Presented By: Cynthia Stinson, Chair, Lamar University Dishman School of Nursing
Thursday, September 14, 2023
Report By: Kathie Platt
Dr. Cynthia Stinson, Ph.D., APRN, CNS, RN-BC, Chair of Lamar University School of Nursing, recently presented an educational seminar on Mental Health Issues Related to Diagnosis of Chronic Illness at the Gift of Life offices in Beaumont. Part of the Gift of Life Cancer Crusaders ongoing educational series for medical professionals, each topic provides in-depth training, as well as CNEs, on issues related to cancer prevention, diagnosis, treatment, and recovery. This latest seminar is also intended for the general public who can benefit from this new information and research on chronic disease and mental health. The presentation coincides with National Suicide Prevention Month (September), followed by Mental Health Awareness Week (the first week of October).
Stinson pointed out that, since the COVID-19 pandemic, suicide rates in the US are now highest among health care professionals compared to the general population. A study (published Tuesday, September 26, 2023) in the medical journal JAMA, states that:
Compared with people who don’t work in the medical field, health care workers face an increased risk of suicide, especially registered nurses, health care support workers and health technicians, according to a new study.
“Our results extend earlier research from outside the United States that health care workers compared with non-healthcare workers have greater risks for mental health problems and long-term work absences due to mental disorders,” Dr. Mark Olfson, a professor at Columbia University and an author of the new study, said in a news release. “The importance of increased suicide risk of health care support workers is underscored by their growth from nearly 4 million in 2008 to 6.6 million in 2021.” – CNN
Significantly, the increased risk for suicide among stressed or over-worked healthcare workers is followed closely by people diagnosed with a chronic illness. A chronic illness is defined broadly as conditions that last one year or more and that require ongoing medical attention or limit activities of daily living or both. “It should not be surprising that chronic diseases, such as heart disease, cancer, and diabetes are not only the leading causes of death and disability in the United States, but chronic health conditions cause stress, grief and loss that correlate highly with mental health challenges, mental illness and suicide,” Stinson explained.
Chronic Disease: A Risk Factor For Mental Illness
Many chronic illnesses are accompanied by pain, a factor that doubles risk of suicidal thoughts and behaviors. Severity and consistency of pain, as well as diagnostic ambiguity, have been reported to increase this risk. One of the least understood and ambiguous pain conditions, fibromyalgia, has a risk of death by suicide that has been reported to be ten times that of the general population. Validating and addressing that pain is essential to a patient’s resilience, as this study highlights that risk is reduced when the patient is receiving ongoing and consistent medical care.
COVID – Chronic Disease & Mental Health
COVID-19 has had a devastating effect, globally. However, it’s impact on mental health and its long-term status as a chronic condition for many adds complexity to the existing challenge. Since the pandemic began, 41% of Americans said that they experienced symptoms of anxiety or depression. This is a 30% increase since pre-pandemic 2019. With more people experiencing mental illnesses for the first time, an already-burdened and under-resourced mental health system cannot address adequately (Guerra, 2022).
Depression: A Risk Factor For Chronic Disease Epidemiologic studies have shown that 50.6% of people with mental disorders also had a chronic medical condition. People with depression have an increased risk of cardiovascular disease, diabetes, stroke, pain, and Alzheimer’s disease. Research also suggests that people with depression may be at higher risk for osteoporosis. The reasons are not yet clear. Scientists are also exploring whether physiological changes seen in depression may play a role in increasing the risk of physical illness. In people with depression, scientists have found changes in the way several different systems in the body function that could have an impact on physical health. Depression and anxiety have been show to cause increased inflammation, changes in the control of heart rate and blood circulation, abnormalities in stress hormones, and metabolic changes such as those seen in people at risk for diabetes (NIH, Mental Health, 2021).
“What Happens When Your Life Comes To A Standstill?”
“Western medicine approaches to treating conditions separately, rather than approaching a patient holistically, often leaves relevant factors and features of a patient’s concerns and overall wellbeing unaddressed,” said Stinson. “Our western way of dealing with a disease is giving a pill or a treatment, rather than dealing with root causes and treating a patient as a person, i.e., holistically.”
Stinson shared her own experience of being diagnosed with Stage 2 invasive breast cancer in 2007 and the uncertainly and life upheaval caused by that diagnosis and treatment. “I just wanted my life to be normal. But when you have a chronic illness, you have a new normal and have to find ways to deal with it.”
“If your heart is hurting, then it’s still beating,” Stinson said. “But the world feels different now, full of unanswered questions like: Who can help me? Will I keep my job? Will I have insurance? Will my insurance pay? Am I alone? Why is everyone else so happy? Am I going to die? How can I tell my family? Will my partner leave me?”
“The diagnosis of a chronic illness is a source of stress in itself, along with uncertainly about the future, unpredictability about the disease, fear of disability, and financial difficulties. Whatever the disease, it changes your lifestyle by imposing treatments, therapies, medicines, refills, new schedules and routines, as well as interrupting your plans and dreams.”
Red Flag Symptoms
Mental illness symptoms include: Irritability and difficulty in relationships; anxiety, tension and sadness; loss of interest in things you once enjoyed; disturbed sleep; fatigue; body aches and pains, including headaches; and cognitive issues. Disturbed sleep can particularly contribute to depression and anxiety.
Five Stages of Grief
In 1969 Kubler-Ross first popularized the five stages of grief associated with chronic illness, death and dying: Denial, Anger, Bargaining, Depression, and finally Acceptance. In order to adjust to a life-changing diagnosis, one must first address the grief caused by unavoidable life changes brought on by a chronic illness.
Stinson stressed, “People don’t always share what they’re going through with their family and may need a counselor or therapist to talk to. When a close family member was receiving a diagnosis of cancer, she chose to let me know only after a positive biopsy. ‘Because I didn’t want to worry you,’ she explained.”
“A diagnosis of chronic disease changes what’s normal for you,” Stinson said. “You have to give people permission to grieve in their own way, realizing that there is no right or wrong way, and we all walk different paths. Some people don’t get through all five stages of grief. The most important thing is to allow people to bring their emotions and feelings to the forefront and allow them to talk about it. Rather than pushing the grief down, minimizing, or avoiding it, help them get down into the layers of grief. The only way to get people to tell you the truth is if they trust you.”
What Can We Do? Strategies & Recommendations
“Treating stress, anxiety and depression with medication, psychotherapy (also called “talk therapy”), or a combination of the two, may help improve the physical symptoms of a chronic illness or reduce the risk of future problems. Psychotherapy may involve either individual counseling, or a family or couples-trained mental health provider,” she shared.
In addition to seeking professional treatment, strategies involve lifestyle changes. Disturbed sleep can be addressed by instituting a sleep hygiene routine: going to bed and awaking at the same time each day, no alcohol before bed, and no TV or devices before sleep. Other recommendations include: “Eat a healthy diet. Get as much physical activity as you can. Avoid negative coping mechanisms like alcohol and substance abuse. Explore stress-relief activities like meditation. Let go of obligations that you don’t really need to do or want to do. Ask for help when you need it. And stay in touch with family and friends. Support groups are also a valuable option as these provide a useful sharing experience. They provide an environment where individuals can learn new ways of dealing with their illness from other people’s coping strategies,” Stinson said.
And Don’t Forget, Physical Activity
Physical activity can protect against many morbidities, including mental health problems. The Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) recommend that adults exercise for at least 30 minutes on most days to improve their health and quality of life. Clinical trials have confirmed that regular exercise effectively treats the disease, including physical ailments, e.g., cardiovascular disease, and psychiatric disorders , e.g., depression. Further, cross-sectional studies frequently associate regular exercise with general well-being and lower mood and anxiety disorder rates.
“People don’t really understand how a chronic diagnosis upends everything in your world because ‘You don’t really get it until you get it,’” Stinson shared. “A life-altering diagnosis of chronic disease brings about unwanted changes with no sense of control. It’s not just a slight change of plans but a life re-orientation. It’s not your normal but a new normal for you. It’s important to know that we’re not alone,” Stinson said.
While September is National Suicide Prevention Month, the National Alliance for Mental Illness (NAMI) celebrates Mental Health Awareness Week the first week of October each year, and the World Health Organization (WHO) celebrates World Mental Health Awareness Day on October 10.
Bellamy, M. (2022) Chronic Illness: A factor in suicide risk retrieved from https://jameskirkbernardfoundation.org/uncategorized/chronic-illness-as-a-factor-in-suicide-risk
Guerra, M. (2022) The cascading effect of comorbidities: Addressing chronic medical disease alongside mental health retrieved from https://healthcare.rti.org/insights/mental-health-and-chronic-disease-comorbidities
LaFlam, J., Nathanson, A., Sookdeo, T. (2021) Chronic illness & mental health: An introductory guide retrieved from https://www.choosingtherapy.com/chronic-illness-mental-health
National Institute Mental Health (2021) Chronic illness and mental health: Recognizing and treating depression retrieved from https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health