Mental health problems and heart diseases (cardiovascular diseases CVDs) are one of
the leading sources of morbidity and mortality across the world [1], [2]. Pervious
research has found that individuals with heart problems are more likely to experience
depression which is associated with the two-fold or greater risk of cardiovascular
mortality [3], [4]. Multitude of bio-behavioral mechanisms has been associated with
health-related behaviors, behavioral risk behaviors, impairment in autonomic nervous
system functioning, increased proinflammatory cytokines, and platelet activation [5],
[6], [7]. Many researches have found that mood, anxiety disorders, and stress occurred
among individuals with heart disease at higher rates than among individuals with the
comparable age and gender in the absence of heart disease. There is a decade of researches
speculating whether psychological disorders are a cause or consequence of heart disease
[8]. Although, the struggle to find the precise nature of these links is underdeveloped,
yet the proposed discussion on the state-of-the-art structure of the epidemiology
and pathophysiological aspects of possible bi-directional relation between mental
illness and heart problems with an understanding of possible causal relationship between
heart problems and psychological illness among the diverse cultural contexts, linguistic
differences, socioeconomic status of individuals, low and middle income countries
(lmics), and prevalence (predisposing, precipitating and perpetuating) mental illnesses
exists [8]. There is a high possibility of prevalence of mental disease in individuals
with cardiovascular problems and conversely, individuals with mental health problems
seems to have an increased risk of cardiovascular problems – including common pathophysiological,
epidemiological and pathophysiological mechanisms between mental illness and heart
disease.
Coronary artery disease or ischemic heart disease (CHD) is a term for the buildup
plaque in the heart’s arteries, leading to the failure of coronary circulation to
cardiac muscle and surrounding tissue which results in myocardial infarction (MI)
[9], [10]. Some of the risk factors include dyslipidemia, arterial hypertension, diabetes,
obesity, substance use (smoking, alcohol consumption, drugs), sedentary lifestyle
(diet higher in calories, saturated fat, and cholesterol, decreased compliance and
adherence to medication intake, and high physical inactivity) stress and old age [11]
– a perfect recipe under the global pandemic outbreak and quarantine policy for individuals
with heart problems who are also at risk/existing mental health problems. Mental illness
is also one of major contributor to the global burden of diseases [12], [13] as more
than 300million people suffer from depression worldwide and 14.3% deaths [14], [15]
each year are attributed to mental illness. Mental illness and psychological distress
are two highly prevalent common terms used to describe the current situation, experience,
and symptoms in a person’s life during the pandemic COVID-19 outbreak. A wide range
of mental health problems and unprecedented life situations during the coronavirus
outbreak including bereavement, grief, stress, loss of a job, sleep problems, violence,
abuse, accidents, trauma and health threat can induce psychological distress or exacerbate
pre-existing physical and mental health problems – acting as a contributor to or resulting
from the cardiovascular disease [16].
The prevalence of mental health problems with heart disease is threefold higher than
the general population and there is about 80% increase in the risk of developing new
or exacerbation of pre-existing cardiovascular disease [17] (complications or hospitalization)
during a perceived or actual threatening or stressful situation such as the advent
of COVID-19 [18], [19]. The prevalence of depression and anxiety is seen more common
among individuals with angina, at risk of developing myocardial infarction, stroke,
and atrial fibrillation, the bi-directional relationship in other words states that,
mental health problems can increase the risk of developing cardiovascular disease;
cardiovascular disease can increase the risk of developing mental health problems
[12], [13], [14], [15], [16], [17], [18]. General anxiety, psychological distress,
anger, negative emotions, fear, worry, grief, severe emotional stress [20] can result
in the release of the hormone adrenaline temporarily increasing blood pressure and
constricting arteries resulted in myocardial infarction (or the ‘broken heart syndrome’)
which have been shown to precipitate and perpetuate cardiovascular diseases [20],
[21].
The psychological impact of COVID-19 related quarantine includes post-traumatic stress
disorder, confusion and frustration [22]. Such major pandemic outbreak are showing
negative effects on psychological health of individuals and society, for instance,
psychological issues, mental distress, grief and bereavement, deliberate or unintentional
harm to family, loss/separation from family, self-injury, shame, guilt, helplessness,
posttraumatic stress symptoms, addiction or substance use, medical mistrust and inclination
towards conspiracies, panic attacks, stress, anxiety, depression, loneliness, suicidal
ideation, mood problems, sleep problems, worry, denial, boredom, ambivalence, uncertainty,
frustration, anger, fear, stigmatization, marginalization, xenophobia, mass hysteria,
socio-economic status, and other mental health concerns would require pre-established
coalition to mobilize resources for effective intervention, management and preventive
measures for affected individuals. [23], [24], [25], [26]. Mental health problems
can occur or aggravate or trigger psychological and emotional distress in self-isolated
and quarantined individuals [27]. Empirical findings are salient features at this
state of COVID-19 outbreak – addressing the individuals with cardiovascular disease
regarding health risks and perceived threats; reiterating mental health concerns predispose
to fixation on the stressful cognitive patterns; and encouraging lifestyle modification
and motivate behavior change helps stress appraisal and coping strategies [18]. Medication
as well as non-medication interventions including cognitive-behavioral therapy, mindfulness
meditation, transcendental meditation, spiritual/religious meditation, physical activity
staying, breathing exercise, could dramatically increase the efficacy of interventions
and quality of life. The goal of cultivating resilience, coping, mindfulness and healthy
adjustment with the change of lifestyle behavioral modification and mental wellbeing
will bring the immediate the focal of attention towards physical sensation (heart)
and emotions and thoughts (mental health) by contributing to a more coherent and healthy
sense of self and identity while living through the COVID-19 pandemic outbreak.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal
relationships that could have appeared to influence the work reported in this paper.