How do mental health and physical health interact?

While physical and mental health are often thought about as separate entities, they are closely related and affect each other in a number of ways.

Evidence has shown that physical health problems can significantly increase the risk of mental illness, and the same is true vice versa.¹ Looking after your physical health is therefore essential for overall wellbeing.

According to the Royal College of Nursing², people with severe mental illness (SMI) are more likely to die prematurely and have a preventable condition or disease, including:

respiratory disease;
sexually transmitted infection;
sexual dysfunction;
obstetric complications;
osteoporosis;
cancer;
dental problems;
metabolic disease;
diabetes or pre-diabetes;
cardiovascular disease;
obesity;
hypertension; and
raised cholesterol.

People with a poor mental health are also more likely to make unhealthy lifestyle choices such as smoking, eating a poor diet, abstaining from exercise, drinking too much alcohol, misusing drugs and partaking in unsafe sex.

However, despite these risks, physical health conditions in people with SMI often go unnoticed for long periods of time. This is because this group is more likely to experience diagnostic overshadowing – when healthcare professionals assume a physical condition is part of the patient’s mental illness, rather than looking at symptoms or performing an examination.

Why are people with a mental health condition more likely to have poor physical health?

The reasons behind this increased risk of physical illness among people with SMI are complex and multifaceted. The Royal College of Nursing suggests various possible explanations.²

Firstly, genetics may play a role. People with SMI are more likely to have raised blood glucose, low lung function values, and low levels of ‘good cholesterol’ (high-density lipoprotein) which protects against cardiovascular disease.

Secondly, having a mental health condition may decrease motivation levels, which will affect the person’s ability to cook, exercise and clean, all of which can contribute to poor physical health.

Similarly, this group are more likely to struggle with concentration and planning which can affect daily function and could make them more likely to miss health appointments or avoid making them altogether.

Lastly, people with SMI are less likely than the general population to receive medical examinations, support and intervention measures to change unhealthy behaviour.

All of these factors, either together or separately, can contribute to the likelihood of developing poor physical and mental health as comorbid conditions.

Risk factors for poor mental and physical health in the older population

As people age, they become more susceptible to disease and disability. This can act as a significant stressor, particularly if the individual becomes reliant on long-term care.

According to the World Health Organization,³ older people are also more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement.

These stressors can result in the isolation and loneliness of older people, which has been shown to increase the risk of a variety of physical conditions as well as the risk of premature mortality.⁴

Older adults are also vulnerable to ‘elder abuse’, with estimates suggesting that nearly one in six older people experience physical, verbal, psychological, financial and sexual abuse; abandonment; neglect; or serious losses of dignity and respect.

For these reasons, older people are more vulnerable to mental health problems. Indeed, depression is affect around 22% of men and 28% of women aged 65 years and over, yet it is estimated that 85% of older people with depression receive no help at all from the NHS.⁵

Healthcare professionals should therefore explore the likelihood of a mental health condition in their older patients who present with physical ailments, and offer support where appropriate.

How can healthcare professionals meet the needs of the older population?

The World Health Organization suggests various measures to ensure that health providers meet the specific needs of the older population.³

This includes: training health professionals in providing care for older people; preventing and managing age-associated chronic diseases; designing sustainable policies on long-term and palliative care; and developing age-friendly services and settings.

Social prescribing can also be a good way to improve both the mental and physical health of older adults. This could be promoting physical activity and a healthy diet, or referring the individual to services that ensure they have security and freedom, adequate housing, social support and access to community development programmes.

If a mental health problem is identified, it should be promptly addressed and treated. This could be through medication, therapy or support groups. Physical illnesses and pain must also be well-managed as this can in turn help to improve the mental health of the individual.

It is important for healthcare professionals to remember that those in deprived areas are significantly more likely to have a mental health disorder than those who live in affluent regions.⁶ Healthcare professionals who work in more deprived areas should therefore be acutely aware that their patients are more likely to suffer with comorbidity of physical and mental health disorders.

The role of the GP

People under the age of 65 are also likely to suffer from multimorbidity, and should not be overlooked. While geriatricians play a key role in caring for older patients, there is no equivalent for people below the age of 65, and specialists are often reluctant to provide care or coordination outside their area of expertise.

Researchers writing in The Lancet say that since most patients first present in primary care, GPs should be particularly aware of this gap and try to establish a long-lasting relationship with their patients with multimorbidity, and provide a person-centred approach.⁶

For this reason, they state that general practice staff must be well-equipped to care for this group of patients. They explain: “A strong, generalist primary care system based around an appropriately skilled multiprotection team is the most obvious way to deliver this holistic, longitudinal care for most people with multiple disorders, and should seek to maximise quality of life and minimise future disability and morbidity.”

However, as our ageing population grows and multimorbidity increases, this will present a challenge to primary care. The authors say undergraduate and postgraduate training and continuous professional development is therefore needed to ensure health professionals are well-versed in the delivery of systematic chronic disease management and the coordination of longitudinal care.

References

1. Physical health and mental health. Mental Health Foundation. https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/physical-health-and-mental-health. Published 2022. Accessed May 2022.
2. Physical health in mental illness | Mental health | Royal College of Nursing. The Royal College of Nursing. https://www.rcn.org.uk/clinical-topics/mental-health/physical-health-in-mental-illness. Published 2022. Accessed May 2022.
3. Mental health of older adults. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults. Published 2017. Accessed May 2022.
4. Loneliness: Risk to Health. Campaign To End Loneliness. https://www.campaigntoendloneliness.org/threat-to-health/. Published 2022. Accessed May 2022.
5. Older people: statistics. Mental Health Foundation. https://www.mentalhealth.org.uk/explore-mental-health/statistics/older-people-statistics. Published 2022. Accessed May 2022.
6. Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet. 2012; 380(9836):37-43. doi:10.1016/s0140-6736(12)60240-2.