Top Things to Know: Psychological Health, Well-Being, & the Mind-Heart-Body Connection
Published: January 25, 2021
Prepared by Anne Leonard MPH, BSN, RN, FAHA, Senior Science and Medicine Advisor – Lead
- Clinicians delivering health care generally focus on treating disease but are not as good at treating the patient as a whole.
- The World Health Organization defines mental health as “a state of well-being in which an individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. Several terms have been used to describe and capture overall state of health. Wellness is not only the absence of disease, but an active process directed toward a healthier, happier, more fulfilling life. Well-being can be defined as one’s cognitive and affective evaluation and assess of one’s life, including physical health, satisfaction, happiness, and a sense of fulfillment.
- Well-being can serve as an umbrella term for the different valuations people make regarding their lives. This includes their physical and mental health, their financial position, their social supports and connectedness to community, their opportunities for growth and ability to achieve their goals, and a general sense of purpose and satisfaction with their life course. Improving patient well-being is a key goal of the American Heart Association 2030 Impact Goal Presidential Advisory. While there is no universal definition of “positive psychological health,” this statement considers it as multi-faceted and may be characterized by a sense of optimism, sense of purpose, gratitude, resilience, positive affect and happiness, mindfulness, and emotional vitality (having a sense of positive energy and capacity to regulate emotions effectively).
- Research has clearly demonstrated that negative psychological factors, personality traits, and mental health can impact cardiovascular health. Negative psychological health encompasses depression, chronic stress, anxiety, anger and hostility, pessimism, and dissatisfaction with one’s current life.
- Positive psychological states can plausibly lead to lower cardiovascular disease (CVD) risk through healthier behaviors. Individuals with better psychological health tend to have better social support.
- This Scientific Statement discusses biological pathways linking psychological health and CVD. Pathways include: biological, behavioral and psychological processes.
- Psychological illness and psychological health have been shown to be associated with medication non-adherence. Numerous studies have found a relationship between major depressive disorder and poor adherence to cardiovascular medications.
- This statement discusses interventions for psychiatric disorders or symptoms if present in the patient. Among interventions addressed are antidepressants, psychotherapy, and care management.
- Clinical cardiology visits can provide an excellent opportunity to assess psychological factors that may impact cardiac health maintenance. Clinicians can use simple screening tools in the care of patients with or at risk for CVD to assess psychological health status. Two examples are the Patient Health Questionnaire-2 (PHQ-2) depression screen and the Generalized Anxiety Disorder -2 (GAD-2) questionnaire anxiety screen.
- CVD should not be addressed in isolation but seen as one part of an integrated system in which mind, heart and body are interconnected. Both positive and negative psychological factors appear to impact CV health and prognosis directly. Wellness and well-being are physical factors as well as psychological. Clinicians should have as their goal to treat the whole patient, not only the patient’s disease state.
Citation
Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, Labarthe DR, Lavretsky H, Michos ED, Spatz ES, Kubzansky LD; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Council on Lifestyle and Cardiometabolic Health. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association [published online ahead of print January 25, 2021]. Circulation. doi: 10.1161/CIR.0000000000000947