1 of 5 | People with mental health disorders can reduce their risk for physical diseases by eating a healthy diet and exercising, among other steps, according to cardiologist Dr. Sandeer Al-Kindi. Photo courtesy of University Hospitals
NEW YORK, Aug. 31(UPI) -- Research that links mental health disorders such as depression and anxiety to physical maladies, including cancer, diabetes and heart disease, has raised an important question: Can people think themselves sick?
The answer is it's complicated, experts told UPI.
Given how many people are affected by these disorders, interest has been growing within the medical research community about how they may affect a person's physical health, cardiologist Dr. Sadeer Al-Kindi, who has studied the topic, told UPI in an email.
For example, "there is mounting evidence that anxiety and depression are risk factors for cardiovascular disease, including heart attacks and strokes," said Al-Kindi, who practices at University Hospitals Cleveland Medical Center in Houston.
"These associations seem to be independent of established risk factors, such as diabetes and smoking," he said.
People with depression and anxiety need to know about their risk for certain physical illnesses and what can they do about it, the experts said.
Symptoms of anxiety
Up to 40% of adults in the United States have experienced "recent symptoms of an anxiety or a depressive disorder," according to the Centers for Disease Control and Prevention.
This figure rose during the height of the COVID-19 pandemic in 2020-21, but the disorders were common even before the public health emergency, the agency says.
About 5% of adults in the United States have been formally diagnosed with depression, agency data suggests.
A 2017 analysis found that people with major depressive disorder, the clinical name for depression, have a 72% higher risk for heart disease compared with those who don't have the mental health condition.
A separate study published in 2010 found that people with depression had only a 4% higher risk for heart disease, but that the risk was more than twice as great among those with anxiety.
Similarly, a study involving more than 72,000 people published in July by Diabetic Medicine found that people with depressive symptoms were more than eight times more likely to develop Type 2 diabetes compared with those who had prediabetes alone.
Those with anxiety symptoms were more than six times more likely to develop Type 2 diabetes compared with those who had only prediabetes, a condition the CDC defines as blood sugar levels are higher than normal, but not yet high enough to be Type 2 diabetes, the researchers added.
Also, a review published in May by the Journal of the European Academy of Dermatology and Venereology noted links between depression and anxiety and psoriatic disorders.
Examples of these autoimmune diseases include psoriasis, a skin disease that causes a rash with itchy, scaly patches, and psoriatic arthritis, which causes joint pain and swelling, according to the Mayo Clinic.
However, the data on any association between the mental health disorders and cancer is mixed.
A 2020 study suggested that depression and anxiety increased a person's risk for a cancer diagnosis by 13%, but an analysis published Aug. 7 by the journal Cancer found no links between depression or anxiety and breast, prostate, colorectal and alcohol-related cancers, some of the most common forms of the disease.
"We know individuals with physical health conditions have a higher rate of anxiety and depression," psychiatrist Dr. Jesse Fann, director of psychosocial oncology at Fred Hutchinson Cancer Center in Seattle, told UPI in an email.
"However, there is also evidence that the association is bi-directional, that is, anxiety and depression can also increase the risk of physical health conditions," he said.
What people experience
Bonnie Von Dohre, of Brooksville, Fla., a 43-year-old military veteran and content creator at notsomodern.com saw this "bi-directional" relationship firsthand.
Having suffered from depression and anxiety for years, she developed and was diagnosed with psoriasis in 2018 "after a period of extreme stress," Von Dohre told UPI in an email.
Although new treatments called biologics, which are designed to offset the immune system dysfunction that causes psoriasis, have helped, she said she is still "far from ... whole."
"Unfortunately, the physical symptoms of psoriasis have at times had an even greater negative impact on my mental health as treatments have so far been unsuccessful at eliminating my symptoms," she explained.
Similarly, Amiyah Watts, a 30-year-old from San Francisco, was diagnosed with depression in her early 20s and was diagnosed with heart disease "a few years later."
"During my struggle with depression, I noticed how the emotional toll it took on me seemed to impact my overall lifestyle and I had difficulty maintaining a healthy diet, regular exercise routine and proper sleep patterns," she told UPI in an email.
"The constant stress and anxiety seemed to contribute to this downward spiral and, while I cannot definitively claim that my mental health issues directly caused my heart disease, I do believe they played a role," she said.
"It's not necessarily true that a person's psychological status can cause [physical illness," cancer prevention specialist Dr. Patricia A. Ganz, one of the experts who described the complex relationship, said in a phone interview.
However, "people who are depressed, for example, often neglect their health -- they may not get routine cancer screenings, they smoke or drink to excess," said Ganz, who is director of cancer prevention and control research at UCLA's Jonsson Comprehensive Cancer Center.
But, "There are a number of behavior risk factors that could lead to an increased risk" for certain physical diseases, she added.
What to do
Watts' story is common among people with depression and anxiety -- two disorders that often occur together, according to Ganz and Fred Hutchinson's Fann.
For people who experience symptoms of these disorders, such as avoiding activities, isolating, frequently thinking negative thoughts and recurring feelings of sadness, it's important to get diagnosed and treated, added Al-Kindi, of the University Hospitals Cleveland Medical Center in Houston.
This includes taking medications for depression and anxiety as prescribed and reporting any side effects promptly, as well as getting non-drug treatments such as cognitive behavioral therapy, he said.
"Untreated symptoms may be worse for physical health," Al-Kindi added.
"Most medications for anxiety and depression are very safe and well-tolerated when prescribed and monitored by an experienced clinician," Fann said.
As for everyone, taking steps to ensure overall health -- including regular exercise, healthy diet, stress reduction and adequate sleep -- are important, according to Al-Kindi.
However, because many people with depression and anxiety experience a lack of "activation energy," or motivation to engage in certain activities, support from friends and family may be needed, Ganz said.
Watts said she found support from others dealing with depression and heart disease, adding that "shared stories" helped motivate her to make necessary changes and take an active role in her health.
Support networks should also help encourage people with depression and anxiety to keep up with routine cancer screenings and other healthcare appointments, according to Ganz.
"About 50% to 60% of breast and prostate cancers, the two most common cancers in women and men, are related to exposures, including diet and lifestyle," she said.
"People who are depressed may be less physically active, and they also may be smoking and drinking to excess," she added.
A study published in May by the Journal of Gerontology found that older adults who felt they had adequate support from family, friends and neighbors had better overall health and were more likely to engage in steps needed to maintain it.
Those with depression and anxiety should also be sure to work with their care team to control blood pressure, cholesterol and blood sugar levels to reduce their risk for heart disease and diabetes, Al-Kindi said.
"It's also important to discuss any underlying personal or family history of health problems with your healthcare provider so that they can provide the most effective and safe treatment," Fann said.
"Close coordination among your different healthcare providers is particularly important if you have multiple medical conditions that are being managed by different medical specialists," he said.