Life's Essential 8: Updating and Enhancing the American Heart ...

Mental Illness Makes You Age More Quickly

Source: Pavel Danilyu / Pexels

No doubt living with a mental illness can make you feel worn out, but a new study has shown that it's more than just a feeling–your body really is wearing out more quickly.

According to research presented at the 2023 European Congress of Psychiatry in Paris, those with a history of mental health conditions like anxiety, depression, or bipolar disorder have biomarkers suggesting we're older than we really are.

"Our findings indicate that the bodies of people with mental health problems tend to be older than would be expected for an individual their age," lead researcher Julian Mutz explained. "For example, people with bipolar disorder had blood markers indicating that they were around two years older than their chronological age."

How did the study determine biological age?

To pin down their subjects' biological age, Mutz and colleague Cathryn Lewis, both of King's College London, analyzed the blood metabolites of over 100,000 UK residents. Metabolites are small organic compounds created by the human metabolism, like glucose, cholesterol, and amino acids. The concentration of some metabolites in the bloodstream increases over time while others decline, enabling researchers to use them as a measure of age. Mutz and Lewis found that individuals who were mentally ill had a metabolite profile beyond their years.

Previous studies have shown that people with long-term mental illness tend to be less physically healthy than the general population. We're more prone to conditions like heart disease and diabetes, and we have shorter life expectancies, too–seven years shorter on average for women and ten years shorter for men.

Why do people with mental illness age more quickly?

There are several ways that mental illness can take a toll on the body.

People with mental disorders are at higher risk of poverty and homelessness, precarious living conditions known to shorten life expectancy. The stigma around mental illness can lead to social isolation and even violence, which have a negative effect on overall wellness.

The symptoms of mental illness can also interfere with a person's ability to maintain healthy habits. People who are mentally ill are more likely to smoke and less likely to eat a nutritious diet and get regular exercise.

Finally, the illness itself has a physical impact. Anxiety and depression increase the circulation of stress hormones in the bloodstream and lead to chronic inflammation, contributing to age-related diseases.

What can you do to avoid aging before your time?

Accelerated aging isn't a foregone conclusion when you have a mental illness. You can take steps to stay healthy and slow the aging process.

The first and foremost is to pursue treatment for your mental health symptoms–don't just muddle through on your own. Diagnosis, therapy, and, if appropriate, medication can improve your quality of life and ease the strain mental illness puts on your body.

Regular mindfulness meditation, meanwhile, has been shown to reduce not only the psychological symptoms of anxiety and depression but also their physical effects in the form of stress hormones and inflammation.

If your symptoms are under control, you can work on living a healthy lifestyle by eating well, getting physical activity, giving up smoking, and nurturing positive relationships. All of these practices will benefit both your physical and your mental health.

For Mutz, this research isn't a bad-news story but an opportunity to improve health outcomes for those with mental illness.

"If we can use these markers to track biological aging," he says, "this may change how we monitor the physical health of people with mental illness and evaluate the effectiveness of interventions aimed at improving physical health."

Hidden Signals Can Reveal Mental Illness More Clearly Than A Brain Scan

© Provided by ScienceAlert Silhouetted Man Near Window

The notion that what goes on inside our heads can profoundly influence our body's typical functions has gained momentum over time, with decades of research revealing how gut health can influence mood and even neurological disease.

A new study by a team of researchers from Australia now suggests mental illness might manifest in the body even more obviously than it does in the brain. An analysis of more than 175,000 individuals suggests that poor physical health scores could be a better indicator of mental illness than changes detected on brain scans.

Lead author, psychiatrist and neuroscientist Ye Ella Tian, explained on Twitter that those diagnosed with a mental illness showed subtle brain changes as you might expect, but they also had "considerably poorer physical health across multiple body systems compared to their healthy peers."

In some respects, this isn't so surprising. Research shows that mental illness is associated with poor physical health and chronic illness, such as obesity and diabetes, which may be related to the side effects of medication or disparities in access to healthcare.

For example, people with schizophrenia are around three times more likely to develop diabetes than the general population; they also have a two-fold increased risk of coronary heart disease, Tian says.

However, the impact of severe mental health conditions on other aspects of physical health, such as lung health, liver dysfunction, and bone loss, is less well-studied. To make matters worse, physical health more generally has been "underestimated, inadequately treated, and often overlooked in psychiatry" for decades, the University of Melbourne's Tian and colleagues write.

Compiling a suite of measurements from MRI brain scans and health assessments from a number of different study collectives, the team produced scores of brain health and the function of seven body systems, including the immune system, liver (hepatic) function, heart, lung and kidney health. This allowed them to compare health scores among people diagnosed with mental illness to populations of people the same age.

Differences in brain imaging results could accurately differentiate between the four mental health conditions studied: schizophrenia, bipolar, depression, and generalized anxiety disorder.

And yet, despite the neural basis of mental illness, the study found that individuals with one or more of these disorders could be differentiated "with modest accuracy" from healthy controls of a similar age based on body health alone.

Body health scores for liver and kidney function, the immune system, and metabolism were consistently poor across mental health conditions compared to healthy controls – and turned out to be better predictors of a mental health diagnosis than brain imaging scores.

That physical health measures would surpass differences in brain imaging results "was quite a surprising finding" given how mental illness is rooted in the disordered brain, University of Melbourne neuroscientist Andrew Zalesky explained in a podcast.

Even so, there are many possible reasons that explain why poor physical health goes hand in hand with mental severe illness: from the side effects of antipsychotic medications and mood-stabilizing drugs, to the chronic stress, increased infections, and enhanced immune responses that people with mental ill-health experience. For instance, research shows that for people with schizophrenia, their risk of dying from COVID-19 was nearly three times higher than people without the disorder.

The researchers note that their findings – which are mostly from white, British populations – aren't meant to be used as a diagnostic tool. "We should note here that these are individuals with an established diagnosis," Zalesky added. "Whether this would hold before the onset of the disorder we don't know."

Instead, the findings should help psychiatrists to appreciate how different aspects of physical health are affected by mental illness, and encourage them to treat both the body and the mind when managing people with mental health conditions.

In this particular study, chronic physical health issues were often not diagnosed in people with mental health conditions but the findings suggest "that poor body health and function may be important illness manifestations that require ongoing treatment in patients," the researchers conclude.

The study has been published in JAMA Psychiatry.

Digital Health Reduces Anxiety, Depression In Patients With Chronic Diseases

All technology-based interventions substantially improved mental health, but those partially supported by health care providers were shown to be most effective.

A broad range of digital health technologies were effective for managing mental health issues in adults living with a chronic disease, according to an international meta-analysis published in Systemic Reviews.

Further, when guided by health care providers, technology systems were even more effective in lessening anxiety and depression, the authors wrote. 

Most people with a chronic disease, such as diabetes, hypertension, or cancer, have more than 1 concurrent condition and are at higher risk for developing comorbidities in mental health, the authors explained. Previous research suggests the prevalence of depression or anxiety, together with a chronic disease, is approximately 27%.

"There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services," study investigators said.

The aim of the study was to assess what types of digital health interventions were most effective in managing concomitant mental health and chronic diseases.

At the start, the researchers convened a panel of knowledge users (clinicians, decision makers), lived experience experts (patients), review methodologists, and researchers to assist with the investigation. They then analyzed data from a rapid review of systemic reviews, identified knowledge gaps, held a virtual workshop with knowledge users to discuss their preliminary findings and gather suggestions, and conducted a secondary meta-analysis of primary studies, which included an outcome measurement of anxiety or depression, identified through the rapid review process.

Eighty-four primary studies conducted in 12 countries and published between 2010 and 2019 met the meta-analysis inclusion criteria. The studies comprised a sample of 11,037 participants.

Most of the studies compared technology-based interventions to usual care (76%), and some compared 2 or more digital interventions (24%). Eight percent were based on cognitive behavioral therapy.

To classify specific types of technological tools, researchers consulted WHO Classification of Digital Health Interventions and previous reviews on digital mental health systems. However, given the limitations of existing classifications, they ultimately developed their own, which included 10 categories: internet or website, computer software, mobile application, electronic messaging (email, SMS), electronic health record, telehealth (telemedicine, telepsychiatry), virtual reality/augmented reality, robot, connected devices, and other system.

In addition to studying the effectiveness of different digital health technologies, the investigators considered characteristics of various delivery methods, comparing self-administered systems with those guided by a health care provider (partial support).

Systems that offered partial support from a health care provider, identified in 29 studies reporting anxiety outcomes and 33 studies reporting depression outcomes, showed a significant decrease in anxiety scores, of –0.46 (95% CI, –0.39 to –0.53), and depression scores, –0.43 (95% CI, –0.36 to –0.50).

Self-administration delivery methods, identified in 30 studies with anxiety outcomes and 40 studies reporting depression outcomes, also showed a significant decrease in anxiety scores, at –0.35 (95% CI, –0.30 to –0.41), and depression scores, at –0.28 (95% CI, –0.23 to –0.33).

Although the study found varying levels of effectiveness, the researchers emphasized that all technology-based interventions and levels of support were effective in managing mental health issues. In addition, digital technologies were more effective than in-person care for both depression and anxiety conditions, they noted.  

However, the findings should be interpreted with caution. Heterogenicity between studies was generally high, although the results were consistent across studies, and some studies used multiple systems in the same intervention, which could have overestimated the effect size.

Still, the authors emphasize that their results demonstrate that digital technologies can significantly reduce anxiety and depression in persons living with a chronic disease. Technology-based interventions could also save clinical time and resources, as well as care engagement, the authors suggested.

The study identified electronic messaging as the most effective digital health intervention to improve mental health conditions.

"While our meta-analysis indicates different levels of effectiveness associated with digital interventions' characteristics, all technologies and levels of support can be used," the study authors concluded. "Indeed, as our results show that all types of technologies are equally or more effective than usual care, stakeholders could choose and implement interventions in relation with the needs of the population."

Reference

Sasseville M, LeBlanc A, Tchuente J, et al. The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis. Systemic Reviews. Published online May 4, 2023. Doi:10.1186/s13643-023-02241-1

---