In this contributor piece, the connection between the complexities of mental health and heart disease in at-risk communities is explored, with the authors stressing the importance of risk factor evaluation and multidisciplinary patient education from both mental and physical health providers.
When it comes to decreasing the risk of heart disease, doctors have previously focused mainly on physical considerations, such as exercise and a healthy diet, for their adult patients. Mental health factors and childhood stressors, meanwhile, are often ignored. For the past 2 years, Families Together of Orange County (FTOC) has tailored treatment to incorporate patient and community education about the intersection of mental health and heart health.
COVID-19 forced unforeseen changes on many of us, especially our children. Although many youth supported by their families were able to adapt well, other youth struggled with the toll that adverse changes created in their lives. These adverse experiences are directly connected to both mental health and physical health in adulthood.
Suffering from mental health concerns over a long period of time can lead to physical reactions in the body such as a higher heart rate, high blood pressure, rapid breathing, and increased cortisol—all of which impact heart health. Depression and anxiety, specifically, have been linked to heart health and contribute to negative lifestyle behaviors that increase the risk of heart disease.
About 1 in 4 people in the United States dies from heart disease each year.1 In 2021, the California Department of Public Health reported that cancer and heart disease were the top contributing causes of death in the United States; Orange County reported 16,967 deaths related to heart disease last year alone.2
At FTOC, the Behavioral Health Department helps address any identified and suspected mental health concerns that could possibly affect patient overall health. All medical patients are screened using a reliable and valid questionnaire that assesses for symptoms of depression. If the screening is positive, it will automatically generate a referral to the Behavioral Health Department.
At intake, behavioral health therapists screen for depression, anxiety, substance use, childhood trauma, and other conditions. Then, once the therapist and patient have established appropriate treatment goals, therapists use evidence-based treatments, such as cognitive behavioral therapy, dialectical behavioral therapy, motivational interviewing, solution-focused therapy, etc, to support patients in meeting their treatment goals and decreasing symptoms. Leaning into the integrated health model, FTOC holds a monthly multidisciplinary team meeting to consult about and discuss patients who have co-occurring medical and mental health conditions that affect their overall well-being and level of functioning.
Patients’ needs are tackled with services that include medical support, physical training, nutrition and cooking classes, art, and education about how mental health and adverse experiences in childhood can affect an adult’s physical health. Since the growth of the behavioral health program over the last 2 years, there have been close to 12,000 therapeutic visits.
Many people today are unaware that what you experience as a child can have a lasting impact into adulthood. In 1995, the CDC and Kaiser Permanente conducted a study that showed a strong relationship between childhood adverse experiences and health risk factors in adults. The study revealed that the more exposure to abuse or household dysfunction as a child, the greater the risk for physical and emotional conditions as an adult, including a higher risk of earlier death.3 Although studies show that many Americans experience some sort of adverse experience as a child, those who face the biggest mental and heart health challenges live in at-risk communities.
The Adverse Childhood Experiences (ACEs) questionnaire from the CDC is a 10-item form that assesses the traumatic experiences from a person’s childhood for all patients who come through our doors.4 Currently, trained therapists have been administering the questionnaire to patients who display certain symptoms, but all therapists are being trained to administer and provide appropriate intervention. The goal for this year is to begin administering this questionnaire to all behavioral health patients.
The ACEs questionnaire is vital to assessing a person’s risk factors, because people who score higher will sometimes engage in maladaptive coping mechanisms such as smoking, drug use, overeating, and other behaviors that can increase the risk of heart disease. It is therefore critical that mental health and physical health providers work together to educate clients about the connections among adverse experiences, mental health, and physical health in order to best support each patient.
Adverse experiences in childhood and mental health issues can greatly impact heart health. Lack of education about this connection and lack of resources to seek support can cause long-term damage. By helping to identify mental health concerns in medical patients and medical concerns in mental health patients, many families and individuals can hope to get the care they need.
Health care providers must educate patients on the connection between mental health and physical health. By starting these conversations and encouraging educated contributions, patients will be able to implement positive change for themselves, for their families, and for future generations.
1. Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254-e743. doi:10.1161/CIR.0000000000000950
2. 2021-2022 provisional deaths by month by county. California Health and Human Services. April 15, 2021. Accessed March 8, 2022. https://data.chhs.ca.gov/dataset/death-profiles-by-county/resource/2e546f88-bba8-4d77-846a-7fb77846cac6?
3. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study. Am J Prev Med. 1998;14(4):P245-P258. doi:10.1016/S0749-3797(98)00017-8
4. Adverse childhood experiences (ACEs). CDC. Accessed March 9, 2022. https://www.cdc.gov/violenceprevention/aces/