THE RELATIONSHIP BETWEEN MENTAL HEALTH & PHYSICAL HEALTH Javier I. Rosado, PhD
Disclosure Statem ent • We have no real or perceived vested interests that relate to this presentation nor do we have any relationships with pharm aceutical com panies, biom edical device m anufacturers and/ or other corporations whose products or services are related to pertinent therapeutic areas.
Declaración de ausencia de conflicto de interés No tenem os interés alguno real o percibido relacionado con esta presentación, ni tenem os relación alguna con productos o com pañías farm acéuticas, fabricantes de dispositivos biom édicos y/ u otras corporaciones cuyos productos o servicios estén relacionados con áreas terapéuticas pertinentes.
Objec ectives es • This presentation will help participants better understand the link between mind, behavior and body. Understanding this link is an important step in identifying strategies to help agricultural workers who are living with chronic physical conditions and who also present with mental health conditions – such as depression and anxiety.
Introduction • Mental health & physical health have a bi-direction and complex relationship Mental Health Physical Health • The World Health Organization (WHO) defines: Health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. “There is no health without mental health.”
The association between mental and physical health are: 1. Poor mental health is a risk factor for chronic physical conditions 2. People with serious mental health conditions are at high risk of experiencing chronic physical conditions 3. People with chronic physical conditions are at risk of developing poor mental health
Chronic M Medical C Conditions s & A & Asso sociated ed Mental H Health th Conditions DIABETES ARTHRITIS OBESITY GASTRO- CANCER ASTHMA HEART DISEASE INTESTINAL • Major • Mood • Anxiety and • Clinical • Anxiety and • Bipolar • Anxiety and Disorders 16 depression 13 Depression 12 Depression 17 Disorder 18 Depression 10 Depressive • Schizophrenia 19 Disorder 2x • Anxiety • Phobic • Eating greater 11 Disorders 16 anxiety 14 Disorders 12 • Panic • Panic Disorder, Disorder 15 Generalized Anxiety Disorder, PTSD 11
Prevalence o of h health risks a and c chronic diseases b by d depression statu tus 19% Smoking 45% 17% Physical Inactivity 36% 26% Obesity 34% No Depression 6% Depression Diabetes 9% 8% Asthma 14% 7% CVD 9% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Source: Wisconsin Behavioral Risk Factor Survey
Prevalence o of h health risks a and c chronic di dise seases es b by s ser erious p psychological di distress ss 18% Smoking 36% 18% Physical Inactivity 50% 25% Obesity 44% No SPD SPD 6% Diabetes 13% 9% Asthma 26% 6% CVD 18% 0% 10% 20% 30% 40% 50% 60% Source: Wisconsin Behavioral Risk Factor Survey
No H Health w without Mental Health
Stress a about Medical Symptoms • Medical condition can Medical Symptom-Stress Cycle 20 lead to pressures & changes of lifestyle that patient finds unpleasant • Unplanned & unwanted Stress Medical Symptoms lifestyle changes can lead to stress • Patient feels worse than Undesired Lifestyle anticipated resulting in Changes acute stress that interferes with physical recovery
Depress ssion on Stressful situation or event Spiral 20 Sp 20 Physical Symptom Tired/Fatigued Behavior Change Doing Less Physical Symptom Appetite Change (increase/decrease) Emotions Sadness Physical Symptom Aches & Pains Thoughts Difficulty Concentrating DEPRESSED
Physical/Mental Health Impact Ph The direct and indirect effects between physical and mental health. 21* Explanatory variables Mediator variables Outcome variables Social factors Life style choices • Social interactions • Physical activity • Loneliness • Diet • Social isolation • Smoking Physical health Physical health • Drinking Socio-Economic Biological factors Status Mental health Mental health • Stress • Income/wage • Cognitive skills • Job conditions • Retirement Direct Effect *Adapted from Ohrnberger, J., Fichera, E., Sutton, M. (2017). The relationship between physical and mental health: A mediation analysis. Social Science & Medicine, 195:42-49.
SOCIAL AL F FACTORS I S IMPAC ACTING NG M MIGRANT ANT F FARM-WOR ORKER KERS INDIVIDUAL FACTORS LIFESTYLE FACTORS LIVING CONDITIONS WORKING CONDITIONS SOCIAL & COMMUNITY FACTORS GOVERNANCE & SOCIOECONOMIC CONDITIONS • age, sex & • economic • access to • access to • existence • existence hereditary class, safe & of of factors cultural or housing existence discrimina- legislation linguistic of jobs tion, and barriers, providing stigma, policies substance living wage social affecting abuse inclusion migrants’ health *Adapted from World Health Organization Commission on Social Determinants of Health (CDSH) report (2008:43)
No H Health w without Mental Health Diabetes Stress of daily diabetes Abnormal levels of management (primarily, daily norepinephrine and difficulty of keeping blood serotonin sugar levels under control) High levels of cortisol (impairs insulin sensitivity) Occasional tension between patient and doctor Loss of energy Fatigue/exhaustion exercising Nervousness/anxiety Suicidal thoughts Difficulty making dietary changes Change in appetite Depression
Ap Application t to Diabetes Explanatory variables Mediator variables Outcome variables Social factors Life style choices • Social isolation • Physical inactivity • Decreased self- Hypoglycemia management Physical health Physical Factors : increased • Poor diet Progression of Diabetes heart rate, headaches, hunger, shakiness Socio-Economic Biological factors Mental Health Factors : mood Mental health Status changes, concentration problem Depression • Stress • Income/wage • Cognitive skills • Job flexibility • Food affordability Direct Effect *Adapted from Ohrnberger, J., Fichera, E., Sutton, M. (2017). The relationship between physical and mental health: A mediation analysis. Social Science & Medicine, 195:42-49.
No H Health w without Mental Health • Risk factors for asthma attacks are embedded in acute negative life events 2.5 The experience of an acute negative life event, increases risk of subsequent asthma attack by nearly 2-fold. 2 1.5 1 0.5 0
No H Health w without Mental Health Premise: Stress operates by altering the magnitude of the airway inflammatory response that irritants, allergens, and infections bring about in persons with asthma
Psychosocial Fact ctors & Asth thma • Unexpected nature of asthma attacks can generate anxiety and fear • Uncertainty of illness • Risk for learned helplessness & depression • Emotional reactions (anxiety) play a major role in overutilization of services in asthma treatment
Recomme mmendations • Improve access to screening and prevention services • Assessing emotional & cognitive factors relevant to diabetes: The Diabetes Distress Scale 2 22
Recomme mmendations • Targeted interventions: • Priority access to healthy lifestyles services • Smoking cessation • Psycho-social interventions • Social support • Psychoeducation: debt/financial advice • Integrated Care: • Integrated program in primary care with mental health worker • Depression case managers • Social: • Identifying and partnering with social organization to support the patient
Cente ter R Resourc rces www.fsustress.org
Conta ntact FSU Center for Child Stress & Health www.fsustress.org 239-658-3162
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