others may need medication, for example, antidepressant medication, but this will be guided by the healthcare professional.

Mental health conditions are very common, but much can be done to treat and support people. The important factor is that the person experiencing symptoms related to a mental health problem should not feel alone and seek help and support early. Everyone should remember ‘it’s okay not to be okay!’.

Where to Get Help

• Your family doctor
• Cardiac rehabilitation team
• Institute of Mental Health
• Singapore Association for Mental Health
• Silver Ribbon Singapore
• Care Corner Counselling Centre

Article is contributed by Prof Susan Dawkes, Former President, British Association for Cardiovascular Prevention and Rehabilitation (BACPR) and Head of School, School of Nursing, Midwifery and Paramedic Practice and a Professor of Nursing and Cardiovascular Health at Robert Gordon University, Scotland. She was also a keynote speaker at the Singapore Prevention and Cardiac Rehabilitation Symposium 2021, organised by the Singapore Heart Foundation.

References:

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