Recent research has shown that mental health issues are on the rise among young adults in the United States. One study published in JAMA in 2023 found that, while the total number of pediatric and young adult Emergency Room visits remained relatively stable from 2011 to 2020, the proportion of visits for mental health reasons nearly doubled, including a 5-fold increase in the proportion of visits for suicide-related symptoms.

According to a 2023 study published in the Journal of the American Heart Association, young adults with depression or overall poor mental health report more heart attacks, strokes and risk factors for cardiovascular disease than their peers without mental health conditions.

The study's lead author, Dr. Yaa Adoma Kwapong, a postdoctoral research fellow at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore, says heart disease and depression likely influence each other, with each condition potentially contributing to the development of the other. Still, focusing on improving mental health in younger adults can help decrease the risk of heart disease and improve overall health.

To explore the link between mental and heart health in young adults, Kwapong and colleagues examined data from nearly 600,000 adults, averaging 35 years old, from 2017 to 2020. Participants reported on depression diagnoses and days of feeling mentally unwell. They also shared information on heart disease risk factors, such as high blood pressure, high cholesterol, obesity, smoking, diabetes, lack of physical activity and poor diet.

The study found that nearly 20% of participants had depression, a rate that rose in 2020 due to the COVID-19 pandemic. Those with depression were more than twice as likely to have heart disease compared to those without. Furthermore, the likelihood of heart disease increased with the number of days of poor mental health, with those experiencing up to 13 days of poor mental health being 1.5 times more likely to have heart disease.

Senior study author Dr. Garima Sharma, director of Cardio-Obstetrics and director of Cardiovascular Women’s Health at Inova Health System, says researchers need to collect more data to investigate whether these trends have changed post-pandemic. Regardless, she says, "Clinicians need to be better at recognizing and referring patients with poor mental health for aggressive risk factor control and vice versa.”

Other research suggests that at least one-fourth of people with heart problems and one-third of stroke survivors develop symptoms of depression. However, scientists have been trying to figure out if depression causes heart disease or if heart disease causes depression. Dr. Helen Lavretsky, a professor of psychiatry at UCLA, says both seem to be true.

Levretsky was not involved in the recent research, but she coauthored a 2021 report published in Circulation. The report showed strong evidence from various studies connecting mental health to heart disease in a few different ways.

First, the report shows that mental health influences how well people stick to their medication routines. Poor mental health can also lead to unhealthy habits such as poor diet choices, especially for those needing low-sodium diets, and affect adherence to heart health programs such as cardiac rehabilitation. Chronic stress from daily life or traumatic events can increase the risk of heart disease by promoting unhealthy habits such as smoking and poor diet. PTSD can boost coronary heart disease risk by over 60%, and anxiety and depression are linked to higher risks of heart problems, too.

What helps?

Experts say that future research should look into how things like social factors and health inequalities affect mental health and overall health outcomes. Also, it should work to pinpoint which positive and negative mental health factors put people at the highest risk for heart disease.

Still, both the 2021 report and the more recent study call on cardiac care teams to consider and help treat their patients’ mental health alongside their cardiovascular health. "Just diagnosing depression does not help. You have to treat it,” says Levretsky.

The study from 2023 suggests that a multidisciplinary approach is essential, meaning mental health physicians, psychologists, psychiatrists, nutritionists, addiction specialists, primary care doctors and cardiologists, should work together. This collaborative effort can effectively enhance mental health and reduce the risk of CVD, ensuring comprehensive care for patients.

Health care professionals can help treat mental health conditions in various ways. Medications such as antidepressants, therapy and stress management programs can all help. Regular screenings can also help spot any cardiovascular problems early on, so care teams can treat any issues before they get worse. With evidence pointing to a crucial intersection between mental health and cardiovascular health, a field-wide commitment to integrated care will be essential in enhancing  patient outcomes and overall health.