Many people have mental health concerns from time to time.

But a mental health concern becomes a

mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to
function.Many people have mental health concerns from time to time. But a mental health concern
becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your
ability to function.

Mental illness, also called mental health disorders, refers to a wide range of mental health conditions —
disorders that affect your mood, thinking and behavior. Examples of mental illness include depression,
anxiety disorders, schizophrenia, eating disorders and addictive behaviors.

Many people have mental health concerns from time to time. But a mental health concern becomes a
mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to
function.

Symptoms

Signs and symptoms of mental illness can vary, depending on the disorder, circumstances and other
factors. Mental illness symptoms can affect emotions, thoughts and behaviors.

Examples of signs and symptoms include:

Feeling sad or down

Confused thinking or reduced ability to concentrate

Excessive fears or worries, or extreme feelings of guilt

Extreme mood changes of highs and lows

Withdrawal from friends and activities

Significant tiredness, low energy or problems sleeping

Detachment from reality (delusions), paranoia or hallucinations

Inability to cope with daily problems or stress

Trouble understanding and relating to situations and to people

Problems with alcohol or drug use

Major changes in eating habits

Sex drive changes

Excessive anger, hostility or violence

Suicidal thinking

Sometimes symptoms of a mental health disorder appear as physical problems, such as stomach pain,
back pain, headaches, or other unexplained aches and pains.

Causes

Mental illnesses, in general, are thought to be caused by a variety of genetic and environmental factors:

Inherited traits. Mental illness is more common in people whose blood relatives also have a mental
illness. Certain genes may increase your risk of developing a mental illness, and your life situation may
trigger it.

Environmental exposures before birth. Exposure to environmental stressors, inflammatory conditions,

toxins, alcohol or drugs while in the womb can sometimes be linked to mental illness.

Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other
parts of your brain and body. When the neural networks involving these chemicals are impaired, the
function of nerve receptors and nerve systems change, leading to depression and other emotional
disorders.

Risk factors

Certain factors may increase your risk of developing a mental illness, including:

A history of mental illness in a blood relative, such as a parent or sibling

Stressful life situations, such as financial problems, a loved one's death or a divorce

An ongoing (chronic) medical condition, such as diabetes

Brain damage as a result of a serious injury (traumatic brain injury), such as a violent blow to the head
Traumatic experiences, such as military combat or assault

Use of alcohol or recreational drugs

A childhood history of abuse or neglect

Few friends or few healthy relationships

A previous mental illness

Complications

Mental illness is a leading cause of disability. Untreated mental illness can cause severe emotional,
behavioral and physical health problems. Complications sometimes linked to mental illness include:

Unhappiness and decreased enjoyment of life

Family conflicts

Relationship difficulties

Social isolation

Problems with tobacco, alcohol and other drugs

Missed work or school, or other problems related to work or school

Legal and financial problems

Poverty and homelessness

Self-harm and harm to others, including suicide or homicide

Weakened immune system, so your body has a hard time resisting infections

Heart disease and other medical conditions

Prevention
There's no sure way to prevent mental illness. However, if you have a mental illness, taking steps to
control stress, to increase your resilience and to boost low self-esteem may help keep your symptoms
under control. Follow these steps:

Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your
symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or
therapist if you notice any changes in symptoms or how you feel. Consider involving family members or
friends to watch for warning signs.

Get routine medical care. Don't neglect checkups or skip visits to your primary care provider, especially
if you aren't feeling well. You may have a new health problem that needs to be treated, or you may be
experiencing side effects of medication.

Get help when you need it. Mental health conditions can be harder to treat if you wait until symptoms
get bad. Long-term maintenance treatment also may help prevent a relapse of symptoms.

Take good care of yourself. Sufficient sleep, healthy eating and regular physical activity are important.
Try to maintain a regular schedule. Talk to your primary care provider if you have trouble sleeping or if
you have questions about diet and physical activity.

Mental health: What's normal, what's not

What's considered normal mental health? Patterns in thoughts, feelings and behaviors can suggest
when to get help for yourself or someone you care about.

What is mental health?

Mental health is the overall wellness of how you think, regulate your feelings and behave. Sometimes
people experience a significant disturbance in this mental functioning.

A mental disorder may be present when patterns or changes in thinking, feeling or behaving cause
distress or disrupt a person's ability to function. A mental health disorder may affect how well you:

Maintain personal or family relationships

Function in social settings

Perform at work or school

Learn at a level expected for your age and intelligence

Participate in other important activities

How do mental health professionals diagnose disorders?

A diagnosis of a mental health condition may be made by a psychiatrist, psychologist, clinical social
worker or other mental health professional. Your primary care doctor may also be involved in a
diagnostic assessment or make referrals to a mental health specialist.

A diagnosis may be based on the following:

A medical history of physical illness or mental health disorders in you or in your family

A complete physical to identify or rule out a condition that may be causing symptoms

Questions about your current concerns or why you're seeking help

Questions about how recent events or changes in your life — trauma, relationships, work, death of a
friend or relative — have affected how you think, feel or behave

Questionnaires or other formal tests that ask for your feedback on how you think, feel or behave in
typical situations

Questions about past and current alcohol and drug use

A history of trauma, abuse, family crises or other major life events

Questions about past or current thoughts about violence against yourself or others

Questionnaires or interviews completed by someone who knows you well, such as a parent or spouse

When is an evaluation or treatment needed?

Each mental health condition has its own signs and symptoms. In general, however, professional help
might be needed if you experience:

Marked changes in personality, eating or sleeping patterns

An inability to cope with problems or daily activities

Feeling of disconnection or withdrawal from normal activities

Unusual or "magical" thinking

Excessive anxiety

Prolonged sadness, depression or apathy

Thoughts or statements about suicide or harming others

Substance misuse

Extreme mood swings

Excessive anger, hostility or violent behavior

Many people who have mental health disorders consider their signs and symptoms a normal part of life
or avoid treatment out of shame or fear. If you're concerned about your mental health, don't hesitate to
seek advice.

What is mental health?

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel,
and act as we cope with life. It also helps determine how we handle stress, relate to others, and make
choices. Mental health is important at every stage of life, from childhood and adolescence through
adulthood and aging.

What are mental disorders?

Mental disorders are serious conditions which can affect your thinking, mood, and behavior. They may
be occasional or long-lasting. They can affect your ability to relate to others and function each day.
Mental disorders are common; more than half of all Americans will be diagnosed with one at some time
in their life. But there are treatments. People with mental disorders can get better, and many of them
recover completely.
Why is mental health important?

Mental health is important because it can help you to:

Cope with the stresses of life

Be physically healthy

Have good relationships

Make meaningful contributions to your community

Work productively

Realize your full potential

Your mental health is also important because it can affect your physical health. For example, mental
disorders can raise your risk for physical health problems such as stroke, type 2 diabetes, and heart
disease.

What can affect my mental health?

There are many different factors that can affect your mental health, including:

Biological factors, such as genes or brain chemistry

Life experiences, such as trauma or abuse

Family history of mental health problems

Your lifestyle, such as diet, physical activity, and substance use

Can my mental health change over time?

Over time, your mental health can change. For example, you may be dealing with a difficult situation,
such as trying to manage a chronic illness, taking care of an ill relative, or facing money problems. The
situation may wear you out and overwhelm your ability to cope with it. This can worsen your mental
health.

What are the signs that I might have a mental health problem?

When it comes to your emotions, it can be hard to know what is normal and what is not. There are
warning signs that you may have a mental health problem, including:

A change in your eating or sleeping habits

Withdrawing from the people and activities you enjoy

Having low or no energy

Feeling numb or like nothing matters

Having unexplained aches and pains

Feeling helpless or hopeless

Smoking, drinking, or using drugs more than usual

Feeling unusually confused, forgetful, angry, upset, worried, or scared

Having severe mood swings that cause problems in your relationships

Having thoughts and memories that you can't get out of your head

Hearing voices or believing things that are not true

Thinking of harming yourself or others

Not being able to perform daily tasks like taking care of your kids or getting to work or school

Mental Health: Keeping Your Emotional Health

Emotional health is an important part of overall health. People who are emotionally healthy are in
control of their thoughts, feelings, and behaviors. They’re able to cope with life’s challenges. They can
keep problems in perspective and bounce back from setbacks. They feel good about themselves and
have good relationships.

Being emotionally healthy doesn’t mean you’re happy all the time. It means you’re aware of your
emotions. You can deal with them, whether they’re positive or negative. Emotionally healthy people still
feel stress, anger, and sadness. But they know how to manage their negative feelings. They can tell
when a problem is more than they can handle on their own. They also know when to seek help from
their doctor.

Research shows that emotional health is a skill. There are steps you can take to improve your emotional
health and be happier.

Path to improved health

Emotional health allows you to work productively and cope with the stresses of everyday life. It can help
you realize your full potential. It helps you work with other people and contribute to society.

It also affects your physical health. Research shows a link between an upbeat mental state and physical
signs of good health. These include lower blood pressure, reduced risk of heart disease, and a healthier
weight.

There are many ways to improve or maintain good emotional health.

Be aware of your emotions and reactions.Notice what in your life makes you sad, frustrated, or angry.
Try to address or change those things.

Express your feelings in appropriate ways.Let people close to you know when something is bothering
you. Keeping feelings of sadness or anger inside adds to stress. It can cause problems in your
relationships and at work or school.
Think before you act.Give yourself time to think and be calm before you say or do something you might
regret.

Manage stress. Learn relaxation methods to cope with stress. These could include deep breathing,
meditation, and exercise.

Strive for balance.Find a healthy balance between work and play, and between activity and rest. Make
time for things you enjoy. Focus on positive things in your life.

Take care of your physical health. Exercise regularly, eat healthy meals, and get enough sleep. Don’t
abuse drugs or alcohol. Keep your physical health from affecting your emotional health.

Connect with others. Make a lunch date, join a group, and say hi to strangers. We need positive
connections with other people.

Find purpose and meaning.Figure out what’s important to you in life, and focus on that. This could be
your work, your family, volunteering, caregiving, or something else. Spend your time doing what feels
meaningful to you.

Stay positive.Focus on the good things in your life. Forgive yourself for making mistakes and forgive
others. Spend time with healthy, positive people.

Mental Illness Types, Symptoms, and Diagnosis

Mental health conditions are disturbances in a person's thinking, feeling, or behavior (or a combination
of these) that reflect a problem in mental function. They cause distress or disability in social, work, or
family activities. Just as the phrase “physical illness” is used to describe a range of physical health
problems, the term "mental illness" encompasses a variety of mental health conditions.

What Is Mental Illness?

The American Psychiatric Association defines mental illness as a health condition that involves “changes
in emotion, thinking, or behavior—or a combination of these.”1 If left untreated, mental illnesses can
have a huge impact on daily living, including your ability to work, care for family, and relate and interact
with others. Similar to having other medical conditions like diabetes or heart disease, there is no shame
in having a mental illness, and support and treatment are available.
Signs of Mental Illness

Everyone goes through changes in their emotions, thoughts, and behavior from time to time. But when
these changes make you less able to function day to day, they may be signs of a mental illness.

Mental illness takes many forms, including depression, anxiety disorders, bipolar disorder, and
schizophrenia. It's common, affecting some 44 million Americans each year.

There's no simple test to tell you whether you or someone you know has a mental illness. Often, you or
people around you will notice small changes in how you act long before the symptoms seriously affect
you.

If you recognize when something seems amiss, you can talk to a doctor or mental health professional
about what to do. Getting help, early on, often keeps mental illness from getting worse.

Certain symptoms could be a sign that it’s time to seek help, especially if you notice more than a couple.
They include:

Sadness or crankiness that lasts longer than usual

Withdrawal from friends and family

Loss of interest in things you used to enjoy

High and low extremes of emotion

Big changes in sleeping or eating habits

Worries or fears that seem out of proportion

Ignoring personal grooming and hygiene

Changes in your sex drive

Disorganized or confused thoughts

Excessive anger

Drug or alcohol abuse

Many unexplained physical illnesses

Ideas that don’t line up with reality

Seeing or hearing things that others can’t

Thinking or talking about suicide

The five main warning signs of mental illness are as follows:

Excessive paranoia, worry, or anxiety

Long-lasting sadness or irritability

Extreme changes in moods

Social withdrawal

Dramatic changes in eating or sleeping pattern

How do you suspect mental illness in a person?

Signs and symptoms of mental illness can vary, depending on the mental disorder and severity of the
condition.

Some signs and symptoms that are seen in mental disorders include:

Feeling sad and unhappy

Inability to concentrate

Excessive fears

Unnecessary feelings of guilt

Severe mood changes

Easy irritability
The tendency to react with violence

Withdrawal from friends and activities

Inability to maintain relationships

Inability to work or study

Disorganized speech (talking meaningless sentences that don’t make sense)

Feeling tired and lethargic

Insomnia (difficulty sleeping) or sleeping too long

Detachment from reality

Delusions (false and sometimes unrealistic beliefs in which the person refuses to stop believing, despite
providing proof, for example, believing they are God, that aliens are reading their minds, etc.)

Paranoia

Hallucinations (having unreal sensations such as hearing voices, seeing things, feeling sensations on the
skin, having strange odors that aren’t real, etc.)

Inability to cope with daily problems or stress

Consuming excessive alcohol

Drug abuse

Loss of appetite or excessive eating

Decreased sex drive

Suicidal thinking (requires immediate medical attention)

The essence of who we are and how we experience life depends on maintaining a healthy, active brain.
Our individuality as human beings is anchored to the lifetime memory of our personal experiences and
accumulated knowledge. Therefore, understanding the brain mechanisms underlying learning and
memory, and how these are affected by brain injury, disease and aging hold exceptional interest.

Understanding what makes us human is no small task..

Even though COVID has been declining globally, World Health Organisation (WHO) asserted that with
winter approaching for Southern Hemisphere, chances of another coronavirus wave are high. The UN
health agency also pointed out that with the virus still circulating, the risk of more deadly variants
emerging still remains.

WHO warned that with winter approaching for Southern Hemisphere countries, “there is a high risk of
another wave of new COVID infections." The coronavirus spreads more easily in cooler temperatures
when people are more likely to gather in larger numbers indoors.

“With the virus still circulating, the risk of new and potentially more deadly variants emerging remains,
and the pandemic control measures are pivotal to effective response to a surge in infections," said Dr.
Matshidiso Moeti, WHO's Africa director.
COVID-19 (coronavirus): Long-term effects: COVID-19 symptoms can sometimes persist for months. The
virus can damage the lungs, heart and brain, which increases the risk of long-term health problems.

Most people who have coronavirus disease 2019 (COVID-19) recover completely within a few weeks.
But some people — even those who had mild versions of the disease — continue to experience
symptoms after their initial recovery.

These people sometimes describe themselves as "long haulers" and the conditions have been called
post-COVID-19 syndrome or "long COVID-19." These health issues are sometimes called post-COVID-19
conditions. They're generally considered to be effects of COVID-19 that persist for more than four weeks
after you've been diagnosed with the COVID-19 virus.

Older people and people with many serious medical conditions are the most likely to experience
lingering COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for weeks to
months after infection. Common signs and symptoms that linger over time include:

Fatigue

Shortness of breath or difficulty breathing

Cough

Joint pain

Chest pain

Memory, concentration or sleep problems

Muscle pain or headache

Fast or pounding heartbeat

Loss of smell or taste

Depression or anxiety

Fever
Dizziness when you stand

Worsened symptoms after physical or mental activities

Organ damage caused by COVID-19

Although COVID-19 is seen as a disease that primarily affects the lungs, it can also damage many other
organs, including the heart, kidneys and the brain. Organ damage may lead to health complications that
linger after COVID-19 illness. In some people, lasting health effects may include long-term breathing
problems, heart complications, chronic kidney impairment, stroke and Guillain-Barre syndrome — a
condition that causes temporary paralysis.

Some adults and children experience multisystem inflammatory syndrome after they have had COVID-
19. In this condition, some organs and tissues become severely inflamed.

Blood clots and blood vessel problems

COVID-19 can make blood cells more likely to clump up and form clots. While large clots can cause heart
attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from very small
clots that block tiny blood vessels (capillaries) in the heart muscle.

Other parts of the body affected by blood clots include the lungs, legs, liver and kidneys. COVID-19 can
also weaken blood vessels and cause them to leak, which contributes to potentially long-lasting
problems with the liver and kidneys.

Problems with mood and fatigue

People who have severe symptoms of COVID-19 often have to be treated in a hospital's intensive care
unit, with mechanical assistance such as ventilators to breathe. Simply surviving this experience can
make a person more likely to later develop post-traumatic stress syndrome, depression and anxiety.

Because it's difficult to predict long-term outcomes from the new COVID-19 virus, scientists are looking
at the long-term effects seen in related viruses, such as the virus that causes severe acute respiratory
syndrome (SARS).
Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a
complex disorder characterized by extreme fatigue that worsens with physical or mental activity, but
doesn't improve with rest. The same may be true for people who have had COVID-19.

Many long-term COVID-19 effects still unknown

Much is still unknown about how COVID-19 will affect people over time, but research is ongoing.
Researchers recommend that doctors closely monitor people who have had COVID-19 to see how their
organs are functioning after recovery.

Many large medical centers are opening specialized clinics to provide care for people who have
persistent symptoms or related illnesses after they recover from COVID-19. Support groups are available
as well.

It's important to remember that most people who have COVID-19 recover quickly. But the potentially
long-lasting problems from COVID-19 make it even more important to reduce the spread of COVID-19 by
following precautions. Precautions include wearing masks, social distancing, avoiding crowds, getting a
vaccine when available and keeping hands clean.

Even with the rollout of vaccines, normal life can still seem a long way off. But no matter how hopeless
or confined you feel at the moment, there are steps you can take to ease the burden on your mental
health.

Overview : The global COVID-19 pandemic makes this a deeply distressing time for all of us. Even if you
or your loved ones haven’t contracted the virus, your life has likely been turned upside down by its
spread. Whatever your circumstances, there are ways to help manage your fear, stress, and anxiety and
protect your mental health.

The Lancet: COVID-19 pandemic led to stark rise in depressive and anxiety disorders globally in 2020,
with women and younger people most affected.

First global estimates of impact of the COVID-19 pandemic on mental health in 2020 suggests additional
53 million cases of major depressive disorder and 76 million cases of anxiety disorders were due to the
pandemic.
Women and younger people were the most affected by major depressive disorder and anxiety disorders
in 2020.

Countries hit hardest by the pandemic in 2020 had the greatest increases in cases of major depressive
disorder and anxiety disorders.

The authors call for urgent action by governments and policy makers to strengthen mental health
systems globally to meet increased demand due to the pandemic.

Cases of major depressive disorder and anxiety disorders increased by more than a quarter worldwide in
2020 due to the COVID-19 pandemic, according to the first global estimates of impacts of the pandemic
on mental health, published in The Lancet.

In 2020, cases of major depressive disorder and anxiety disorders increased by 28% and 26%,
respectively. Women were affected more than men, and younger people were more affected than older
age groups. Countries with high COVID-19 infection rates and major reductions in the movement of
people – a consequence of measures such as lockdowns and school closures – had the greatest
increases in prevalence of major depressive disorder and anxiety disorders.

Even before the COVID-19 pandemic, major depressive disorder and anxiety disorders – which can
increase the risk of other health outcomes such as suicide – were major contributors to the global
burden of disease, affecting millions of men and women of all ages around the world.

Lead author Dr Damian Santomauro, of the Queensland Centre for Mental Health Research, School of
Public Health, University of Queensland, Australia, said: “Our findings highlight an urgent need to
strengthen mental health systems in order to address the growing burden of major depressive disorder
and anxiety disorders worldwide. Promoting mental wellbeing, targeting factors contributing to poor
mental health that have been made worse by the pandemic, and improving treatment for those who
develop a mental disorder should be central to efforts to improve support services. Even before the
pandemic, mental health-care systems in most countries have historically been under-resourced and
disorganised in their service delivery. Meeting the added demand for mental health services due to
COVID-19 will be challenging, but taking no action should not be an option.” [1]

Until now, no studies had analysed the global impact of the COVID-19 pandemic on prevalence of major
depressive disorder and anxiety disorders in 2020. Most previous work consisted of surveys in specific
locations over a short time period.
The new study is the first to assess global impacts of the pandemic on major depressive disorder and
anxiety disorders, quantifying the prevalence and burden of the disorders by age, sex, and location in
204 countries and territories in 2020.

A systematic literature review was performed to identify population survey data published between
January 1, 2020, and January 29, 2021. Eligible studies reported prevalence of depressive or anxiety
disorders that were representative of the general population and had a pre-pandemic baseline. Using a
disease modelling meta-analysis tool, data from eligible studies was used to estimate changes in
prevalence of major depressive disorder and anxiety disorders due to COVID-19 based on age, sex, and
location, including in locations for which no eligible studies were available. Estimates of daily COVID-19
infection rate and movement of people were used as indicators of the impact of the pandemic on
populations.

The systematic review identified 5,683 unique data sources, of which 48 (one of which reported across
two regions) met inclusion criteria. Most studies were from Western Europe (22) and high-income North
America (14), with others from Australasia (5), high-income Asia Pacific (5), East Asia (2), and central
Europe (1).

The meta-analysis indicates that increased COVID-19 infection rate and reduced movement of people
were associated with increased prevalence of major depressive disorder and anxiety disorders,
suggesting that countries hit hardest by the pandemic in 2020 had the greatest increases in prevalence
of the disorders.

In the absence of the pandemic, model estimates suggest there would have been 193 million cases of
major depressive disorder (2,471 cases per 100,000 population) globally in 2020. However, the analysis
shows there were 246 million cases (3,153 per 100,000), an increase of 28% (an additional 53 million
cases). More than 35 million of the additional cases were in women, compared with close to 18 million
in men.

Model estimates suggest there would have been 298 million cases of anxiety disorders (3,825 per
100,000 population) globally in 2020 had the pandemic not happened. The analysis indicates there were
in fact an estimated 374 million cases (4,802 per 100,000) during 2020, an increase of 26% (an additional
76 million cases). Almost 52 million of the additional cases were in women, compared with around 24
million in men.
Younger people were more affected by major depressive disorder and anxiety disorders in 2020 than
older age groups. The additional prevalence of these disorders peaked among those aged 20-24 years
(1,118 additional cases of major depressive disorder per 100,000 and 1,331 additional cases of anxiety
disorders per 100,000) and declined with increasing age.

Co-author Alize Ferrari, GBD mental disorders team lead at the Queensland Centre for Mental Health
Research, School of Public Health, University of Queensland, Australia, said: “The COVID-19 pandemic
has exacerbated many existing inequalities, and social determinants of mental health. Sadly, for
numerous reasons, women were always more likely to be worse affected by the social and economic
consequences of the pandemic. Additional caring and household responsibilities tend to fall on women,
and because women are more likely to be victims of domestic violence, which increased at various
stages of the pandemic.

“School closures and wider restrictions limiting young people’s ability to learn and interact with their
peers, combined with the increased risk of unemployment, also meant that young people were also
more heavily impacted by major depressive disorder and anxiety disorders during the pandemic. It is
crucial that policymakers take underlying factors such as these into account as part of measures to
strengthen mental health services.”

The authors acknowledge that their study was limited by a lack of high quality data on the effects of
COVID-19 pandemic on mental health in many parts of the world, particularly low- and middle-income
countries. As a result, they say extrapolated estimates generated for countries where data was lacking
should be interpreted with caution, and call for improved data coverage and quality globally. Most
available data was based on self-reported symptom scales that only estimate probable cases of major
depressive disorder and anxiety disorders. More data from diagnostic mental health surveys
representative of the general population – of which only three covered the study period – will improve
understanding of the pandemic’s effects on mental health. The prevalence of other mental disorders –
such as eating disorders – might also have been affected by the COVID-19 pandemic, and the authors
say these should be assessed as new mental health surveys are undertaken.

Writing in a linked Comment, Dr Maxime Taquet and Professor Paul Harrison, from the University of
Oxford, and Professor Emily Holmes, from Uppsala University and the Karolinska Institute, who were not
involved in the study, said: “The first global insight into the burden of depressive and anxiety disorders
during the pandemic by Santomauro and colleagues starkly highlights the impact of the pandemic on
mental health globally.” They echo the study authors’ calls for action to strengthen mental health
systems, saying: “The study should therefore urgently incentivise more research to determine the fuller
geographic distribution of depression and anxiety, the prevalence of depressive and anxiety disorders,
and the underpinning mechanisms to improve mental health in the context of the COVID-19 pandemic
globally.”

As clinicians delivering health care, we are very good at treating disease but often not as good at
treating the person. The focus of our attention has been on the specific physical condition rather than
the patient as a whole. Less attention has been given to psychological health and how that can
contribute to physical health and disease. However, there is now an increasing appreciation of how
psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also
in a positive way to better cardiovascular health and reduced cardiovascular risk.

As clinicians delivering health care, we are very good at treating disease but often not as good at
treating the person. The focus of our attention has been on the specific physical condition rather than
the patient as a whole. Less attention has been given to psychological health and how that can
contribute to physical health and disease.

The World Health Organization defines mental health as “a state of well-being in which an individual
realizes his or her own potential, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to her or his community.”1 Negative psychological health
encompasses depression, chronic stress, anxiety, anger, pessimism, and dissatisfaction with one’s
current life. Positive psychological health is also multifaceted and may be characterized by a sense of
optimism, sense of purpose, gratitude, resilience, positive affect (ie, positive emotion), and happiness.

Several terms have been used to describe and capture an overall state of health. Wellness is more than
simply the absence of disease. It is an active process directed toward a healthier, happier, and more
fulfilling life and includes not only physical but also psychological and emotional dimensions.

The related term well-being can be defined as one’s cognitive and affective evaluation and assessment
of one’s life, including physical health, satisfaction, happiness, and a sense of fulfillment.

Negative Psychological Health and CVD

Research has now clearly demonstrated that negative psychological factors, personality traits, and
mental health disorders can affect cardiovascular health. Although many of these studies have
considered CVD risk in relation to specific negative emotions,

Chronic Stress and Social Stressors

The concept of stress is complex, and the many conflicting definitions and causes of stress have made
studying the impact of stress on CVD challenging. Stressful life events, chronic daily stressors, and high
levels of perceived stress have been shown to affect CVD health.14 Psychological stress can result from
numerous sources such as challenges from work, poor-quality or insufficient relationships, financial
hardships, and discrimination. Beyond these types of stressful experiences, people may also be exposed
to traumatic stress if they experience or witness events that involve a threat to safety.

Anxiety

The American Psychological Association defines anxiety as “an emotion characterized by feelings of
tension, worried thoughts, and physical changes like increased blood pressure,”35 suggesting the
likelihood of a link between anxiety and CVD risk. Anxiety may occur as a transient state or as a general
tendency (ie, trait-like) or, when experienced frequently or persistently at high intensity and in
inappropriate settings, may be characteristic of a clinical disorder such as generalized anxiety disorder.
In the United States, the lifetime prevalence of anxiety disorders is >25%.36

There is some evidence that anxiety is a risk factor for hypertension, excess adiposity, and smoking,
which can accelerate atherosclerosis.37,38 Several meta-analyses of studies examining the association
of anxiety and CVD have been published, with the largest study from 2016 including 2 017 276
participants from 46 cohorts. Anxiety was associated with an increased risk of CVD mortality (RR, 1.41
[95% CI, 1.13–1.76]) and specific types of CVD, including CHD (RR, 1.41 [95% CI, 1.23–1.61]), stroke (RR,
1.71 [95% CI, 1.18–2.50]), and heart failure.

Depression

The lifetime prevalence of major depressive disorder in the United States is 20.6%, with women,
younger adults, and those earning lower income being at greater risk

Positive Psychological Health and CVD

There is no single universal definition of positive psychological health. For the purposes of this scientific
statement, positive psychological health includes the presence of positive psychological factors such as
happiness, optimism, gratitude, sense of purpose, life satisfaction, eudaimonic (virtuous) well-being, and
mindfulness.

Optimism

Optimism is characterized by having a sense of hopefulness and confidence that things will work out
well in the future and anticipating the best possible outcomes.

Sense of Purpose

Sense of purpose can be defined in many ways, but it is generally conceptualized as finding meaning in
one’s daily life and being motivated and directed by one’s values and life goals.

Happiness and Positive Affect

Happiness is a form of positive affect, characterized by a state of positive well-being and contentment.
Happy individuals tend to sleep better, exercise more, eat better, and not smoke.

Mindfulness

Mindfulness can be defined in many ways. For the purposes of this article, mindfulness can be defined
as a present, moment-by-moment, nonjudgmental awareness of one’s thoughts, emotions, and actions.