Have you ever felt so stressed or anxious about something that your stomach begins to hurt? I have. As it turns out, stomach problems are actually among the most common symptoms of stress and anxiety. But are there other ways in which what we think affects how we feel physically or psychologically, or vice versa? This interest in the “mind-body” connection has long been present in my mind (or is it my brain?). I do know that it triggered fascination when I came across this 2020 review article investigating the impact of the connection between mental health and women’s heart health. The article describes an interesting aspect of the research that often doesn’t make headlines but perhaps should. This paper was written for an Australian journal, and its implications carry global importance as women face the worsening impact of pandemic-exacerbated mental health challenges.
It also demonstrates to me, even as February’s American Heart Month has ended, that the importance of heart health is not limited to one month. Particularly concerning women.
Historically, cardiovascular diseases (CVD) — a term for all diseases of the heart and blood vessels, notably myocardial infarction (heart attack) — were assumed to primarily impact men. However, heart disease — meaning all diseases that affect the structure or functioning of the heart — is the leading causes of death for women in the United States. The under-recognition of heart disease risk for women has resulted in knowledge gaps on how women might present with symptoms of heart disease, resulting in women not always receiving the most appropriate treatment. Luckily, over the past two decades much work has been done to elucidate and highlight sex-and-gender differences in CVD, which includes stroke (the sudden interruption of blood supply to the brain). Today, we are aware of important differences for women, including age of onset, symptom presentation, management, outcomes, as well as traditional and psychological risk factors. Awareness and study of CVD’s impact on women has greatly increased, but more work needs to be done to continue understanding the wide-ranging factors affecting women’s heart (and brain) health. This includes the ways in which mental health affects cardiovascular health.
Applying concepts of “how we think affects how we feel psychologically and physically” (and vice versa!) to research is a relatively new and exciting frontier in the study of sex-and-gender differences in heart health. While more research is required to understand the specifics, we know that certain factors (genetic, biological, psychological, cultural, and racial) are associated with greater cardiovascular risk in women with a chronic mental disorder (CMD). One hypothesis is that associations between depression and cardiac disease have a genetic component. Other hypotheses suggest hormonal factors that contribute to depression also influence CVD. For example, postpartum depression was found to be associated with increased rates in heart attack, stroke, and combined CVD after five years. It is also believed that other psychological factors, such as childhood adversity, are associated with increased CVD risk. Finally, some researchers suggest that sex/gender, race/ethnicity, and other potential sources of inequality — with regard to sexuality, religion, and geographic region — inflate the “additive and multiplicative effects” of CMD on cardiovascular risk.
This example is a new approach to the mind-body connection. To me, it is especially significant now as the pandemic aggravates existing mental health challenges, particularly for women, who generally have a higher prevalence of chronic mental disorders from adolescence to old age.
The pandemic has had uniquely profound effects on the lives of women, who serve large roles in the health and service sectors and at home, where lockdowns and quarantine measures have increased the load of childcare and other family responsibilities traditionally carried by women. Stress from the disproportionate share of jobs lost by women during the pandemic and from the need to keep everyone safe and healthy adds to the mental burden and its physical toll.
The saga of research and public knowledge about women’s heart health demonstrates just how crucial it is to study sex-and-gender differences and the intersection of thinking and feeling. Now, more than ever, it will be important to increase awareness of how stress and CMDs — especially depression and anxiety — may increase cardiovascular risk factors in both men and women. We should strive to care for ourselves as well as our loved ones as we continue living through unprecedented challenges.
Ke'ala Akau is a fellow with Women's Health Research at Yale and a junior in Branford College majoring in the History of Science, Medicine, and Public Health. Read more on her blog: "Why Didn't I Know This?"