Comorbid Mental Health Symptoms and Heart Diseases: Can Health Care and Mental Health Care Professionals Collaboratively Improve the Assessment and Management?

Article excerpt

Coronary heart disease (CHD) is the leading cause of mortality in the United States (American Heart Association, 2008). By the year 2020, the World Health Organization (WHO) anticipates that cardiovascular diseases and major depression will become the two leading contributors to the global burden of disease (Murray & Lopez, 1996).Therefore, mental health practitioners in the medical industry and community must be made aware of the close association between mental health symptoms and a wide range of heart diseases, such as CHD, cardiomyopathy, pulmonary heart disease, congestive heart failure (CHF), myocardial infarction (MI), irregular heart beat (arrhythmia), and valvular heart disease.

Ai and Carrigan (2007) described the impact of race/ethnicity and socioeconomic status on the assessment and management of heart disease. In this article, we describe the association between mental health symptoms and heart disease on the basis of epidemiological and clinical research. We begin with current evidence of the culturally and historically important heart-mind link. We then address depression and anxiety, both as manifestations of heart disease and as contributors to the disease prognosis. Then we highlight issues related to clinical assessment and intervention for these symptoms, describing factors that decrease the risks for co-occurrence of mental health problems and heart disease. Finally, we discuss implications of recent research for health care and mental health care professionals--including medical, gerontological, and community social workers--in a highlighted chronic care model.


Given the prevalence of cardiac disorders and the aging of the population, heart disease has become a priority of global health promotion efforts. The earliest formal commitment to health promotion worldwide, the Ottawa Charter, was made 20 years ago at the First International Conference on Health Promotion, held in Ottawa, Canada (WHO Regional Office for Europe, 2006). According to the Ottawa Charter, the cornerstone of the health promotion approach is the idea of health creation: "Health is created where people live, love, work and play" (WHO Regional Office for Europe, 2006, p. 3). Unlike work and play, however, love is often considered to reside deep within people's hearts, at the core of mentality and spirituality, where it has traditionally been thought to affect the healing of mind, body, and soul.

In 1628, for example, English physician William Harvey correctly described, in exact detail, systemic circulation, and he proposed a link between the mind (for example, desire, hope, fear) and the heart. In Germany, where Goethe's poems emphasized the romantic aspects of the heart, the term heart means emotional warmth. In traditional Chinese medicine, the heart is an organ that holds the emotion of joy, and the care of the heart includes the care of emotions (Ai, in press). Today, as investigators explore whether the heart-mind association is more than a metaphor or myth, they are discovering that the heart responds to various mental activities, and they are also finding biomarkers that link the heart and mind (Ai et al., 2009).


The prevalence of comorbid mental health conditions in cardiac patients is now well documented (Carroll, Phillips, Hunt, & Der, 2007; Lichtman et al., 2008; Mosovich et al., 2008). Over the past decade, many studies have associated depression and anxiety with a poor prognosis for heart diseases, including deadly heart attacks (Barth, Schumacher, & Herrmann-Lingen, 2004; van Melle et al., 2004). A comprehensive review over the past three decades of scientific investigations about psychosocial treatments of cardiac patients suggests that an immense amount of resources have been used in this endeavor (Peck & Ai, 2008). …