Mental health disorders and their impact on cardiovascular health disparities

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  Fig. 1. Mental health disorders: risk factors, consequences and high-risk groups. The main risk factors for mental health disorders are rooted in the social environment and in adverse exposures, especially those occurring early in life. Childhood abuse and other traumatic events are powerful predictors of mental health disorders. Poverty, social disadvantage and other chronic social/psychological stressors are also linked with poor mental health. Physical health problems like disability can also contribute to mental health disorders, especially depression. Substance use can induce mental health disorders, and genetic and familial factors are also implicated. There are high-risk populations, i.e., groups that are more likely to have risk factors for mental health disorders or are more vulnerable to their consequences on CVD risk. These include adolescents and young adults, women, combat veterans, sexual minorities, refugees and asylum seekers, incarcerated people, and caregivers of critically ill people. Patients with CVD represent another high-risk group for mental health disorders, especially for depression, anxiety disorders and PTSD. In turn, mental health disorders are leading…

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  Fig. 2. Behavioural and biological pathways linking mental health and cardiovascular health. There are many behavioural and biological pathways that can explain the comorbidity of mental health disorders and CVD. An unhealthy lifestyle is a common consequence of mental health problems and can lead to adverse cardiovascular risk factors such as obesity, diabetes, and dyslipidaemia. Biological factors include, among others, inflammation, autonomic nervous system dysregulation, thrombogenesis, insulin resistance, high blood pressure and vascular dysfunction. Opposite pathways can also be at play, such that CVD could trigger mental problems such as depression, anxiety and PTSD, and inflammation and autonomic dysfunction can contribute to the aetiology of mental health disorders. Finally, there could be common aetiology, involving risk factors that are shared between mental health disorders and CVD. These include social determinants of health, health behaviours like smoking and physical inactivity, inflammation, psychosocial stress, and familial and genetic influences.

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  Fig. 3. Multilevel model of cardiovascular disease disparities in persons with mental health disorders. Social determinants of health, healthcare systems and healthcare access and quality are highly interconnected and play a driving role in cardiovascular health disparities based on mental health at multiple levels. Interventions at the policy level to address social determinants of health and the structure of systems of care, and interventions at the clinical level to enhance access and quality of care tailored to the complex needs of people with mental health disorders are likely to provide the largest impacts to reduce disparities and improve outcomes of both mental health disorders and cardiovascular disease.