Screen your patients for anxiety and depression as a routine

Anxiety and depression are as strong predictors of various diseases such as high blood pressure, heart disease, arthritis, headaches, back pain and stomach upset as are obesity and smoking, according to the new research from the University of California San Francisco published online Dec. 17, 2018 in Health Psychology.

A population-based cohort study in the US analyzed data from more than 15,000 older adults enrolled in the Health and Retirement study over a four-year period and examined the longitudinal associations of anxiety and depression symptoms with onset of self-reported physical health indices. Baseline anxiety and depression were measured and tested as predictors of medical illness including heart disease, stroke, arthritis, high blood pressure, diabetes and cancer and somatic symptoms such as stomach issues, shortness of breath, dizziness, back pain, headache, pain and eyesight issues.

The study found that anxiety and depression not only predicted greater incidence of nearly all medical illnesses and somatic symptoms, they also independently increased risk for most physical health indices assessed. Overall, 16% of study participants had anxiety and depression symptoms, 31% were obese and 14% were current smokers.

·         Those with anxiety and depression symptoms were at 65% higher risk for a heart condition, 64% higher risk for stroke and 50% higher risk for hypertension.

·         Anxiety and depression also predicted greater incidence of most somatic symptoms, including headache, stomach upset, back pain and shortness of breath. Anxious and depressed patients had 161% increased risk of headache.

In a patient of heart disease or hypertension or back pain, for instance, the questions when eliciting history, usually relate to risk factors like smoking, alcohol, unhealthy diet, sedentary life or trauma etc. And, accordingly, lifestyle modifications and/or pharmacological management of risk factors, if present, are advised.

But, this approach may be overlooking two significant factors - anxiety and depression - as this study elucidates. The observed effects of anxiety and depression were found to be as strong as or even more powerful than those of obesity and smoking.

Hence, it is important to routinely screen patients for anxiety and depression. The presenting symptoms may not be just due to a physical illness, but may be due to an underlying mental health disorder such as anxiety and depression.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA