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Depression, Anxiety May Take Same Toll on Health as Smoking and Obesity

Incidence of Arthritis, Heart Disease, Stroke – But Not Cancer – Strongly Predicted by Elevated Depression and Anxiety, UCSF Study Shows

When you think about changing your lifestyle, do you include your mental health? When it comes to your risk for developing major chronic diseases in later life, our recent study indicates that availing of evidence-based treatments for depression and anxiety may be as important as maintaining a healthy body weight or quitting smoking.

In a sample of 15,418 people who took part in the Health and Retirement Study, we found that depression and anxiety increased risk for new onset medical conditions during a four-year period when the participants had an average age of 68 years. Specifically, the combination of depression and anxiety significantly increased risks for multiple major medical conditions, such as heart disease and arthritis, and general bodily symptoms, such as pain and stomach problems.

One of our goals was to better understand the clinical and public health importance of depression and anxiety’s effects on physical health. Thus, we compared the size of the effect for depression and anxiety with the size of the effects for obesity and smoking in the same people. In the case of almost all of the health conditions and bodily symptoms, depression and anxiety conferred risks that were similar to or larger than those associated with obesity and smoking. The exception to this pattern was diabetes, which was more strongly associated with obesity than with depression and anxiety.

Findings from this research are in line with those from many other studies linking depression with poor physical health. In our study, depression alone increased risk for developing a heart condition, high blood pressure, diabetes, arthritis, and stroke. Anxiety is a common mental health issue that is often underappreciated and undertreated, even compared to depression. In our study, anxiety alone also increased risk for developing a heart condition, high blood pressure and stroke, even independent of depression.

One striking finding in our data was that depression and anxiety did not predict the onset of cancer diagnoses over the four years of follow up. Despite widespread beliefs that psychological distress increases risk for cancer, this finding is actually in line with other studies that have found no relationship of stress and depression with cancer risk.

Overall, few patients presenting with depression and anxiety in primary care are adequately assessed, and even fewer receive evidence-based treatments. Although further research is needed, it is possible that such treatments could prevent onset of health conditions and alleviate distress associated with somatic symptoms that frequently require far more costly and invasive treatment procedures.

Our findings also have implications for health equity and equality. Societal factors such as financial strain, discrimination, and stigma increase risk for depression and anxiety and may also limit access to mental health treatments. Expanding access to evidence-based treatments for mental health disorders is critical for all of society, but particularly for vulnerable groups. In resource-poor healthcare settings, this presents a major challenge. Digital health interventions such as web-based cognitive behavioral therapy (e.g., tiny.ucsf.edu/betterbet) and app-based interventions may provide a partial solution to this challenge. From a public health perspective, the message is clear. Initiatives focused on expanding access to and uptake of evidence-based treatments for depression and anxiety may have knock-on effects on physical health.

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