What’s the link between physical and mental health?
The time when we used to think the mind and the body were entirely separate entities may be long gone, but few of us probably realise how closely linked they are when it comes to our health and wellbeing. Yet the evidence that physical health has a significant impact on mental health – and vice versa – is mounting up.
When we talk about health these days we no longer just mean health in a physical sense. According to the World Health Organization health is ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’ (i). Indeed if you want to lead a happy, fulfilling life, it’s important to be aware of how your physical health and fitness affect your mental health as well as why your state of mind is important for your physical wellbeing.
Today we know if you’re living with a serious mental illness you have a higher risk of being affected by a range of chronic physical conditions too. Experts from the Kings Fund suggest 46 per cent of people with a mental health problem also have a long-term physical condition (ii). Scientists have also recently discovered people with more mental health problems may also age faster than the rest of the population (iii).
The opposite is also true: if you have a chronic physical health condition you’re more likely to experience mental health issues such as anxiety and depression than if you were physically well. In fact, according to the Mental Health Foundation, almost one in three people with a long-term physical health condition also has a mental health problem (iv).
So, given that more than 15 million people in England alone are believed to have one or more long-term physical conditions – including diabetes, arthritis, asthma and cardiovascular disease – it should be no surprise that mental health problems in general are considered the largest single cause of disability in the UK, compared with specific physical illnesses such as cancer and heart disease (v).
Yet if you have a physical health condition it doesn’t automatically mean you’ll experience mental illness too (or the other way around). Discovering how your wellbeing in one area can directly or indirectly affect the other could help you discover the steps you can take to stay as healthy as possible – both physically and mentally.
How physical health affects mental health
If you’re living with a long-term physical condition, in addition to physical symptoms and chronic pain you may also experience the emotional stress that comes with having to cope with your symptoms on a day-to-day basis. All of these things can lead to mental health problems such as depression and anxiety, not to mention feeling isolated and cut off from your social supports.
Having a chronic physical condition can also deplete your energy, which can mean you won’t be as active as you should be. However not being physically active can have a negative impact on your mental wellbeing too (for more details see below).
Some of the physical conditions that can often co-exist with mental wellbeing issues include the following:
Psoriasis This often debilitating skin condition is associated with high levels of stress, low self-esteem as well as depression, with those affected often experiencing problems with their quality of life. Read more about it in our psoriasis guide.
Diabetes According to Diabetes UK, around four in 10 people with diabetes experience diabetes-related emotional distress, which can make it more difficult for them to manage their condition (vi). The charity also claims the variable blood glucose levels that are a feature of diabetes can cause feelings of anxiety of anger, while research suggests those with diabetes are twice as likely to experience depression than the rest of the population (vi).
Heart problems The Centers for Disease Control in the US claims there’s evidence to suggest mental health disorders such as depression, anxiety and post-traumatic stress disorder (PTSD) can develop in people who’ve had a cardiac event such as heart failure, stroke or heart attack (vii). It believes this may happen when heart patients experience pain, fear of death or disability, lack of confidence, anxiety and financial problems as a result of having their condition.
Parkinson’s disease People with Parkinson’s often experience mental health issues alongside their physical symptoms, says Parkinson’s UK (viii). Two of the most common health conditions affecting people with Parkinson’s are anxiety and depression, with nearly half of those with Parkinson’s experiencing one or the other. According to the charity, anxiety and depression can be triggered by the stress of receiving a diagnosis of the condition, as well as by physical changes in the brain caused by the condition itself.
Multiple sclerosis According to the MS Society it’s not unusual to experience depression, stress and anxiety if you have multiple sclerosis (MS), with up to half of people with the condition experiencing depression at some point (ix). Some of the factors that can contribute to mental health issues, says the charity, include nerve damage in the frontal lobe caused by MS as well as having to cope emotionally with a diagnosis of the condition. Certain medicines commonly used to treat MS and its related symptoms can also cause temporary mood and behaviour changes in some people (x).
Thyroid problems Thyroid disorders, says the British Thyroid Foundation, often have mental as well as physical symptoms, most notably hyperthyroidism (overactive thyroid), hypothyroidism (underactive thyroidism), thyroid-related eye disease and thyroid cancer (xi). The charity cites anxiety, depression, mood swings, concentration difficulties, short-term memory lapses and lack of mental alertness as common thyroid-related emotional problems.
Why is physical fitness important for mental health?
Being physically active on a regular basis is good for your body in many ways. However it also helps maintain your mental health and wellbeing, with scientists believing exercise could play an important role in the management of mild to moderate mental health conditions, particularly depression and anxiety (xii).
Physical activity can have a positive effect on your mood, particularly at times when you’re feeling a bit low. It can help you deal with stress too, as well as boost your self-esteem and generally make you feel better in yourself. Why? Because physical activity is thought to release feel-good hormones that make you feel better in yourself overall. According to the mental health charity Mind, doing some exercise also gives your brain something to focus on and can be a positive coping strategy for difficult times (xiii).
If you’re not very physically fit, on the other hand, you could have an increased risk of experiencing mental health issues such as depression, anxiety or both, says a large-scale UK study (xiv). The results of the study found those who had low combined cardiorespiratory fitness and muscle strength were 98 per cent more likely to experience depression and 60 per cent more likely to experience anxiety compared with others who were physically fitter.
For tips on how to improve your physical fitness see below (Supporting your physical and mental wellbeing).
Mental health impacts on physical health
While many physical health conditions are associated with emotional and mental wellbeing problems, it’s true that people living with mental illness tend to have a higher-than-average risk of being physically unwell too.
One possible explanation is that having a mental illness can sometimes make people adopt unhealthy habits, such as smoking, drinking too much alcohol or abusing drugs – all of which can have consequences for their physical health.
People with mental illness may also be less motivated to look after themselves physically compared with those who are mentally well. Similarly people living with mental ill health sometimes have higher rates of unemployment, housing insecurity and social isolation, any or all of which can also contribute to their vulnerability towards developing chronic physical conditions.
According to the Mental Health Foundation, people with mental health problems may be more likely to experience poor physical health because (iv):
They have genes that increase their risk of developing both mental and physical health problems.
They may have difficulties with concentration and planning – this could, for instance, make it harder for them to arrange or attend appointments with doctors and other health professionals.
They don’t get the support they need to change unhealthy behaviours such as drinking and smoking, as it may be assumed they aren’t capable of making such changes.
They’re less likely to get medical help because doctors may assume their physical symptoms are part of their mental illness. This could mean physical symptoms aren’t investigated properly.
They’re also less likely to get routine tests such as blood pressure and cholesterol, which could help spot symptoms of physical conditions earlier.
Mental illness and cardiovascular disease
Mental ill health has been linked to a number of physical conditions including cancer, musculoskeletal problems such as back pain, irritable bowel syndrome (IBS), respiratory illnesses and several others including cardiovascular disease.
A study carried out by King’s College London that followed more than 3.2 million people with severe mental illness showed they have a substantially increased risk for developing cardiovascular disease compared to the general population (xv).
In the study, those with illnesses such as schizophrenia, bipolar disorder and major depression were found to have a 53 per cent higher risk for cardiovascular disease than the general population, with a 78 per cent higher risk of developing cardiovascular disease in the long term. Their risk of dying from cardiovascular disease was also found to be 85 per cent higher than those of a similar age in the general population.
A scientific statement issued by the American Heart Association (xvi) also claims mental health problems can negatively impact your health and risk factors for heart disease and stroke. The statement adds that mental health conditions including depression, chronic stress, anxiety, anger, pessimism and dissatisfaction with life are associated with potentially harmful biological responses including:
In a more positive light, researchers based at Duke University and the University of Michigan suggest treating mental health problems in young people could help them stay physically healthier in later life (iii).
They discovered that, during the 30-year study period, people with mental disorders were more likely to develop physical diseases plus they died earlier than those without mental health problems. The researchers conclude that getting prompt mental health care for young people who need it could help reduce the development of physical diseases in the same people when they’re older.
How do you maintain physical and mental wellbeing?
If you have a physical health condition, it’s not inevitable that you’ll also develop a mental health illness, or vice versa. To improve your chances of staying as physically or mentally well as possible, there are a few things you can do, including the following:
Eat as healthily as you can
A balanced diet can help improve and maintain your physical health as well as your mental wellbeing and mood. Here in the UK, the basis of a healthy diet is outlined in the Eatwell Guide (xvii), and includes:
At least five portions of a variety of fruit and veg every day to provide a range of vitamins, minerals and other valuable nutrients. If you fall short of this target regularly or just occasionally, you could consider taking a good quality multivitamin and mineral supplement that provides decent levels of important nutrients. There’s even some evidence that taking a multivitamin could help boost your mood and improve your feelings of wellbeing (xviii).
Starchy foods – preferably higher-fibre wholegrain varieties (potatoes with their skins on, wholewheat pasta and brown rice, for instance).
Some dairy or dairy alternatives (ideally lower-fat varieties) to provide protein and calcium for healthy teeth and bones.
Some non-dairy protein such as fish, poultry or lean meats, or plant-based sources of protein such as beans, peas and lentils. You should also aim to eat at least two portions of fish each week, one of which should be oily. If, however, you don’t like eating fish you could try a high-strength fish oil supplement, as the omega-3 fatty acids found in oily fish such as salmon, trout, herring, mackerel and sardines have been linked with a range of physical and mental health benefits.
Vegetarian and vegan omega-3 supplements are also more widely available these days. These supplements source their active ingredients from plant organisms called microalgae rather than fish.
Oily fish are also one of the few foods that supply us with vitamin D, which we need for several important functions including better calcium absorption and healthy immunity. However many people in this country may not be getting enough vitamin D, especially during the winter months. That’s why official UK guidelines recommend everyone consider taking a daily vitamin D supplement from October to March, with some people who have very little or no sun exposure or those with dark skin advised to take a supplement all year round (xvix).
If you want to take a vitamin D supplement the recommended form is vitamin D3 (cholecalciferol), as this is the natural form of vitamin D our bodies make when we’re exposed to sunlight. You can get these in tablet form as well as in veggie-friendly drops. Most vitamin D3 supplements aren’t suitable for vegans, however, since they’re made from the fat of lamb’s wool. But the good news is you can get vegan vitamin D3 supplements available these days that are sourced from lichen.
Small amounts of fats, ideally mostly healthier unsaturated fats such as vegetable, rapeseed, olive and sunflower oils.
Only occasional small amounts of foods high in sugar and fat, such as chocolate, biscuits, cakes, butter and ice cream.
Get plenty of exercise
This doesn’t mean you have to join a gym or start training for a marathon. Just stay as active as you can – even a quick 10-minute stroll will help improve your energy levels and your mood. To support your physical and mental wellbeing, try to achieve the target of 150 minutes of moderate activity each week (or gradually work up to it if you need to). Achieving 150 minutes a week shouldn’t be difficult – it can work out as little as three 10-minute bursts a day on five days of the week if you don’t have time for more prolonged activities.
If you have a physical or mental health condition, check with your GP before you start, especially if you’re taking any medication (some medicines can affect the type and amount of physical activity that’s safe for you to do).
Also, remember: any exercise you do counts towards your target, even if it’s just walking to the shops, dancing around your living room or tidying up your garden. Plus you don’t have to do vigorous exercise – more gentle activities are also beneficial, such as yoga, t’ai chi or walking the dog.
Tackle your stress levels
Good nutrition and regular physical activity can also help you manage chronic stress and the effects it can have on your mind and body. Other things that could help you cope with stress more effectively include spending time outdoors in green spaces, practising mindfulness or meditation, having plenty of social interaction and getting lots of good-quality sleep (try reading our guide to sleep and insomnia for tips on sleeping better if you struggle to get a regular eight hours a night).
Give up smoking
According to the Mental Health Foundation, smoking has a negative impact on both mental and physical health (iv). Even if you smoke because you feel it helps you cope with stress or other mental health issues, the truth is the effects don’t last, and smoking is likely to make you feel worse in the long run. If you’re a smoker, quitting is also the best thing you can do for your physical health.
The good news is there’s never been a better time to stop smoking, thanks to the variety of stop smoking aids available that are designed to help – by relieving nicotine withdrawal symptoms for instance (products are widely available and include nicotine patches, gum and lozenges). See our article on stopping smoking for additional tips to help you quit.
For lots more information on what you can do to help relieve the symptoms of a wide range of physical and mental health conditions, take a look around our pharmacy health library.
(i) Available online: https://www.who.int/about/governance/constitution
(ii) Available online: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/long-term-conditions-mental-health-cost-comorbidities-naylor-feb12.pdf
(iii) Available online: https://theconversation.com/the-link-between-mental-health-problems-and-later-physical-health-156796
(iv) Available online: https://www.mentalhealth.org.uk/a-to-z/p/physical-health-and-mental-health
(v) Available online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/215808/dh_123993.pdf
(vi) Available online: https://www.diabetes.org.uk/resources-s3/2018-08/Diabetes%20and%20Mental%20Health%20%28PDF%2C%205.7MB%29.pdf
(vii) Available online: https://www.cdc.gov/heartdisease/mentalhealth.htm
(viii) Available online: https://www.parkinsons.org.uk/information-and-support/parkinsons-and-mental-health
(ix) Available online: https://www.mssociety.org.uk/about-ms/signs-and-symptoms/mental-health
(x) Available online: https://www.mssociety.org.uk/about-ms/signs-and-symptoms/mental-health/causes-of-mental-health-problems
(xi) Available online: https://www.btf-thyroid.org/psychological-symptoms-and-thyroid-disorders
(xii) Paluska SA, Schwenk TL. Physical activity and mental health: current concepts. Sports Med. 2000 Mar;29(3):167-80. Available online: https://link.springer.com/article/10.2165%2F00007256-200029030-00003
(xiii) Available online: https://www.mind.org.uk/information-support/tips-for-everyday-living/physical-activity-and-your-mental-health/about-physical-activity/
(xiv) Kandola AA et al. Individual and combined associations between cardiorespiratory fitness and grip strength with common mental disorders: a prospective cohort study in the UK Biobank. BMC Medicine 18, Article 303 (2020). Available online: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01782-9
(xv) Corell CU et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017 Jun;16(2):163-180. Available online: https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20420
(xvi) Available online: https://newsroom.heart.org/news/mental-health-is-important-to-overall-health-and-heart-disease-prevention-and-treatment
(xvii) Available online: https://www.nhs.uk/live-well/eat-well/the-eatwell-guide/
(xviii) Harris E. et al., The Effect of Multivitamin Supplementation on Mood and Stress in Healthy Older Men. Hum Psychopharmacol. 2011 Dec;26(8):560-7. Available online: https://pubmed.ncbi.nlm.nih.gov/22095836/
(xvix) Available online: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.