We often come across many who are saddled with a chronic illness. It could be a loved one or you yourself who is suffering from a debilitating condition. This can undoubtedly take a toll on one’s mental health. Since there is a co-occurrence of chronic illnesses and mental health issues, we spoke to University of Colombo Faculty of Medicine Senior Lecturer in Psychiatry and National Hospital of Sri Lanka Honorary Consultant Psychiatrist Dr. Chathurie Suraweera.
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University of Colombo Faculty of Medicine Senior Lecturer in Psychiatry and National Hospital of Sri Lanka Honorary Consultant Psychiatrist Dr. Chathurie Suraweera[/caption]
According to Dr. Suraweera, people with chronic illnesses may have mental health issues due to several reasons. It could result from disability – for example, those who are suffering from cancer can have back pain, and therefore the chronic pain can result in both physical and mental health challenges. At times, mental health issues are a component of the illness itself. Hypothyroidism, vitamin D deficiency, epilepsy, and HIV/AIDS are examples. A high percentage of people develop depression following strokes and heart attacks, which lead to increased morbidity and mortality if not properly treated. Illnesses like diabetes have a bi-directional association with depression, where both contribute to the management of the condition. If they are co-occurring, it can adversely affect proper management. Some medications given for chronic diseases can also result in mental health issues, especially epilepsy and arthritis. However, sometimes it may be the psychiatric illness that contributed to the physical illness, as in the case of alcohol dependence leading to liver failure.
How common is it?
Approximately a third of patients attending medical and surgical outpatient clinics have a psychiatric disorder. Half of these patients have depressive and anxiety disorders, and the rest suffer from somatoform disorders. Similarly, around 20% of medical and surgical inpatients have a depressive or anxiety disorder co-existing with their medical illness. It’s also estimated that 10% have an alcohol-use disorder, and at least 25% of elderly inpatients experience delirium. Mental health issues are also present in a third of patients with serious, acute, recurrent, or progressive medical conditions. All these figures thus highlight the importance of actively looking for mental health issues in patients with severe and long-term physical health issues. If they’re not identified and addressed early, there is an increased risk of suicide in the medically ill compared to the general population. These associations are particularly higher in diseases such as cancer and multiple sclerosis, as some of them will suffer from depression.
Some common signs and symptoms of mental health issues
For all patients, early recognition and prompt treatment of the psychiatric disorder can improve the outcomes immensely. For example, if a patient with diabetes has depression, they would not be motivated to adhere to lifestyle modifications such as exercising and eating a healthy diet. Additionally, a loss of appetite may lead to reduced blood glucose, which might be exacerbated with medication. Therefore, it might affect the optimal control of diabetes. A depressed patient with cancer refusing chemotherapy is another example where mental health issues will negatively affect the physical illness.
How does one differentiate between general symptoms of a chronic illness vs. mental health issues?
It is sometimes difficult to differentiate, as some physical and psychiatric illnesses may have overlapping symptoms such as fatigue and poor sleep. Although challenging at times, this problem can be overcome as the psychiatric conditions are diagnosed using a constellation of symptoms rather than just one symptom. For example, feeling persistently sad, lacking interest in usually pleasurable activities, hopelessness, and fatigability would help establish the diagnosis of depression in a patient who has fatigability due to chronic renal failure.
What are the trends seen in this regard due to long covid?
Covid-19 is associated with psychiatric illnesses due to many reasons. The social isolation, financial hardships, and disruptions in day-to-day life have contributed to many becoming depressed. The threat of Covid-19 for health, finances, and life has increased anxiety among the population. People who have contracted Covid-19, those in quarantine facilities and their contacts are at a higher risk of developing mental health issues.
The World Health Organisation (WHO) stipulates: “Long covid syndrome is diagnosed when a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of Covid-19 with symptoms and that lasts for at least two months and cannot be explained by an alternative diagnosis.” Common symptoms of the long covid syndrome include fatigue, shortness of breath, cognitive dysfunction (difficulties in thinking, planning, language, memory), and generally impacts everyday functioning. It is essential to be mindful of mental health issues, since depression is also a symptom of the long covid syndrome and anxiety disorders are commonly reported in the post-covid period.
One sufferer of the long covid syndrome shared with The Sunday Morning Brunch that she struggled to figure out when something was a symptom of her chronic illness or a mental health issue (she had suffered from depression in the past). “The symptoms were sometimes similar, and chronic illness definitely made the depression worse, and perhaps the other way too. I think those blurred lines were tricky to navigate. I think there was a lot of realisation about how both aspects should be approached looking at the person as a whole, and understanding that one illness was not worse or lesser than the other,” this patient shared.
Sharing her thoughts on how patients with chronic illness and mental illness can be better supported, she added that support doesn’t always have to be medical. She explained: “It’s probably very personal, but just some suggestions because coming up with stuff someone can do for you is very difficult: For example, a friend of mine used to pick me up and go for a short walk and drop me back at the company, and having that regular schedule with someone offered me so much. They also asked me how I was feeling that day or that afternoon, checked in on my capacity to do the activity or chat etc. It was so much more pleasant than the ‘get well soon’, ‘are you better now’ type of talk no matter how well-meaning it was, because there isn’t really a ‘getting better’ with chronic illness; it’s constant ups and downs.”
When should one consult a doctor?
If you or a loved one who is suffering from a physical illness is reporting features of mental health problems, it is advisable to see a doctor as soon as possible, as most of the mental health issues can be successfully managed and controlled. You can report to the doctor or specialist looking after your physical health problem, your general practitioner (GP), or a psychiatrist. If you are going to a doctor other than the doctor/specialist who is treating your physical illness, you must take the details of the physical illness you are having, medications you are on, and any investigations that have been done. This will enable your GP/psychiatrist to give you the best medication suited to your condition with minimal interactions with the medicines that you are taking and aggregable to whatever issues you have with your body systems. Psychiatric units with consultant psychiatrists have been established up to the level of most base B hospitals. Due to a lack of mental health literacy and stigma, one may silently suffer without seeking help, which is detrimental to their mental and physical health. Seeking help would make a definite difference in their quality of life and contribute immensely to the control of physical illness.
What are the available treatment options?
Mental health issues can be managed using medications or psychological therapies (talking therapies). The decision on if it is medications, therapy, or both, depends on several factors like the mental health issue and the severity. In most instances, one must remember that the medications will take about one to two weeks to start acting. The medications should be continued until the doctor decides to discontinue. Contrary to what most people think, medications will not be addictive, stated Dr. Suraweera.
Take-home message
Mental health issues are common among those who have physical illnesses. It is important to identify mental health issues early and treat them vigorously for better outcomes and quality of life.
University of Colombo Faculty of Medicine Senior Lecturer in Psychiatry and National Hospital of Sri Lanka Honorary Consultant Psychiatrist Dr. Chathurie Suraweera[/caption]
According to Dr. Suraweera, people with chronic illnesses may have mental health issues due to several reasons. It could result from disability – for example, those who are suffering from cancer can have back pain, and therefore the chronic pain can result in both physical and mental health challenges. At times, mental health issues are a component of the illness itself. Hypothyroidism, vitamin D deficiency, epilepsy, and HIV/AIDS are examples. A high percentage of people develop depression following strokes and heart attacks, which lead to increased morbidity and mortality if not properly treated. Illnesses like diabetes have a bi-directional association with depression, where both contribute to the management of the condition. If they are co-occurring, it can adversely affect proper management. Some medications given for chronic diseases can also result in mental health issues, especially epilepsy and arthritis. However, sometimes it may be the psychiatric illness that contributed to the physical illness, as in the case of alcohol dependence leading to liver failure.
How common is it?
Approximately a third of patients attending medical and surgical outpatient clinics have a psychiatric disorder. Half of these patients have depressive and anxiety disorders, and the rest suffer from somatoform disorders. Similarly, around 20% of medical and surgical inpatients have a depressive or anxiety disorder co-existing with their medical illness. It’s also estimated that 10% have an alcohol-use disorder, and at least 25% of elderly inpatients experience delirium. Mental health issues are also present in a third of patients with serious, acute, recurrent, or progressive medical conditions. All these figures thus highlight the importance of actively looking for mental health issues in patients with severe and long-term physical health issues. If they’re not identified and addressed early, there is an increased risk of suicide in the medically ill compared to the general population. These associations are particularly higher in diseases such as cancer and multiple sclerosis, as some of them will suffer from depression.
Some common signs and symptoms of mental health issues
- Feeling low or high
- Changes in the levels of energy
- Changes in sleep and appetite
- Poor self-care
- Not attending to usual responsibilities or interests
- Worry and apprehension
- Raising heartbeat
- Difficulty in breathing
- Aches and pains
- Changes in behaviour
- Negative thoughts
- Abnormal beliefs
- Excessive fear
- Issues with attention and concentration
- Use of alcohol and other psychoactive substances
For all patients, early recognition and prompt treatment of the psychiatric disorder can improve the outcomes immensely. For example, if a patient with diabetes has depression, they would not be motivated to adhere to lifestyle modifications such as exercising and eating a healthy diet. Additionally, a loss of appetite may lead to reduced blood glucose, which might be exacerbated with medication. Therefore, it might affect the optimal control of diabetes. A depressed patient with cancer refusing chemotherapy is another example where mental health issues will negatively affect the physical illness.
How does one differentiate between general symptoms of a chronic illness vs. mental health issues?
It is sometimes difficult to differentiate, as some physical and psychiatric illnesses may have overlapping symptoms such as fatigue and poor sleep. Although challenging at times, this problem can be overcome as the psychiatric conditions are diagnosed using a constellation of symptoms rather than just one symptom. For example, feeling persistently sad, lacking interest in usually pleasurable activities, hopelessness, and fatigability would help establish the diagnosis of depression in a patient who has fatigability due to chronic renal failure.
What are the trends seen in this regard due to long covid?
Covid-19 is associated with psychiatric illnesses due to many reasons. The social isolation, financial hardships, and disruptions in day-to-day life have contributed to many becoming depressed. The threat of Covid-19 for health, finances, and life has increased anxiety among the population. People who have contracted Covid-19, those in quarantine facilities and their contacts are at a higher risk of developing mental health issues.
The World Health Organisation (WHO) stipulates: “Long covid syndrome is diagnosed when a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of Covid-19 with symptoms and that lasts for at least two months and cannot be explained by an alternative diagnosis.” Common symptoms of the long covid syndrome include fatigue, shortness of breath, cognitive dysfunction (difficulties in thinking, planning, language, memory), and generally impacts everyday functioning. It is essential to be mindful of mental health issues, since depression is also a symptom of the long covid syndrome and anxiety disorders are commonly reported in the post-covid period.
One sufferer of the long covid syndrome shared with The Sunday Morning Brunch that she struggled to figure out when something was a symptom of her chronic illness or a mental health issue (she had suffered from depression in the past). “The symptoms were sometimes similar, and chronic illness definitely made the depression worse, and perhaps the other way too. I think those blurred lines were tricky to navigate. I think there was a lot of realisation about how both aspects should be approached looking at the person as a whole, and understanding that one illness was not worse or lesser than the other,” this patient shared.
Sharing her thoughts on how patients with chronic illness and mental illness can be better supported, she added that support doesn’t always have to be medical. She explained: “It’s probably very personal, but just some suggestions because coming up with stuff someone can do for you is very difficult: For example, a friend of mine used to pick me up and go for a short walk and drop me back at the company, and having that regular schedule with someone offered me so much. They also asked me how I was feeling that day or that afternoon, checked in on my capacity to do the activity or chat etc. It was so much more pleasant than the ‘get well soon’, ‘are you better now’ type of talk no matter how well-meaning it was, because there isn’t really a ‘getting better’ with chronic illness; it’s constant ups and downs.”
When should one consult a doctor?
If you or a loved one who is suffering from a physical illness is reporting features of mental health problems, it is advisable to see a doctor as soon as possible, as most of the mental health issues can be successfully managed and controlled. You can report to the doctor or specialist looking after your physical health problem, your general practitioner (GP), or a psychiatrist. If you are going to a doctor other than the doctor/specialist who is treating your physical illness, you must take the details of the physical illness you are having, medications you are on, and any investigations that have been done. This will enable your GP/psychiatrist to give you the best medication suited to your condition with minimal interactions with the medicines that you are taking and aggregable to whatever issues you have with your body systems. Psychiatric units with consultant psychiatrists have been established up to the level of most base B hospitals. Due to a lack of mental health literacy and stigma, one may silently suffer without seeking help, which is detrimental to their mental and physical health. Seeking help would make a definite difference in their quality of life and contribute immensely to the control of physical illness.
What are the available treatment options?
Mental health issues can be managed using medications or psychological therapies (talking therapies). The decision on if it is medications, therapy, or both, depends on several factors like the mental health issue and the severity. In most instances, one must remember that the medications will take about one to two weeks to start acting. The medications should be continued until the doctor decides to discontinue. Contrary to what most people think, medications will not be addictive, stated Dr. Suraweera.
Take-home message
Mental health issues are common among those who have physical illnesses. It is important to identify mental health issues early and treat them vigorously for better outcomes and quality of life.