Mental illness and cardiovascular disease (CVD) are major causes of health problems worldwide and locally. Approximately one in four people will develop a mental illness in their lifetime and CVD that includes diseases of the heart and circulation, such as angina, heart attack and stroke, is on the rise and is the second most common cause of death in South Africa.
Mental illnesses, such as depression, anxiety and schizophrenia, are known to have a large negative impact on the individual and on society. "Mental illness and other diseases of the nervous system, are together the second biggest cause of disability in South Africa," says Dr Leigh van den Heuvel, a psychiatrist at the Faculty of Medicine and Health Sciences of Stellenbosch University.
Link between diseases
Many people may not be aware of the fact that there is a strong relationship between mental illness and cardiovascular disease (CVD).
Individuals with mental illness have increased rates of CVD as compared to the general population and individuals with CVD are also at increased risk of developing a mental illness. CVD contributes to increased health problems, as well as a shorter lifespan, in persons with mental illness.
"For example, studies show that persons with schizophrenia tend to have a lifespan that is around 20 years shorter than the general population, with the cause of death mainly due to medical diseases.
"It is not yet fully understood why individuals with mental illness have increased rates of CVD, but various factors seem to play a role. Major contributing factors are those related to lifestyle, such as poor diet, physical inactivity, smoking, alcohol and drug use.
Many of the medications used to treat mental illness can also have side effects that increase CVD risk. Negative social consequences of mental illness, such as poverty and unemployment, also play a role. Furthermore, there is evidence of shared genetic factors and underlying disease pathways, such as inflammation, contributing to the high co-occurrence of mental illness and CVD.
"Individuals with both a mental illness and CVD have worse health outcomes than those with either condition alone, thus highlighting the importance of early recognition and treatment of these conditions. Individuals with mental illness often receive poorer quality of care for physical conditions and are at increased risk of serious medical conditions going undiagnosed or being inadequately treated."
There is a cluster of risk factors, known as the metabolic syndrome, that together predict an increased risk for developing CVD and diabetes. These factors include increased abdominal fat, high blood pressure, raised blood sugar and unhealthy cholesterol levels. It is relatively easy to screen for these factors and identifying individuals with metabolic syndrome provides an opportunity to intervene and decrease their risk of developing CVD and diabetes.
The rates of metabolic syndrome are also known to be higher in individuals with mental illness and yet it frequently goes undetected. "To illustrate this locally, a study conducted in Durban by Saloojee et al. showed that less than 1% of patients with serious mental illness, attending a local mental health clinic, were screened for the metabolic syndrome.
"It is apparent that health services for individuals with mental illness need to be improved. Screening programmes for CVD risk factors need to be incorporated into routine health care for persons with mental illness.
"It is also important that we increase awareness of the dual burden of mental illness and CVD to gather support for improved resource allocation for mental health care services."
Identifying unique health challenges
Persons with mental illness, and the people who care for them, also need to become advocates for their own health and well-being, but they cannot do so if they aren't aware of the unique health challenges they face.
"Increased efforts are required to better understand the relationship between CVD and mental illness in South Africa, and to examine how CVD can best be prevented and treated in our setting.
"There is currently a Medical Research Council Flagship funded study, titled 'Shared Roots', being conducted at Stellenbosch University that will use state-of-the-art research techniques to better understand the various factors that influence the relationship between brain disorders and CVD. Although this study is an indication of increased emphasis being placed on this major health challenge, further efforts are required," concludes van den Heuvel.