Download Mental Health and Diabetes, Stroke and Heart Disease

Mental Health
and
Diabetes, Stroke and Heart Disease
Deborah Nelson, Psy.D.
September 2013
Mental and Physical Health are
Intricately Intertwined
“Treat the Mind and Help the Heart”
“Studies Try to Tease Apart the Links Between Depression and Heart Disease”
“Blood Shortage in Heart Linked to Mental Stress”
“Defective Warning System Tied to “Silent” Heart Disease”
“The Heavy Cost Of Chronic Stress”
“Chance of Heart Attack Increases For Those Who Suffer Depression”
“Prognosis: Diabetes and Depression Track Each Other”
“Which Comes First: Depression or Heart Disease?”
“Of Hearts, Minds and Menopause”
“Serious Depression Raises Risk of Heart Ailments”
“For Some, Psychiatric Trouble May Start in Thyroid”
“Risk of Adult Anxiety Seen in Children’s Stomachaches”
“Can Strep Bring On an Anxiety Disorder?”
“Depression and Anxiety Seen as Cause of Much Addiction”
“People Haunted by Anxiety Appear to Be Short on a Gene”
“Allergies Can Increase the Risk of Depression”
“Depression Raises Stroke Risk in Younger Women”
“Does Depression Contribute to Dementia?”
“Depression May Raise Risk of Gut Infection”
“Exploring the Links Between Depression and Weight Gain”
“Dealing With Depression and the Perils of Pregnancy”
Mental and Physical Health are
Intricately Intertwined
“Inflammation Byproduct Linked to Stress”
“Facing Up to Depression After a Bypass”
“In Sleepless Nights, a Hope for Treating Depression”
“Pregnancy, Depression and Acupuncture”
“Concussions Tied to Depression in Ex-N.F.L. Players”
“After Cancer, Ambushed by Depression”
“Personal Health; Helping the depression-prone to quit smoking”
“Depression May Slow Exercise Recovery”
“Depression Is a Dilemma for Women in Pregnancy”
“Mild Depression and Eroding Immunity”
“Lack of Exercise Explains Depression-Heart Link”
“Gene Link Seen in Drug Abuse and Depression”
“Linking Anxiety, Depression and Strokes”
“Coping With Depression During Pregnancy”
“Probing depression and its ties to diabetes - Health & Science - International Herald Tribune”
“Which Comes First: Depression or Heart Disease?”
“Aging: Depression Tied to Alzheimer’s”
“Virus May Be Linked to Depression”
“Can Migraines Cause Mood Swings?”
“Remedy for Sleep Apnea May Lift Depression's Veil”
“Tracking Stress and Depression Back to the Womb”
“Depression More Deadly for Diabetics”
Anxiety and Depression
Anxiety
• Stress: Level and quality of challenge when
weighed against our ability to manage
• Stress can come from any event or thought
that makes you feel frustrated, angry, or
nervous.
• Chronic stress is one of the major causes of
anxiety
• Anxiety is a feeling of fear, unease, and worry
and you may not know the source of this fear
Anxiety Symptoms
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Racing heart
Trouble sleeping
Digestive problems
Sense of impending danger/doom
Sweating, trembling
Prevalence of Anxiety
nimh
Depression
• Depression is not sadness or grief
– Sadness and grief are normal, transitory feelings
• Depression is an illness for which sadness may
be one symptom among many others.
• Depression is more of a constant experience
that reacts less to what goes on and affects
function.
Depression Symptoms
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Low or irritable mood most of the time
A loss of pleasure in usual activities
Trouble sleeping or sleeping too much
Significant change in appetite, often with weight gain or
loss
Tiredness and lack of energy
Feelings of worthlessness, self-hate, and guilt
Difficulty concentrating
Lack of activity and avoiding usual activities
Feeling hopeless or helpless
Repeated thoughts of death or suicide, and low self-esteem
Prevalence of Depression
http://www.cdc.gov/nchs/da
ta/databriefs/db07.pdf
Co-Morbidity of
Depression and Anxiety
• More than 50% of primary care patients who present with anxiety
or depression also suffer from a secondary depressive or anxiety
disorder (Hirschfeld, 2001)
• According to the National Comorbidity Survey, 51% of those with
major depression also suffer from lifetime anxiety
• Individuals with a high level of work-related stress are more than
twice as likely to experience a major depressive episode, compared
with people who are under less stress.
• Depression shares some of the symptoms of stress, including
changes in appetite, sleep patterns, and concentration
• Research shows that worry precedes the onset of depression – you
can literally worry yourself into a depression. (The Worry Cure)
The Body’s Reaction to Stress
Links between Anxiety, Depression and
Heart Disease
• In one 2013 study, for middle- aged women, new onset of heart disease is
associated with a history of comorbid depression and anxiety. (BereckiGisolf, J et al 2013)
• There is growing evidence that depression, anxiety, social isolation, anger,
mental stress, are risk factors for cardiovascular morbidity, mortality, or
both, in patients with established CHD (e.g., Ahern et al., 1990; Berkman,
Leo–Summer, & Horwitz, 1992; Carney, Freedland, & Jaffe, 2001; Carney et
al., 1988; Frasure–Smith, Lespérance, & Talajic, 1993, 1995; Penninx et al.,
2001). (as quoted in Day, Freedland & Carney, 2005)
• Cardiac patients who are anxious or depressed are more likely to attribute
their heart disease, to negative emotions such as stress, anger, fear,
anxiety, or depression, than are their less anxious or depressed
counterparts. Anxiety is an independent correlate of heart disease
attributions after adjusting for the effects of gender and age. (Day,
Freedland, & Carney, 2005).
Links between Anxiety, Depression and
Stroke
• In some people, prolonged or frequent mental stress causes an
exaggerated increase in blood pressure, a risk factor for stroke.
• Some studies have shown that depression increases the risk of first stroke
and recurrent stroke by 45% to 80% (Wassertheil, Shumaker, Ockene,
Talaver, Greenland, 2004 in Yuan 2012)
• Being depressed nearly doubled the risk for stroke, even after the
researchers accounted for other risk factors like age, education, high blood
pressure, diabetes, heart disease, smoking, alcohol intake, physical activity
and body mass index.
Links Between Anxiety and Depression
and Diabetes
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A prospective population-based study (N=37,291) investigating the
associations between symptoms of depression/anxiety and diabetes was
conducted. Individuals reporting symptoms of depression and anxiety at
baseline had increased risk of onset of type 2 diabetes at 10-year follow-up.
(Engum, 2007)
Emotional stress can increase the risk for the development of type 2 diabetes
through different pathways.
– The first pathway is via behavioral mechanisms. Emotional stress was
found to be associated with unhealthy lifestyle behaviors, (Bonnet et al.,
2005; Rod et al., 2009).
– The second pathway is via physiological mechanisms. Chronic stress
reactions and depression are often characterized by long term activation
of the hypothalamic-pituitary-adrenal axis and sympathetic nervous
system which were found to be associated with the development of
abdominal obesity, and this may explain why depression or chronic stress
increases the risk of diabetes (Bjorntorp, 2001; Vogelzangs et al., 2008)
But what if you already have diabetes,
heart disease or have had a stroke?
Mental Health and Diabetes
– Rates of depression among individuals with diabetes
are estimated to be approximately two to four times
that of adults without diabetes [2,3].
– Depression is associated with poorer adherence to
treatment regimens, greater symptom burden, poorer
glyceamic control, more diabetes-related
complications, exacerbations of health problems
relating to diabetes, higher hospitalization rates and
higher mortality (Poulsen & Pachana, 2010)
– Aggressive treatment of depression can prolong the
lives of diabetic patients. (NY Times,
http://well.blogs.nytimes.com/2007/12/05/depressio
n-more-deadly-for-diabetics/)
Mental Health and Stroke
– Post stroke depression is associated with a higher risk of recurrent
stroke at 1 year. (Yuan et al, 2012)
– Post stroke depression is the most common psychological disorder
among stroke survivors (Hacakett, Yapa, Parag, Anderson 2005 in Yuan
et al, 2012)
– 37% of older stroke survivors reported depressive symptoms
(Klinedinst, Clark, 2013)
– Middle-aged men who suffer from psychological problems like
depression and anxiety are much more likely to die of strokes than
men who do not, a study reports. But they are no more likely to suffer
nonfatal strokes . (NY Times,
http://www.nytimes.com/2002/01/29/health/vital-signs-at-risklinking-anxiety-depression-and-strokes.html)
– Neurocognitive changes can include personality changes, mood
changes/fluctuations, increased anxiety and depression re: changes
Mental Health and Heart Disease
•People with heart disease are more likely to suffer from depression
than otherwise healthy people. Angina and heart attacks are closely
linked with depression.
•Up to 15 percent of patients with cardiovascular disease and up to 20
percent of patients who have undergone coronary artery bypass graft
1
(CABG)
surgery
experience
major
depression.
(http://my.clevelandclinic.org/heart/prevention/stress/depressionandheart.aspx)
• For people with heart disease, depression can increase the risk of
an adverse cardiac event such as a heart attack or blood clots and
increase the risk of death
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During recovery from cardiac surgery, depression can intensify
pain, worsen fatigue and sluggishness, or cause a person to withdraw
into social isolation.
Depression versus Disease Symptoms
• Many symptoms of diabetes, heart disease
and stroke overlap with symptoms of
depression
• Look at cognitive symptoms of depression:
anxious rumination and worry, thoughts of
guillt and regret, feeling like a burden, feeling
worthless, sadness, subjective distress,
tearfulness, suicidal thougths,
What we can do
Knowledge is Power
Knowledge + Action = Power
Anxiety and Depression
Impact on Health
Anxious and depressed moods
lead to poor health behaviors
Decrease in health
increases anxious and
depressive experiences
Poor health
behaviors lead to
physiological
changes over time
Anxiety and Depression’s
Impact on Health
Poor Diet
Lack of exercise
Depression
Anxiety
Decreased Socialization
Poor Health Habits (e.g.
smoking, alcohol consumption)
THOUGHTS
PHYSICAL
HEALTH
EMOTIONS
BEHAVIORS
What We Can Do - Behaviors
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Exercise
Diet
Socialization
Work / hobbies
Create structure in day
Practice deep breathing
Mindfulness
See a mental health care provider
Maintain regular check ups with your primary
care practitioner
What we can do - Thoughts
• Ruminative thoughts
– Notice
– Accept
– Let go
– Work to understand triggers
– Work to understand how connected to behaviors and
feelings and physical sensations
What we can do - Feelings
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Awareness of / Acknowledge
Accept / be gentle
Learn triggers for feelings
Work to understand how connected to
behaviors and thoughts and physical
sensations
• Share with someone you trust
What we can do - Physical
– Know your body
– Be aware of changes
– Become aware of triggers
– Become aware of connections to thoughts,
feelings and behaviors
Questions?
Know Thyself
And
Live Well
Deborah Nelson, Psy.D. 2013
References
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Scherrer, J.F., Xian, H., Lustman, P.J., Franz, C.E., McCaffery, J., Lyons, M.J.,
Jacobson, K.C., Kremen, W.S. (2011). A test for common genetic and environmental
vulnerability to depression and diabetes. Twin Research and Human Genetics, 14,
2, 169-172.
Poulsen, K. & Pachana, N.A. (2010). Depression and anxiety in older and middleaged adults with diabetes. Australian Psychologist, 47, 90-97.
Yuan, H.W., Wang, C.X., Zhang, N., Bai, Y., Shi, Y.Z., Zhou, Y., Wang, Y.L., Zhang, T.,
Zhou, J., Yu, X., Sun, X.Y., Liu, Z.R., Zhao, X.Q., Wang, Y.,J. (2012). Poststroke
depression and risk of recurrent stroke at 1 year in a Chinese Cohort Study. Plos
One, 7(10), 1-7.
McDade-Montez, E.A. (2011). Examining the potential influence of diabetes and
anxiety symptoms via multiple sample confirmatory factor analysis. Annals of
Behavioral Medicine, 42, 341-351.
Klinedinst, N.J. & Clark, P.C. (20130). Adult stroke survivors discussing poststroke
depressive symptoms with a healthcare provider: a preliminary analysis.
Rehabilitation Psychology. Advance online publication. Doi: 10.1037/a0033005.
References
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Mezuk, B., Lee, H., Abdou, C.M., Johnson-Lawrence, V., Rafferty, J.A., Uzogara, E.E., Jackson, J.S.
(2013). Ignorance Bliss? Depression, antidepressants, and the diagnosis of prediabetes and Type 2
diabetes. Health Psychology, 32(3), 254-263
Engum, A. (2007) The role of depression and anxiety in onset of diabetes in a large populationbased study. Journal of Psychosomatic Research, 62(1), 31-39.
Berecki-Gisolf, J., McKenzie, S.J., Dobson, A.J., McFarlane, A., McLaughlin, D. (2013). A history of
comorbid depression and anxiety predicts new onset of heart disease. Journal of Behavioral
Medicine. 36, 347-353.
Day, R.C., Freedland, K.E., Carney, R.M. (2005). Effects of anxiety and depression on heart disease
attributions. International Journal of Behavioral Medicine. 12(1), 24-29.
http://www.nimh.nih.gov/statistics/1anyanx_adult.shtml
http://www.nimh.nih.gov/statistics/1mdd_adult.shtml
Hirschfeld, R.M.A. (2001). The comorbidity of major depression and anxiety disorders: recognition
and management in primary care. Journal of Clinical Psychiatry. 3(6), 244-254.
The Worry Cure
National CoMorbidity survey
http://www.cdc.gov/nchs/data/databriefs/db07.pdf
. (NY Times http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/print.html)