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Integrating physical and mental health

Physical improvement helps with improving mental health as well

Good physical health is closely associated with the treatment of general anxiety and post-traumatic stress disorder (PTSD). Mental health problems can make physical recovery tough. Similarly, recovering from mental health problems can prove to be equally or more difficult if physical problems exist.

A study, published in the January 2015 issue of Critical Care Medicine, gathered assessments through a two-year longitudinal study that included data from 13 intensive care units from four U.S. hospitals. Around 520 patients were included who suffered from an archetypal critical illness called acute respiratory distress syndrome. An estimated 200,000 people in the U.S. suffer from acute respiratory distress syndrome annually.

“The mortality used to be around 70 percent,” said O. Joseph Bienvenu, M.D., Ph.D., director of the Psychiatry Consultation-Liaison Service at Johns Hopkins Medicine. “Today, more than half survive.”

Out of the 520 patients participating in the study, about one-half survived for the first follow-up after three months. Hence, 186 consenting adult survivors of all ages finished at least one Hospital Anxiety and Depression Scale (HADS) and one Impact of Event Scale-Revised (ISER) assessment over the duration of two years.

The assessments revealed the majority of acute respiratory distress syndrome survivors to also be suffering from clinically significant symptoms of general anxiety, PTSD or depression. This was in accordance with findings from other studies. Most often, patients having symptoms of one condition were more likely to have symptoms of another as well. The results depicted a strong need for clinicians to check patients for a full range of mental and physical issues. This is now known as post-intensive care syndrome, a frequent occurrence in survivors of critical illness.

The researchers also measured whether study participants’ physical function changed over time by assessing the activities of daily living they did for themselves, such as managing finances, shopping and home maintenance.

“The path to recovery, physically, may be more difficult if you’re having mental health problems,” stated Dale M. Needham, M.D., Ph.D., medical director of the Critical Care Physical Medicine and Rehabilitation Program at Johns Hopkins and senior author of the study. “Similarly, the mental health recovery may be more difficult if you have physical problems.”

Despite the fact that many study participants visited psychologists and counselors as some took psychiatric medications as well, physical improvement was observed to be the best indicator for combating general anxiety and PTSD symptoms. An increase in physical activity and recovery of physical function was observed to be correlated with the possibility of an improvement in their mental health as well.

“Getting people active allows them to return to activities that they were doing before critical illness, like work and social interactions,” said Bienvenu. “Those symptoms didn’t go away on their own.”

Such behavioral activation therapy is a standard for treating patients with depression as well.

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