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It goes by many names — a circus, adventure or even a game. It’s life. How we navigate the topographic contours of the one we lead is largely influenced by the resources we have at our disposal and who we are, including our physical and mental health.

Physical and mental health do not exist in a vacuum. They are bound to each other and influenced by our past — outcomes of our environment, experiences and learned behaviors — while simultaneously influencing our decisions and our lives moving forward. Add a mental health disorder like depression, anxiety or addiction to the equation and life can feel overwhelming. The death of a loved one, losing a job and the end of a relationship are all challenges most people can eventually overcome if they are well-adjusted, have self-esteem and self-worth, and are buoyed by a healthy support system — along with a strong dose of grit and resilience. Yet for those whose mental states are already strained these obstacles can sometimes feel insurmountable.

Scientists and mental health professionals have for decades been trying to unpack the complexities associated with mental health and wellness. Consequently, the collective knowledge base and treatments have expanded to significantly help those who need it.

Mental health includes our emotional, psychological and emotional well-being, and affects how we think, feel and act, according to the Centers for Disease Control and Prevention (CDC). The state of a person’s mental health determines how they handle stress, relate to others and make healthy choices.

The American Psychiatric Association (APA) describes mental health as the foundation for emotions, thinking, communication, learning, resilience and self-esteem. Good mental health is also key to maintaining positive relationships, personal and emotional well-being, and contributing to a community or society as a whole.

Nature and Nurture

Mental health affects every dimension of a person’s life, and being mentally unwell can wreak havoc on one's overall quality of life — derailing relationships, careers and self-esteem.

“Mental health problems have enormous consequences for quality of life," says Fordham University Professor of Psychology Dean McKay. "In general, mood is directly tied to ability to enjoy daily activities. Further, our behaviors are influenced by mood, which in turn can have consequences for the quality of our relationships. This means that mental health problems impact every sphere of our life — family relationships, friends, and career with its associated interpersonal relationships with colleagues and supervisors.”

With such a cycle of influence, the question is whether the origins of chronic mental problems are related to environment, genetics or physical health.

“There is a long-standing debate of which comes first,” says Kenneth Thorpe, chair of the Department of Health Policy and Management at Emory University’s Rollins School of Public Health.

Mind and Body

During the past decade, more attention has been paid to the relationship between physical health and mental health — and it is clear the relationship goes both ways. What we eat, how much we exercise, and thinking positive thoughts or expressing gratitude can impact our mental state. Likewise, our thoughts, sense of self, and how we cope with stress, anxiety and other psychological factors can affect our physical health.

Emotions are perceived in the brain, which signals the body to release chemicals. Adrenaline, serotonin and dopamine are chemical messengers that cause sensations of acute stress or hyperarousal, calm and pleasure, respectively. Those emotions can hold a powerful sway on the lifestyle decisions a person makes daily and, ultimately, one’s physical and mental health.

Health statistics emphasize the interrelated tangle between the mind and body. An estimated 50% of all Americans have a mental disorder diagnosis at some point in their lifetime, according to the CDC. Thorpe notes 16% of the U.S. adult population has at least one chronic behavioral health disorder and, of that group, 92% have at least one chronic health care condition. About 56% have four or more chronic conditions. The National Institutes for Health (NIH) points out that at least one quarter of cardiac patients suffer with depression, and that adults with depression often develop heart disease.

“It’s not sufficient to treat just depression,” Thorpe says. "You really need a whole care plan that deals with the full package. A medical professional must manage the whole patient.”

The Initial Foothold

How a mental health disorder develops is difficult to pinpoint, but it is indisputable that unresolved issues can snowball into mental and emotional stress, which can then further develop into more serious mental health disorders and illnesses.

“There are numerous potential contributors to mental health problems," says McKay, who is in expert in anxiety disorders. "Some of the most common, such as depression and anxiety, can be a result of persistent stress. This can be worsened when the individual has a difficult time coping with stress. Persistent mood problems can, in turn, lead to substance use and abuse, since many substances provide relief, even if only for a short time.”

Thorpe explains that genetics may be a contributor, but genetics can be compounded by other factors. A person with a medical condition that impairs their ability to work effectively or perform household functions can be subject to an overall decline in their quality of life.

Childhood experiences and trauma are another potential source. Studies have shown a link between abuse and a pattern of behavior as that child grows into an adult. The abuse may not necessarily always be evident or directed at a child.

“If your parents drink as a coping mechanism to alleviate stress, then you might be learning to do the same,” McKay says. “Research is continuing to evaluate a potential role for genetics, and while it appears many mental health problems are passed down, it is not clear whether that is due to biology or observational learning.”

Is There Help?

Because the number of mental health disorders is so vast, there are numerous recommended treatments, including counseling and medications. McKay says treatments should be tailored and aligned to the individual and their specific condition. He lists the most effective as the programs emphasizing coping skills, interpersonal effectiveness and behavioral changes under a therapist’s guidance.

“Unfortunately, there are a lot of treatments offered that have questionable benefit, and many people seeking treatment receive interventions that are unhelpful,” McKay observes. “Do a bit of research on your condition, struggles and the recommended treatments.”

Thorpe, meanwhile, has his sights set on how we approach and pay for healthcare. He wants to see a package of care that addresses the comprehensive person in both mind and body.

“We need a collaborative care delivery model that addresses all the conditions a patient is facing.” Thorpe says. “You can’t treat the individual condition, like depression, unless you treat the underlying factors.”

It’s those factors that will, ultimately and hopefully, unlock a happier and more satisfactory life for everyone who is experiencing a mental health challenge.

 

A Closer Look

Mental health disturbances appear in many forms. Anxiety, depression and eating disorders are three of the more common afflictions.

Anxiety

Anxiety, and the array of disorders that fall under this category — eating disorders, post-traumatic stress disorder (PTSD), phobias, generalized anxiety disorders (GAD), panic disorder (PD), social anxiety disorder (SAD) and more, affect 40 million adults in the U.S. (18.1% of the population) making it one of the most common mental illnesses in America, according to The Anxiety & Depression Association of America (ADAA). The ADAA attributes anxiety orders to a complex set of risk factors, including genetics, brain chemistry, personality and life events.

Despite these disorders being highly treatable, only 36.9% of individuals (according to the ADAA) receive treatment. Recognition is key. Symptoms for anxiety disorders are varied and differ depending on the condition. NIH lists the following for GAD and PD:

• Restlessness, feeling wound-up or edgy

• Being easily fatigued

• Difficulty concentrating; mind going blank

• Irritability

• Muscle tension

• Difficulty controlling feelings of worry

• Sleep problems

• Heart palpitations, a pounding heartbeat or an accelerated heartrate (PD)

• Sweating (PD)

• Trembling or shaking (PD)

• Sensations of shortness of breath, smothering or choking (PD)

• Feelings of impending doom (PD)

• Feelings of being out of control (PD)

Depression

Like anxiety, there are many types of depressive disorders that fall under the category of depression, the most common version being major depressive disorder. In 2017, the ADAA says there were about 17.3 million U.S. adults who had experienced at least one major depressive episode within the previous year. It also cites depression as the leading cause of disability in the U.S. among people ages 15-44.

The following nine common symptoms characterize depression when they persist two weeks or longer:

• Overwhelming feeling of sadness or loss of interest and pleasure in daily activities

• Decrease or increase in appetite

• Insomnia or hypersomnia

• Psychomotor agitation (e.g., pacing room, finger tapping, rapid talking)

• Constant fatigue

• Feelings of worthlessness

• Excessive or inappropriate guilt

• Recurrent thoughts of death and/or suicidal ideation

• Cognitive difficulties (e.g., diminished ability to think, concentrate, or make decisions)

Eating Disorders

An eating disorder (e.g., compulsive overeating, anorexia, bulimia, binge-eating, avoidant-restrictive food intake,) stems from anxiety. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) says about 9% of the U.S. population (or 28.8 million Americans) will have experienced an eating disorder in their lifetime. Despite the lower number of those affected in comparison to depression, eating disorders are among the most deadliest of mental illnesses resulting in 10,200 deaths each year, second only to opioid overdose.

According to ANAD, symptoms for eating disorders are common to other mental illnesses and are often diagnosed with anxiety and/or depression. Other signs include:

• Preoccupations with food or exercise

• Avoidance of eating around others (but may enjoy making food for others)

• Weight loss due to significant food restriction

• Weight loss while eating a lot suggesting purging behaviors.

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