|Year : 2020 | Volume
| Issue : 2 | Page : 67-69
Mental disorders and noncommunicable diseases: A likeness, an overlap or an affiliation?
Devakshi Dua, Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||09-Dec-2020|
|Date of Decision||14-Dec-2020|
|Date of Acceptance||20-Dec-2020|
|Date of Web Publication||21-Jan-2021|
Dr. Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dua D, Grover S. Mental disorders and noncommunicable diseases: A likeness, an overlap or an affiliation?. J Geriatr Ment Health 2020;7:67-9
|How to cite this URL:|
Dua D, Grover S. Mental disorders and noncommunicable diseases: A likeness, an overlap or an affiliation?. J Geriatr Ment Health [serial online] 2020 [cited 2021 Apr 17];7:67-9. Available from: https://www.jgmh.org/text.asp?2020/7/2/67/307593
The rubric of noncommunicable diseases (NCDs), include cardiovascular diseases such as coronary artery disease, diabetes mellitus, malignancies, and chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). These are traditionally defined as those which cannot be transmitted from one person to another, to distinguish them from infectious diseases. The NCDs are characterized by long and protracted course, long period of latency, multiple risk factors, complex etiopathogenesis, and generally a slow progression. The complex interplay of the above often leads to a life with disability and impairment, which may not be apparent to the lay observer.
NCDs are a major cause of global mortality, especially in developed countries. In the developing world, although infectious diseases and malnutrition contribute significantly to poor health and even as a cause of death, the NCDs are fast catching up. The World Health Organization has brought NCDs into focus as a part of the Millennium Development Goals. However, the definition has been restricted to the “Big Four.”
If one tries to understand various mental disorders, especially the severe mental disorders, these also are characterized by similar features as used to define NCDs. Mental disorders are the third biggest cause of disability adjusted life years (DALYs), globally. Despite statistics suggesting that mental disorders, especially depression leads to significant morbidity as well as economic burden, the same has not been considered under the rubric of NCDs. Thus, some of the authors have argued and have urged that mental disorders should also be included in the realm of NCDs.
It is also important to note that mental disorders are closely linked with other NCDs. The link has been studied and understood on the basis of different models and the relationship is now considered to be bidirectional. In addition, it is postulated that there may be a common underlying mechanism for mental disorders and other NCDs.,
The elderly population is on rise. Elderly people have higher prevalence of NCDs. In addition, in elderly, NCDs are known risk factors for cognitive decline and dementia. In a recent study conducted in India at an NCD clinic, the elderly population was screened for cognitive impairment. It was observed that nearly a quarter of the attendees had cognitive decline. Cognitive decline was also associated with patients suffering from hypertension, diabetes mellitus, and both of the illnesses. In another similar study, nearly one-third of the participants recruited from an NCD clinic suffered from depressive and anxiety disorders. Hence, it is of paramount importance that association of NCDs and mental disorders among the elderly.
| Mental Disorders as Risk Factors for Noncommunicable Diseases|| |
Available evidence suggests that mental disorders are themselves a risk factor for the development of other NCDs. Patients suffering from mental illnesses often have poor dietary habits, use substances like alcohol and tobacco, and have low physical activity, all of which predispose them to develop medical comorbidities. These can range from obesity, hypertension and metabolic syndrome to the more sinister coronary artery disease, stroke, and cancer. Chronic smoking leads to COPD in many patients. More than one type of comorbidity is often present in patients with severe mental disorders.
| Impact of Mental Disorder on Noncommunicable Diseases|| |
There are robust data to suggest that the presence of mental disorder alters the course and progression of other illnesses. The diagnosis of the physical illness is frequently delayed in the presence of a mental disorder. It can be due to the neglect faced by the patients with mental disorders, which ranges from self-neglect, neglect by family members, as well as by the clinicians. In patients suffering from mental disorders, weight gain, lack of activity are considered as inevitable., These are not attended to, and investigations and efforts to make a diagnosis beyond the already diagnosed mental illness are often low. It is only when complications arise due to the physical illness with marked impairment in functioning that these are diagnosed. The presence of mental disorders has a negative impact on the medication and treatment adherence in patients with various NCDs., The patients' ability to follow the advice of the doctor, such as lifestyle modification may be hampered., Further, patient's perception of the physical illness is often colored by the presence of the mental disorder. Patients with depression who are in the acute phase of the illness may become hopeless about their physical condition. They may have altered threshold for perception of pain and other symptoms. At the same time, they may not perceive the improvement in symptoms which may have occurred after the initiation of treatment. On the other hand, patients suffering from psychotic disorders may not pay much heed to their physical symptoms even when they warrant treatment, or attribute it to some aspect of their psychopathology. In both the scenarios mentioned above, the impact on treatment adherence may be significant., In addition, the progression of physical illness may be faster in patients with mental disorders due to the complex interplay of delayed diagnosis, poor lifestyle choices, treatment nonadherence, and adverse effects of medications.
| Impact of Medical Illness on Mental Health|| |
The presence of any kind of medical illness can be considered as stressful. This is particularly pronounced at the time of acute symptoms, diagnosis, and breaking of bad news, presence of chronic symptoms such as pain, associated disability, and dysfunction can lead to development of mental health issues. In addition, the financial burden accompanying the disease, dependency needs, impaired social relations, and burnout in caregivers can contribute further to the development of mental disorders. In the background of a chronic medical illness, common mental disorders, such as depression and anxiety are more prevalent as compared to the general population. The risk of developing depression has been reported to be higher in those suffering from medical illnesses.
As the symptoms of medical illnesses often overlap with those of common mental disorders like depression and anxiety, the latter are often underdiagnosed. The symptoms are attributed to the medical condition and a more detailed evaluation is not undertaken. This invariably results in prolonged suffering. Due to the persistence of symptoms, the patient remains poorly satisfied with treatment, resorting to doctor shopping, trying alternative treatments, or giving up treatment for the medical as well as mental disorders.
| Common Factors Predisposing to Medical as Well as Mental Illness|| |
NCDs are believed to have a complex etiology with multiple causal risk factors. Some of these include hyperfunctioning of the hypothalamo–pituitary–adrenal axis, genetic factors, childhood adversity, and stressful life events as well as substance use. All of these factors have also been implicated as risk factors with development of mental disorders too, suggesting a common etiology for both the group of disorders.
| What is the Need of the Hour?|| |
With the advancement in science as well as health standards, the NCDs are now the focus of disease prevention targets and goals. As a result, the “Big Four” were identified, considering the large-scale impact associated with them, in terms of morbidity and mortality, as well as the socioeconomic burden. Keeping this in mind, NCD clinics are coming up as a one-stop shop for the management of the “Big four.”
However, despite the fact that depressive disorders are the second largest contributor of DALYs globally, mental disorders have not received much attention in terms of prevention and treatment as an area of focus. Further, although the treatment of mental disorders has received some attention, there is no effort to promote mental health and reduce the disability associated with mental illness. Although the slogan “No health without mental health” is often raised by advocates for mental health, the same has not been extended to the sphere of prevention and treatment.
With an increase in prevalence of mental illness, in combination with other NCDs, the need of the hour is to develop a holistic, multi-pronged approach. It is time to include mental health in the ambit of NCDs and allocate appropriate resources to tackle the problem at hand. Easy availability of care will allow patients in need to avail facilities created for them. In addition, physicians must be equipped to deal with the problems plaguing the patients. This can be done by generalists as well as specialists. At the same time, awareness campaigns have to be made use of so that the stakeholders can appropriately utilize the services available.
In India, NCD clinics have been set up both in the urban as well as rural settings. These, continue to focus on the Big 4. As has already been demonstrated by recent studies from the rural setting, there is a high prevalence of mental disorders within these special populations, especially in the elderly. Thus, it is time to expand the focus to NCDs affecting the elderly.
Considering the overlap of etiological factors, and impact of NCDs and mental disorders on each other, it is important to have a holistic model to identify and manage these ailments together. Hence, it is important that mental disorders should be included under the broad rubric of NCDs and focus should shift from BIG 4 to BIG 5.
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