Joanna Maselko

No health without mental health

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.

Positive emotion and health : Going beyond the negative

This study examined the relationships between positive emotions and health. Two positive emotions were considered, hope and curiosity, in conjunction with 3 physician-diagnosed disease outcomes: hypertension, diabetes mellitus, and respiratory tract infections. Medical data were abstracted over a 2-year period from 1,041 patient records from a multispecialty medical practice, and emotions were assessed through a mailed questionnaire. Across 3 disease outcomes, higher levels of hope were associated with a decreased likelihood of having or developing a disease. Higher levels of curiosity were also associated with decreased likelihood of hypertension and diabetes mellitus. Results suggest that positive emotion may play a protective role in the development of disease.

Optimism and Pessimism in the Context of Health: Bipolar Opposites or Separate Constructs?

One difficulty plaguing research on dispositional optimism and health is whether optimism and pessimism are bipolar opposites or constitute distinct constructs. The present study examined the Life Orientation Test to determine whether the two-factor structure is explained by method bias (due to measurement) or substantive differences. The authors compared three measurement models: bipolar, bivariate, and method artifact. Optimism and pessimism emerged as distinct constructs due to substantive differences. The authors also considered the validity of optimism and pessimism, examining their relations with psychological and physical health outcomes. Optimism and pessimism were more similar in relation to psychological health than to other health-related behavior or physical health outcomes. However, a strongly interpretable pattern for the relation of optimism and pessimism to the health outcomes did not emerge. Further research may benefit from considering optimism and pessimism as bivariate and also should consider the conceptual components and behavioral mechanisms specific to each variable.

The neglected 'm' in MCH programmes - why mental health of mothers is important for child nutrition

In most societies, mothers are the primary providers of nutrition and care to young children. This is a demanding task, and poor physical or mental health in mothers might be expected to have adverse consequences on their children’s health, nutrition and psychological well‐being. Child nutrition programmes do not adequately address maternal mental health. In this article, we consider the evidence from less developed countries on whether maternal mental health influences child growth, with respect to evidence from both observational studies and from clinical trials. We estimate how much of the burden of undernutrition might be averted in one setting, and propose that promoting maternal mental health and treating maternal mental illness offer important new opportunities to tackle the twin scourges of maternal ill‐health and child undernutrition.

Religious service attendance and spiritual well-being are differentially associated with risk of major depression

BACKGROUND The complex relationships between religiosity, spirituality and the risk of DSM-IV depression are not well understood. METHOD We investigated the independent influence of religious service attendance and two dimensions of spiritual well-being (religious and existential) on the lifetime risk of major depression. Data came from the New England Family Study (NEFS) cohort (n=918, mean age=39 years). Depression according to DSM-IV criteria was ascertained using structured diagnostic interviews. Odds ratios (ORs) for the associations between high, medium and low tertiles of spiritual well-being and for religious service attendance and the lifetime risk of depression were estimated using multiple logistic regression. RESULTS Religious service attendance was associated with 30% lower odds of depression. In addition, individuals in the top tertile of existential well-being had a 70% lower odds of depression compared to individuals in the bottom tertile. Contrary to our original hypotheses, however, higher levels of religious well-being were associated with 1.5 times higher odds of depression. CONCLUSIONS Religious and existential well-being may be differentially associated with likelihood of depression. Given the complex interactions between religiosity and spirituality dimensions in relation to risk of major depression, the reliance on a single domain measure of religiosity or spirituality (e.g. religious service attendance) in research or clinical settings is discouraged.

Religious Service Attendance and Allostatic Load Among High-Functioning Elderly

Objective: To examine the association between frequency of religious service attendance and an index of cumulative physiological dysregulation as measured by allostatic load (AL) (systolic and diastolic blood pressure, waist/hip ratio, high-density lipoprotein and total cholesterol, glycosylated hemoglobin, cortisol, serum dihydroepiandrosterone sulfate, norepinephrine, and epinephrine).There is growing empirical evidence of a positive relationship between religious engagement and better clinical health outcomes. However, studies exploring the subclinical levels of physiological dysregulation are rare; hence, the physiological processes underpinning the religion-health relationship are not well understood. Methods: In 1988, 853 participants from the MacArthur Successful Aging Study provided information on the frequency of religious service attendance as well as blood and urine samples needed to obtain measures for a ten-item cumulative AL index. Gender-stratified multivariate linear regression models were used to estimate the direction and magnitude of the association between weekly religious service attendance and AL. Results: At least weekly religious service attendance was associated with lower AL levels among women (b = −0.47; p < .01), but not among men (b = 0.02; p = .88) in models that statistically controlled for age, income, education, marital status, and level of physical functioning. This relationship could not be attributed to the association between religious attendance and any one or two of the components of the AL index. It also was not explained by either higher physical functioning or social integration. Conclusion: Cumulative physiological dysregulation may be one mechanism through which religious engagement may influence a diverse range of clinically relevant health outcomes. IL-6 = interleukin-6; HPA = hypothalamic-pituitary-adrenal; EPESE = epidemiologic studies of the elderly; HDL = high-density lipoprotein; DHEA-S = dihydroepiandrosterone sulfate; OR = odds ratio; CI = confidence interval; CHD = coronary heart disease; AL = allostatic load; SES = socioeconomic status.

Why women attempt suicide: the role of mental illness and social disadvantage in a community cohort study in India

Context: The relative importance of illness (physical and mental) and social disadvantage as risk factors for suicide is controversial. Objectives: To describe the risk for attempted suicide in women when it is associated with social disadvantage and physical and mental illness. Methods: Data were analysed from a population-based cohort study of women aged 18–50, in Goa, India (n = 2494). Baseline information was collected on socioeconomic factors, gender disadvantage and physical and mental illness. The main outcome was self-report attempted suicide (AS) over a 12-month study period. ORs were calculated using exact logistic regression. Results: One-year incidence of AS was 0.8% (n = 18+1 completed suicide) and seven of these women had baseline common mental disorders (CMDs) (37%). In unadjusted models, CMDs (OR 8.71, 95% CI 2.86 to 24.43), exposure to violence (OR 7.70, 95% CI 2.80 to 22.21) and recent hunger (OR 6.59, 95% CI 1.83 to 19.77) were the strongest predictors of incident AS cases. However, in a multivariate model, exposure to violence (OR 5.18, 95% CI 1.55 to 18.75) and physical illness (OR 3.77, 95% CI 1.05 to 12.37) emerged as independent predictors of AS. Conclusions: Multi-pronged strategies to reduce domestic violence, provide poverty relief and improve treatment of mental and physical disorders are needed to reduce the population burden of attempted suicide.

The relationship between mental vitality and cardiovascular health.

Past measurement of vitality has included both emotional and physical components. Since aspects of physical vitality such as fatigue can be indicative of physical illness, the usefulness of existing measures of vitality to predict health is limited. This research was designed to examine the psychometric properties of a new Mental Vitality Scale and to test its associations with measures of cardiovascular health over the course of 2 years. The measure of mental vitality was administered in a two-part study using three different samples. In part 1, the reliability and validity of the scale was assessed with a student and a clinic sample. In part 2, medical data on mental and physical health were abstracted over a two-year period from 1041 patient records from a multi-specialty medical practice, and mental vitality assessed through a mailed questionnaire. The findings indicate that the Mental Vitality Scale is a valid and reliable questionnaire for measuring this construct. Mental vitality was also associated with reduced odds of several cardiovascular outcomes and prospective analyses suggest that mental vitality may serve a protective function in the development of cardiovascular disease. The results lend support for the importance of mental vitality as a construct that may be relevant for considering resilience in relation to cardiovascular disease.

Quality of Parental Emotional Care and Calculated Risk for Coronary Heart Disease

Objective: To evaluate associations between perceived quality of parental emotional care and calculated 10-year risk for coronary heart disease (CHD). Little is understood about the role of parental emotional care in contributing to the risk for CHD. Methods: The study sample was composed of 267 participants from the New England Family Study. Quality of parental emotional care was measured, using a validated short version of the Parental Bonding Instrument (PBI) as the average care scores for both parents (range = 0–12), with higher scores indicating greater care. Ten-year CHD risk was calculated, using the validated Framingham Risk Algorithm that incorporates the following prevalent CHD risk factors: age, sex, diabetes, smoking, total cholesterol, high-density lipoprotein cholesterol, and blood pressure. Multiple linear regression assessed associations of PBI with calculated CHD risk after adjusting for childhood socioeconomic status, depressive symptomatology, educational attainment, and body mass index. Results: Among females, a 1-unit increase in the parental emotional care score resulted in a 4.6% (p = .004) decrease in the 10-year CHD risk score, after adjusting for covariates. There was no association between parental emotional care score and calculated CHD risk score in males (p = .22). Conclusion: Quality of parental emotional care was inversely associated with calculated 10-year CHD risk in females, and not males. Although the gender differences need further investigation and these findings require replication, these results suggest that the early childhood psychosocial environment may confer risk for CHD in adulthood. CHD = coronary heart disease; PBI = parental bonding instrument; BMI = body mass index; SEP = socioeconomic position; HDL = high-density lipoprotein; CES-D = Center for Epidemiologic Studies Depression Scale.

Why do people with an anxiety disorder utilize more nonmental health care than those without

OBJECTIVE It is unclear why nonmental healthcare utilization is greater among those with psychological problems. The authors examined healthcare utilization in HMO patients to determine whether greater utilization in anxiety disorder (AD) patients was explained by anxiety symptoms (increasing sensitivity to physical symptoms) or comorbid illness (causing greater need for services). DESIGN Patients were randomly selected from the database of a multi-specialty practice and 1,041 completed a survey assessing psychological symptoms, health behaviors, and demographics. Anxiety symptoms were assessed by questionnaire and the presence of an AD was determined from the medical chart. Healthcare encounters and medication use were abstracted from medical charts and HMO claims data. MAIN OUTCOME MEASURES Healthcare utilization. RESULTS Both AD and anxiety symptoms predicted utilization, but symptoms were not associated with utilization in a model that also included AD. Comorbid illness was significantly associated with utilization independent of AD and somewhat reduced the strength of the AD-utilization association. The results were replicated in comparison of those with any psychiatric disorder to those without. CONCLUSION Among those with AD, greater utilization is not explained by anxiety symptoms but is partly explained by greater comorbid illness. Further study is needed to understand excess healthcare utilization among AD patients.