Home Heart Health News The head-heart connection: Mental health and heart disease - Harvard Health

The head-heart connection: Mental health and heart disease - Harvard Health

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Common mental health disorders are linked to a higher risk of heart attack and stroke. Learn to spot the warning signs.


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Heart disease and mental health issues are both common. So it's not surprising that these problems often occur together. But are people with depression or anxiety more prone to developing cardiovascular disease?

Teasing out the answer to that question has proved tricky. Some factors known to contribute to a higher risk of heart disease (for example, an unhealthy diet, lack of exercise, and smoking) are also common in people with mental health issues. Now, new research that adjusts for those potentially confounding factors suggests the answer is yes.

The study, in the September Circulation: Cardiovascular Quality and Outcomes, included more than 221,000 people ages 45 and older without any history of heart disease. They all filled out a short mental health questionnaire (see "Assess your distress"). After an average follow-up of more than four-and-a-half years, people who had reported high or very high levels of depression and anxiety were more likely to have had a heart attack or stroke than people without those symptoms.

Assess your distress

The Kessler psychological distress scale is a list of 10 questions used to identify people who need further assessment for anxiety or depression. People can select answers ranging from 1 to 5: 1 (none of the time); 2 (a little of the time); 3 (some of the time); 4 (most of the time); 5 (all of the time).

During the past four weeks, about how often did you feel

___ depressed?

___ nervous?

___ so nervous that nothing could calm you down?

___ restless or fidgety?

___ so restless that you could not sit still?

___ tired out for no good reason?

___ that everything was an effort?

___ so sad that nothing could cheer you up?

___ hopeless?

___ worthless?

Scoring: 15 or lower = low; 16–21= moderate; 22–29 = high; 30–50 = very high

A shared underlying cause?

These findings do not necessarily mean that psychological distress causes heart disease. Instead, both may arise (at least in part) from the same underlying mechanisms, says Dr. Jill Goldstein, a professor of psychiatry and medicine at Harvard Medical School and Executive Director of the Women, Heart and Brain Global Initiative at Massachusetts General Hospital.

"We have found shared causes for both illnesses that begin even before birth that are carried throughout life," she says. If a pregnant woman has abnormal levels of stress hormones and other substances triggered by an immune or inflammatory response, that may affect her fetus. More specifically, those substances seem to alter specific brain regions that regulate both mood and cardiac function. The effects differ depending on the sex of the fetus as well as the timing of the exposure to these maternal factors, she adds.

"Mental health disorders and cardiovascular problems might not just co-occur in adulthood. Instead, people may be vulnerable to both conditions over a lifetime because of their early exposures," Dr. Goldstein says.

Major depression is about twice as common in women than men. This chronic disease frequently first appears just after puberty, although it can develop at any age. Sometimes, major life events — such as the loss of a job, a spouse's illness, or even a heart attack — can unmask depression, says Dr. Goldstein. Anxiety disorders, which are also more common in women, often co-occur with depression. However, she's careful to point out that screening tests for depression and anxiety (such as the psychological distress scale) are not used to diagnose major depression or anxiety disorder, which is done by a clinician. Still, your score could help you recognize a potential problem.

What you can do

If you score high on the distress level test — or just feel depressed or anxious — don't hesitate to seek help. Ask your primary care provider to recommend a mental health professional who can offer therapy (and possibly medication).

Having depression can sap your motivation and energy, sometimes so much that suggestions to exercise can sound like a cruel joke. However, being physically active — even just a little — can make a difference, says Dr. Goldstein. "Exercise is really good for your brain; in fact, there's evidence that it may increase nerve growth factors in ways that improve mood, sleep, responses to stress, and memory function." And moving more is obviously good for your cardiovascular system as well, she adds.

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