Category: HEARTe

“The stigma of mental illness made it difficult for many with long term conditions to reveal the true extent of their emotional distress and have the confidence to seek appropriate help.”
   as shown in: The Living Better Project: Key Research Findings

A significant factor in the explanation for poorer clinical outcomes is that co-morbid psychological problems can reduce a person’s ability to actively manage their own physical cardiac condition. For example, problems such as depression are associated with unhealthy behaviours known to be risk factors for the development and exacerbation of cardiac disease, such as smoking and alcohol use. Self-management is at the core of effective treatment for long-term conditions. The Scottish Government has put self-management at the centre of the policy for the approach to long term conditions (Self-Management Strategy for Long-term Conditions in Scotland 2008).

There are a number of useful resources available to help patients self-manage their mental health:

• Moodjuice
• Living Life to the Full
• NHS inform: Mental Health and Wellbeing
• Breathing Space: Open up when you’re feeling down
• CHSS: Coping with depression and feeling down
• CHSS: Coping with stress and anxiety

There are also a number of useful websites for carers:

• Mind for better mental health: How to cope as a carer
• Carers trust: Mental health conditions

Whichever screening tool you use the score generated should lead to one of four outcomes:

1. No action
2. Low intensity intervention (Step 1 of the Stepped Care Model below.)
3. Medium intensity intervention (Step 2 of the Stepped Care Model below.)
4. High intensity intervention (Step 3 of the Stepped Care Model below.)

Stepped Care Intervention Model

Step one of the model is the least intensive intervention and is typically provided first. People can step up or down the model according to their changing needs and in response to treatment. the important thing is that healthcare professionals involved in working with individuals with cardiac disease are able to assess and recognise any signs of anxiety or low mood/depression.

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The person may require continued monitoring through repeated screening to ensure access to the right level of care.

Screening is a brief, repeatable means of assessing the presence of psychological distress. Use of a screening tool with all patients can be helpful in identifying low mood/depression and anxiety. It is also helpful in putting mood and wellbeing on the agenda, indicating that “this is something that we are interested in and happy to talk to you about. This is normal. It is part of our job”. The screening tool opens up the potential for a conversation where people feel that they can discuss this again, at any time. “You mentioned last time that you were feeling a bit low. How are you feeling this week/now? Would you like to complete the screening tool again?”

A number of assessment and screening tools have been validated and are generally available. The benefit of using an objective screening tool, such as the Distress Thermometer or the Hospital Anxiety and Depression Score (HADS), is because the use of such a tool offers a brief and pragmatic method of identifying patients with psychosocial distress, with the goal of determining who needs referral for more extensive assessment. It is a triage process, to be used in conjunction with your own impressions after speaking to the patient.

Use of a screening tool or standardised questions with all patients at every patient contact greatly increases the chances of identifying low mood/depression and/or anxiety.

People with any chronic physical health condition are significantly more likely to experience mental health problems. The relationship between physical health and mental health is particularly strong within cardiovascular diseases. For example, depression is two to three times more common in a range of cardiovascular diseases including cardiac disease, coronary artery disease, angina, congestive heart failure, or following a heart attack. Anxiety problems are also common in cardiovascular disease.

There are numerous reasons why it is important to effectively manage mental health problems within cardiac care.

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Co-morbid anxiety and depression in individuals with cardiac disease lead to:

Mental wellbeing (also known as emotional health or mental health), can take many forms but a useful description is “feeling good and functioning well”. It describes how we feel and think, and our ability to cope with what is going on in our lives, with its various ups and downs.

“Feelings of contentment, enjoyment, confidence and engagement with the world are all a part of mental wellbeing. Self-esteem and self-confidence are too. So is a feeling that you can do the things you want to do. And so are good relationships, which bring joy to you and those around you” (Professor Sarah Stewart-Brown, University of Warwick)

After completing the module, you will be able to:

• demonstrate increased knowledge in order to identify commonly presenting mental health conditions related to cardiac disease
• demonstrate an awareness of the bidirectional relationship between cardiac ill health and mental health
• understand a generic model of psychological adjustment to cardiac conditions
• explore self management strategies for facilitating emotional and behavioural adjustment to acute and chronic cardiac ill health
• recognise the signs of severe mental distress and associated risks
• outline appropriate referral systems and pathways for individuals experiencing mental health problems
• discuss the possible pharmacological and non-pharmacological management of mental health problems