Too often mental health problems are dismissed as being “all in your head”. With scientific and medical advancements showing mental illness can cause physical changes to the body, we now know the devastating impact mental health has on physical health.

One system that is greatly affected by mental health is the cardiovascular system. Unfortunately, not only is there a link between mental illness and cardiovascular disease, it’s a connection that runs both ways.

Mental Health is Heart Health

People with severe mental illness – conditions like bipolar disorder, schizophrenia, or depression – have a life expectancy that is 15-25 years less than average. While suicide and accidents are believed by many to be the most common causes of death for people with mental illness, cardiovascular disease is actually the leading cause. In fact, cardiovascular mortality for people with mental illness is twice the rate of the general population. Despite the high and growing rate of cardiovascular disease in people with severe mental illness, only 25% are diagnosed with a cardiovascular condition, leaving many untreated and at risk.

People with severe mental illness are more likely to smoke and live a sedentary life, behaviours which likely contribute to higher rates of cardiovascular disease. Mental health medications with side effects including increased risks of obesity, insulin resistance, and cardiac arrhythmias also help to drive up the rate of cardiovascular disease.

But, physical changes associated with mental health conditions can directly damage the heart and blood vessels, a fact that is not widely known. Hormonal and nervous system changes associated with anxiety and depression can trigger irregular heart rhythms called “arrhythmias”, promote blood clot formation, and even cause heart attacks. Depression, schizophrenia, Post Traumatic Stress Disorder (PTSD), and anxiety can alter the immune system and create a state of hyperinflammation, damaging blood vessels and the heart, and promoting cardiovascular disease. In short, the physical consequences of mental illness can cause damage to the cardiovascular system that is potentially fatal.

An Informal Risk is Still a Risk

Mental health reaches beyond diagnosed medical conditions and includes a number of psychological stressors, such as financial problems or socioeconomic status; chronic adversity associated with work or personal conflicts; and dealing with illness or death of a family member or friend. These psychological stressors trigger physical responses in the body that accelerate biological aging and increase the risk of many health conditions, from obesity to diabetes and cardiovascular disease.

Heart Health Drives Mental Health

The link between heart health and mental health is not one-way. People with cardiovascular disease are at greater risk of developing mental health issues.

Up to half of sudden cardiac arrest survivors experience long-term depression and anxiety, and one-third develop PTSD. Heart attacks are associated with a higher risk of anxiety and depression, which in turn increase the risk of dying from another cardiac event. In fact, heart attack survivors who develop PTSD have twice the risk the dying from another heart attack within 3 years, compared to survivors with no mental health issues.

Studies show that cardiac rehabilitation and independent exercise programs are effective at improving physical and mental health. Unfortunately, cardiac patients who suffer from anxiety and PTSD are less likely to participate in regular exercise following their event and are less likely to complete cardiac rehabilitation. The negative effects of mental illness on physical activity confound recovery from cardiovascular disease and increase the risk of complications and death.

A Tailored Fix

Despite the known link between mental health and cardiovascular disease, people with serious mental illness are less likely to be assessed for cardiovascular risk factors and are less likely to be given treatment that follows guidelines. Even when treatments are available many studies show that people with mental health conditions are less likely to follow treatment protocols, and that interventions designed to lower the risk of cardiovascular disease in the general population are not effective when applied to people with mental illness.

The complex interactions between mental illness and cardiovascular disease requires a novel approach that breaks down the silos of medicine.

Facilitating access to care and providing evidence-based treatments are two critical steps necessary to reduce the risk of cardiovascular disease in people with mental illness. Among the recommendations to meet these objectives is widening the circle of care for patients to create a more coordinated and supportive environment. A multidisciplinary team of healthcare professionals would help to ensure that the full spectrum of health concerns is considered and that treatment plans are simplified to help patients follow recommendations. Inclusion of the patient and their support group in decision making helps to improve adherence to treatment plans and gives patients a sense of value. Research also suggests that programs designed to reduce cardiovascular disease risk for people with serious mental illness should be high-intensity and that some behavioural interventions are most effective when delivered alongside pharmacological treatments.

Mental Health By the Numbers

Mental illness is a growing health concern. Approximately 1 in 5 adults experience mental illness every year. A similar number of youth are affected by mental illness and rates of hospitalization for mental health issues in young people grew by ~60% between 2008 and 2018. Despite the high and growing rates of mental illness, a majority of people with mental health conditions do not receive appropriate care.

The interactions between cardiovascular disease and mental illness create a perfect storm for a medical crisis. Acknowledging, understanding, and tackling the threat to global health presented by these growing challenges is critical to avert a healthcare disaster.