Management of mental illness along with chronic physical illness is essential
The onset of aging makes a person vulnerable to several non-communicable diseases (also called lifestyle diseases) such as diabetes, hypertension and heart diseases. The management of these chronic illnesses can be challenging, particularly because it requires the person to make changes to their diet and take medication to manage the illness better. At the same time, the existence of these lifestyle illnesses makes it all the more crucial to pay attention to mental health.
According to WHO (World Health Organization) statistics, chronic illnesses such as heart diseases and diabetes are the leading cause of death and disability in India. Heart diseases and stroke contribute to about 25% deaths in India. Additionally, hypertension is prevalent among 29.8% of the population and diabetes affects nearly 62 million Indians every year.
As these illnesses are chronic in nature, managing them becomes a long-term commitment, requiring the person to make several adjustments including:
Coping with diminishing physical strength and mental cognition
Adjusting their diet according to the illness
Increased dependency on other members of the family
Burden of cost of treatment and medication – either on the elderly person or the caregiver
It is important for family/caregivers to acknowledge that these sudden changes can cause persistent emotional turmoil, which makes them vulnerable to mental health issues. In such cases, the treatment of mental illness becomes even more important as there are risks from management of both the illnesses and the stressors associated with it.
Not every person diagnosed with diabetes will have a mental health issue. But diabetes can increase the risk of onset of mental illnesses such as depression. 4A person with depression may also be more prone to having diabetes than someone who doesn't.
Studies have shown that a person who has diabetes, and with undiagnosed depression can suffer from several complications:
Poor medication adherence: A person with diabetes and undiagnosed depression can ignore their medication schedule due to depression. This can worsen diabetes.
Poor glycemic control: Glycemic control refers to the levels of blood sugar in the body. As the person doesn't adhere to the schedule of medication and dealing with ineffectiveness of the medication due to depression, this can result in the fluctuations in the blood sugar levels.
Both biological and psychosocial factors contribute to the comorbidity (existence of a disease along with a primary disease) of depression and diabetes. A person can have diabetes if their body resists the insulin produced in the body; or not get enough insulin from the pancreas. Both of these conditions lead to high blood sugar. When a person faces a stressor, the cortisol levels increase, leading to a spike in blood sugar levels, making management of diabetes worse. Cortisol imbalance is also said to cause depression.
A person with depression, on the other hand, may already be battling cortisol imbalance, which causes the fluctuation of glucose levels. If the depression is left unaddressed, the cortisol imbalance, which is one of the signs of depression, can cause spike in sugar levels, which can be a cause of diabetes. It is, therefore, clear that both diabetes and depression have strong correlation.
Additionally, psychosocial factors such as stress levels, lifestyle and diet can influence a diabetic person with unaddressed depression. A person with depression may make poor lifestyle decisions - unhealthy eating, ignoring physical activity, smoking, all of which results in obesity – all of which are risk factors for diabetes. Also, a person with depression can make certain decisions (eg., withdrawal from medication) which can adversely affect diabetes.
As a caregiver to someone with diabetes, look out for signs of mental illness in the person if they-
Feel low and sad most of the time
Ignore their medicines and periodic health checkups
Have negative thoughts about their life and future
Suffer from loss of appetite
Lack of interest in activities they usually like
Have thoughts about suicide or death
Read more for signs of depression here.
Due to the comorbidity, a person with depression cannot ignore their risk factors for diabetes and a person with diabetes should keep a check on their mental health and look out for signs of depression. Treatment of both diabetes and depression is necessary for effective management of both the illnesses.
Most heart diseases are considered to be lifestyle-related–dependent generally on the physical activity and diet of the person.
Coronary heart disease (blocked arteries), pulmonary hypertension and stroke are considered to be the biggest cause of mortality in India. Yet, the mental health aspect of heart diseases is often ignored in the treatment and management of the disease.
A study1 notes that persons with a history of heart disease have a higher chances of being affected by mental health issues such as generalized anxiety disorder, obsessive compulsive disorder, social phobia or any other specific phobias. Another study2 mentions that major depression following heart attack is quite common, affecting approximately 20% of the patients, and about 19% of patients experienced elevated anxiety.
“Once a person suffers a heart attack or goes through heart surgery, they can become overcautious about their health, which may lead to health anxiety,” says Dr Ajit Dahale, assistant professor of psychiatry at NIMHANS, Bengaluru.
On the other hand, anxiety is also associated with a higher risk of coronary artery disease. Phobic anxiety, generalized anxiety, panic disorder and worry are predictors of myocardial infarction (heart attack) or cardiac death.
Coping with NCD and mental illness
Experts say that genetic factors aside, the cause for rise in chronic diseases such as diabetes and heart diseases is due to poor lifestyle choices such as excessive consumption of processed foods, lack of physical activity, sedentary lifestyle, smoking and alcohol consumption. It is, therefore, important to note that lifestyle diseases such as these can be prevented by maintaining proper diet and regular physical activity.
If someone you know has been diagnosed with diabetes or heart disease and you have noticed changes in their behavior or emotions, talk to them. You could also help them approach a mental health professional. “If the person is already on any medication for existing mental illness, it is important to discuss about it with the treating physicians as there may be incompatibility issues. It is essential that both the treating physician and psychiatrist are in the know about the medication the patient is using,” says Dr Dahale while citing the example of medication used for hypertension which when combined with anti-psychotic meds have known to cause side-effects in the person such as weight-gain.
The onset of any chronic illness can cause the person with illness and those around them to make adjustments in their diet and lifestyle – make sure they get timely meals, keep a tab on their medication and check on their overall wellbeing. As caregivers, your support and empathy can go a long way in helping the elderly persons lead a life with good health.
1- Depression in Cardiovascular Patients - A Double Whammy : Dr Johnson Pradeep R, Dr Veena A Satyanarayana, Dr Krishnamachari Srinivasan; from Dealing with Depression in Medically Ill Patients, Elsevier Publications
2- A Narrative Review of the Relationship Between Coronary Heart Disease and Anxiety, Ajit Bhalchandra Dahale, Jaideep C Menon, and Jaisoorya T. S.
4- International awareness booklet on Diabetes and Depression by World Federation for Mental Health, USA
With inputs from Dr Kamala Thummala, endocrinologist, Jnana Sanjeevini Medical Centre, Bangalore and Dr Ajit Dahale, assistant professor of psychiatry, NIMHANS.