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Projections indicate that cardiovascular disease and depression will top the list of global disability causes soon, so the urgency for targeted interventions is evident, writes Dr Mosima Mabunda.
A clinical diagnosis of depression is far more complex than mental distress. It is a chronic condition that manifests as unshakeable feelings of sadness, hopelessness, and a lack of interest in activities. The troubling truth is that it's not just a mental issue. It impacts people's physical health too. In many cases, depression can lead to poor eating and sleeping habits and a lack of motivation to do physical activity.
Health practitioners and employers are seeing an increased need to raise awareness around improving mental health. This is also the purpose of Mental Health Awareness Month and World Mental Health Day, which was on 10 October 2023. I am writing this looking at the sobering statistics that 280 million people worldwide live with depression and that research shows a relationship between depression and certain diseases, specifically heart-related conditions.
Projections indicate that cardiovascular disease and depression will top the list of global disability causes soon, so the urgency for targeted interventions is evident.
What is the link between depression and heart health?
I spoke to Prof Renata Schoeman, a general psychiatrist and associate professor in Leadership at the University of Stellenbosch Business School, about this. She says studies show patients with major depressive disorder have a 64% higher risk of eventually developing coronary heart disease. The link between coronary events and depression is also distinct, with up to 40% of patients meeting the criteria for major depression after suffering from a cardiac event. In outpatient clinics, the rate of depression is 30% in patients with coronary heart disease and up to a staggering 50% in patients who are hospitalised for coronary artery bypass surgery. In those who have recently suffered a heart attack, up to 74% are diagnosed with depression.
The relationship between cardiovascular diseases and depression is complex, with numerous factors at play. What is clear is that people with depression are at a greater risk of developing heart disease. Professor Schoeman says major depression causes psychological stress that can lead to deregulation in the sympathetic nervous system and endocrine system, which regulate our stress response. These factors, in turn, can lead to an increase in blood pressure and inflammation, among other factors -- all risks for developing heart disease.
Professor Schoeman says that, unfortunately, people with major depressive disorder often have increased rates of smoking, alcohol intake, physical inactivity, and obesity. She always encourages patients to take responsibility for lifestyle changes and comply with treatment to improve health outcomes.
Her view on the importance of lifestyle changes, looking at depression, is supported by findings of a Vitality study by researchers from Harvard T.H. Chan School of Public Health and the University of Cape Town. It found that one in five cases of depression in women could be prevented if physical activity increased by walking just an extra 5,000 steps a week. In addition, moderate to severe symptoms of depression are 4.9 times proportionally lower when levels of cardiorespiratory fitness are higher.
The solutions
Where do we start? Screening people is a critical step. Professor Schoeman says there is a need for healthcare professionals to screen for depression in cases of heart disease and for mental healthcare providers to screen patients with depression for other illnesses.
Along with adhering to prescribed medicine interventions, adapting lifestyle behaviours is an important part of treating these conditions. Things like not smoking, following a healthy diet, being active, losing weight, managing diabetes, hypertension, high cholesterol and adhering to recommendations from rehabilitation programs are important.
We have seen that having regular health screenings is an effective way to manage health. This insightful snapshot of their health facilitates early detection of risk factors for cardiovascular disease and ways to proactively manage these risks. Assessment is crucial, particularly for those diagnosed with chronic diseases. We have seen that people who complete programs validate depression screenings and are three times more likely to seek mental health support.
Professor Schoeman stressed that we need to be more aware of the interaction between depression and heart disease. Early identification and intervention are crucial. Being aware of a mental health or heart condition means people have an opportunity to adopt behaviour that supports good mental and physical health.
Dr Mosima Mabunda is the Head of Wellness at Discovery Vitality.
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