Amin A. Muhammad Gadit

This year's theme for World Mental Health Day is a reminder that we psychiatrists must work closely with our colleagues not only in primary care but also in cardiology, endocrinology, oncology, and pulmonology.

The theme of the day, which is observed on Oct. 10, is “Mental Health and Chronic Physical Illnesses – The Need for Continued and Integrated Care.”

We know that mental health greatly affects the management of chronic physical illnesses. The four major chronic illnesses mentioned by the World Health Organization – cardiovascular problems, diabetes, cancer, and respiratory illnesses – are responsible for 60% of the world's deaths, and 80% of these deaths are happening among the world's poorest populations. “If nothing is done, experts estimate that we could witness another 388 million people die prematurely within the next 10 years,” authors of the 2010 report prepared by the World Federation for Mental Health (WFMH) wrote.

Not surprisingly, depression has the largest effect on worsening health, compared with other chronic illnesses. According to the report, depression is present in one of five outpatients with coronary heart disease and in one of three outpatients with heart failure, and most such cases go unrecognized. Negative lifestyle habits associated with depression – such as smoking, excessive alcohol consumption, lack of exercise, poor diet, and lack of social support – interfere with the treatment for heart disease.

Major depression puts heart attack victims at great risk and appears to add to the patients' disability from heart disease. It can contribute to a worsening of symptoms as well as to poor adherence to cardiac treatment regimens.

Based on global prevalence estimates of diabetes that were done in 2003, 43 million people with diabetes have symptoms of depression. Furthermore, people who have diabetes and depression have more severe symptoms of both diseases and higher rates of work disability, and they use more medical services than do those who have diabetes alone.

According to the WFMH report, studies suggest that depression increases the risk of developing type 2 diabetes more than 20% in young adults. Depression can lead to poor lifestyle decisions, such as smoking, alcohol abuse, weight gain, unhealthy eating, and lack of exercise.

About half of all patients with terminal or advanced cancer suffer with poor mental health. Adequate recognition of depression is important to enhance quality of life.

Overall, 20% of patients with asthma and chronic obstructive pulmonary disease suffer from major depression and/or anxiety. Studies suggest that psychopharmacologic and/or psychosocial interventions might improve asthma control. Depression and anxiety are associated with unhealthy behaviors, such as poor diet, physical inactivity, sedentary lifestyle, tobacco use, and heavy alcohol consumption. Many of these factors lead to obesity. Obesity has been associated with an increased lifetime risk for major depression and panic disorder. It is suggested that primary care services need to improve ways of screening for depression that is associated with particular chronic illnesses like heart conditions or diabetes.

The American Psychological Association suggests the following 10 ways to build resilience:

▸ Make connections.

▸ Avoid seeing crises as insurmountable problems.

▸ Accept that change is a part of living.

▸ Move toward realistic goals.

▸ Take decisive actions.

▸ Look for opportunities for self-discovery.

▸ Nurture a positive self-view.

▸ Keep things in perspective.

▸ Maintain a hopeful outlook.

▸ Maintain self-care.

Above all, integrated health care is vitally important in order to address mental and physical health problems. Such problems will remain unresolved and complicated if either part is ignored. The important aspect is the collaborative part of psychiatrists, our physician colleagues such as family practitioners, and allied mental health professionals in achieving the goal of addressing and managing this issue.

This, of course, is the right approach if we are serious about addressing global morbidity and mortality. Hence, the theme advocated this year by the WFMH is quite appropriate.

This year's theme for World Mental Health Day is a reminder that we psychiatrists must work closely with our colleagues not only in primary care but also in cardiology, endocrinology, oncology, and pulmonology.

The theme of the day, which is observed on Oct. 10, is “Mental Health and Chronic Physical Illnesses – The Need for Continued and Integrated Care.”

We know that mental health greatly affects the management of chronic physical illnesses. The four major chronic illnesses mentioned by the World Health Organization – cardiovascular problems, diabetes, cancer, and respiratory illnesses – are responsible for 60% of the world's deaths, and 80% of these deaths are happening among the world's poorest populations. “If nothing is done, experts estimate that we could witness another 388 million people die prematurely within the next 10 years,” authors of the 2010 report prepared by the World Federation for Mental Health (WFMH) wrote.

Not surprisingly, depression has the largest effect on worsening health, compared with other chronic illnesses. According to the report, depression is present in one of five outpatients with coronary heart disease and in one of three outpatients with heart failure, and most such cases go unrecognized. Negative lifestyle habits associated with depression – such as smoking, excessive alcohol consumption, lack of exercise, poor diet, and lack of social support – interfere with the treatment for heart disease.

Major depression puts heart attack victims at great risk and appears to add to the patients' disability from heart disease. It can contribute to a worsening of symptoms as well as to poor adherence to cardiac treatment regimens.

Based on global prevalence estimates of diabetes that were done in 2003, 43 million people with diabetes have symptoms of depression. Furthermore, people who have diabetes and depression have more severe symptoms of both diseases and higher rates of work disability, and they use more medical services than do those who have diabetes alone.

According to the WFMH report, studies suggest that depression increases the risk of developing type 2 diabetes more than 20% in young adults. Depression can lead to poor lifestyle decisions, such as smoking, alcohol abuse, weight gain, unhealthy eating, and lack of exercise.

About half of all patients with terminal or advanced cancer suffer with poor mental health. Adequate recognition of depression is important to enhance quality of life.

Overall, 20% of patients with asthma and chronic obstructive pulmonary disease suffer from major depression and/or anxiety. Studies suggest that psychopharmacologic and/or psychosocial interventions might improve asthma control. Depression and anxiety are associated with unhealthy behaviors, such as poor diet, physical inactivity, sedentary lifestyle, tobacco use, and heavy alcohol consumption. Many of these factors lead to obesity. Obesity has been associated with an increased lifetime risk for major depression and panic disorder. It is suggested that primary care services need to improve ways of screening for depression that is associated with particular chronic illnesses like heart conditions or diabetes.

The American Psychological Association suggests the following 10 ways to build resilience:

▸ Make connections.

▸ Avoid seeing crises as insurmountable problems.

▸ Accept that change is a part of living.

▸ Move toward realistic goals.

▸ Take decisive actions.

▸ Look for opportunities for self-discovery.

▸ Nurture a positive self-view.

▸ Keep things in perspective.

▸ Maintain a hopeful outlook.

▸ Maintain self-care.

Above all, integrated health care is vitally important in order to address mental and physical health problems. Such problems will remain unresolved and complicated if either part is ignored. The important aspect is the collaborative part of psychiatrists, our physician colleagues such as family practitioners, and allied mental health professionals in achieving the goal of addressing and managing this issue.

This, of course, is the right approach if we are serious about addressing global morbidity and mortality. Hence, the theme advocated this year by the WFMH is quite appropriate.

This year's theme for World Mental Health Day is a reminder that we psychiatrists must work closely with our colleagues not only in primary care but also in cardiology, endocrinology, oncology, and pulmonology.

The theme of the day, which is observed on Oct. 10, is “Mental Health and Chronic Physical Illnesses – The Need for Continued and Integrated Care.”

We know that mental health greatly affects the management of chronic physical illnesses. The four major chronic illnesses mentioned by the World Health Organization – cardiovascular problems, diabetes, cancer, and respiratory illnesses – are responsible for 60% of the world's deaths, and 80% of these deaths are happening among the world's poorest populations. “If nothing is done, experts estimate that we could witness another 388 million people die prematurely within the next 10 years,” authors of the 2010 report prepared by the World Federation for Mental Health (WFMH) wrote.

Not surprisingly, depression has the largest effect on worsening health, compared with other chronic illnesses. According to the report, depression is present in one of five outpatients with coronary heart disease and in one of three outpatients with heart failure, and most such cases go unrecognized. Negative lifestyle habits associated with depression – such as smoking, excessive alcohol consumption, lack of exercise, poor diet, and lack of social support – interfere with the treatment for heart disease.

Major depression puts heart attack victims at great risk and appears to add to the patients' disability from heart disease. It can contribute to a worsening of symptoms as well as to poor adherence to cardiac treatment regimens.

Based on global prevalence estimates of diabetes that were done in 2003, 43 million people with diabetes have symptoms of depression. Furthermore, people who have diabetes and depression have more severe symptoms of both diseases and higher rates of work disability, and they use more medical services than do those who have diabetes alone.

According to the WFMH report, studies suggest that depression increases the risk of developing type 2 diabetes more than 20% in young adults. Depression can lead to poor lifestyle decisions, such as smoking, alcohol abuse, weight gain, unhealthy eating, and lack of exercise.

About half of all patients with terminal or advanced cancer suffer with poor mental health. Adequate recognition of depression is important to enhance quality of life.

Overall, 20% of patients with asthma and chronic obstructive pulmonary disease suffer from major depression and/or anxiety. Studies suggest that psychopharmacologic and/or psychosocial interventions might improve asthma control. Depression and anxiety are associated with unhealthy behaviors, such as poor diet, physical inactivity, sedentary lifestyle, tobacco use, and heavy alcohol consumption. Many of these factors lead to obesity. Obesity has been associated with an increased lifetime risk for major depression and panic disorder. It is suggested that primary care services need to improve ways of screening for depression that is associated with particular chronic illnesses like heart conditions or diabetes.

The American Psychological Association suggests the following 10 ways to build resilience:

▸ Make connections.

▸ Avoid seeing crises as insurmountable problems.

▸ Accept that change is a part of living.

▸ Move toward realistic goals.

▸ Take decisive actions.

▸ Look for opportunities for self-discovery.

▸ Nurture a positive self-view.

▸ Keep things in perspective.

▸ Maintain a hopeful outlook.

▸ Maintain self-care.

Above all, integrated health care is vitally important in order to address mental and physical health problems. Such problems will remain unresolved and complicated if either part is ignored. The important aspect is the collaborative part of psychiatrists, our physician colleagues such as family practitioners, and allied mental health professionals in achieving the goal of addressing and managing this issue.

This, of course, is the right approach if we are serious about addressing global morbidity and mortality. Hence, the theme advocated this year by the WFMH is quite appropriate.

By definition, nostalgia is a wistful desire to return in thought or fact to a former time in one's life–to one's home or homeland, or to one's family and friends. It is a sentimental yearning for the happiness of a former place or time.

Perhaps this desire explains, in part, the seasonal journeys undertaken by birds of many species. Of course, they are motivated largely by weather and a quest for survival. But like clockwork, these birds return to their original habitats, often after enduring journeys fraught with danger.

We also see this trend among humans, albeit in a different way. The issues are in many ways similar, such as the search for greener pastures and economic uplift, and for better living, education, and employment. Still, the destination often proves alien, and there are many risks involved in migration.

Anthropologists have documented this trend since earlier times, when people used to migrate in large groups. Hence, the phenomenon has always been part of the human experience.

But migration often comes at a huge psychological price. After all, psychologically speaking, people who are born and raised in a particular country develop an attachment to that place, and detachment sometimes leads to emotional turmoil. I've seen this in my practice, and so have my colleagues.

The type of emotional reaction differs, depending on whether the migration is forced or not. But the transition can prove challenging just the same.

Many of our colleagues who originated from developing countries are practicing medicine in places such as the United States, Canada, Australia, New Zealand, and the United Kingdom. These international physicians left their homes for a myriad of reasons, but often because of the prospects of better training and a better life.

Many of these physicians express a desire to repatriate back to their countries of origin, and I speculate that about 90% do not go back for one reason or other. About 10% opt to return home, only to find that they would come back to their adopted countries if they could. Often, life in the home country has changed, which can make people feel alienated when they go back.

In many cases, these medical doctors form listservs with their classmates and continue exchanging e-mails remembering the old days. I receive these kinds of e-mails just about every day from former classmates from medical school. Very often, a sense of emptiness prevails within them.

I suspect that many of these doctors undergo brief periods of depression and other mood changes. However, a large number of them develop a phase of denial and a sense of pseudodetachment.

I have not been able to find anything in the literature that examines the extent to which mental health professionals can help lift the nostalgia among international physicians.

Considering our expertise, however, I'm sure that we psychiatrists have the skills to help.

This appears to be a fascinating area for research, particularly in light of the growing numbers of international medical graduates practicing in the United States, for example (N. Engl. J. Med. 2004;350:2435–7).

I wouldn't be surprised if someday we develop a nostalgia-related diagnostic entity in the psychiatric classification system.

By definition, nostalgia is a wistful desire to return in thought or fact to a former time in one's life–to one's home or homeland, or to one's family and friends. It is a sentimental yearning for the happiness of a former place or time.

Perhaps this desire explains, in part, the seasonal journeys undertaken by birds of many species. Of course, they are motivated largely by weather and a quest for survival. But like clockwork, these birds return to their original habitats, often after enduring journeys fraught with danger.

We also see this trend among humans, albeit in a different way. The issues are in many ways similar, such as the search for greener pastures and economic uplift, and for better living, education, and employment. Still, the destination often proves alien, and there are many risks involved in migration.

Anthropologists have documented this trend since earlier times, when people used to migrate in large groups. Hence, the phenomenon has always been part of the human experience.

But migration often comes at a huge psychological price. After all, psychologically speaking, people who are born and raised in a particular country develop an attachment to that place, and detachment sometimes leads to emotional turmoil. I've seen this in my practice, and so have my colleagues.

The type of emotional reaction differs, depending on whether the migration is forced or not. But the transition can prove challenging just the same.

Many of our colleagues who originated from developing countries are practicing medicine in places such as the United States, Canada, Australia, New Zealand, and the United Kingdom. These international physicians left their homes for a myriad of reasons, but often because of the prospects of better training and a better life.

Many of these physicians express a desire to repatriate back to their countries of origin, and I speculate that about 90% do not go back for one reason or other. About 10% opt to return home, only to find that they would come back to their adopted countries if they could. Often, life in the home country has changed, which can make people feel alienated when they go back.

In many cases, these medical doctors form listservs with their classmates and continue exchanging e-mails remembering the old days. I receive these kinds of e-mails just about every day from former classmates from medical school. Very often, a sense of emptiness prevails within them.

I suspect that many of these doctors undergo brief periods of depression and other mood changes. However, a large number of them develop a phase of denial and a sense of pseudodetachment.

I have not been able to find anything in the literature that examines the extent to which mental health professionals can help lift the nostalgia among international physicians.

Considering our expertise, however, I'm sure that we psychiatrists have the skills to help.

This appears to be a fascinating area for research, particularly in light of the growing numbers of international medical graduates practicing in the United States, for example (N. Engl. J. Med. 2004;350:2435–7).

I wouldn't be surprised if someday we develop a nostalgia-related diagnostic entity in the psychiatric classification system.

By definition, nostalgia is a wistful desire to return in thought or fact to a former time in one's life–to one's home or homeland, or to one's family and friends. It is a sentimental yearning for the happiness of a former place or time.

Perhaps this desire explains, in part, the seasonal journeys undertaken by birds of many species. Of course, they are motivated largely by weather and a quest for survival. But like clockwork, these birds return to their original habitats, often after enduring journeys fraught with danger.

We also see this trend among humans, albeit in a different way. The issues are in many ways similar, such as the search for greener pastures and economic uplift, and for better living, education, and employment. Still, the destination often proves alien, and there are many risks involved in migration.

Anthropologists have documented this trend since earlier times, when people used to migrate in large groups. Hence, the phenomenon has always been part of the human experience.

But migration often comes at a huge psychological price. After all, psychologically speaking, people who are born and raised in a particular country develop an attachment to that place, and detachment sometimes leads to emotional turmoil. I've seen this in my practice, and so have my colleagues.

The type of emotional reaction differs, depending on whether the migration is forced or not. But the transition can prove challenging just the same.

Many of our colleagues who originated from developing countries are practicing medicine in places such as the United States, Canada, Australia, New Zealand, and the United Kingdom. These international physicians left their homes for a myriad of reasons, but often because of the prospects of better training and a better life.

Many of these physicians express a desire to repatriate back to their countries of origin, and I speculate that about 90% do not go back for one reason or other. About 10% opt to return home, only to find that they would come back to their adopted countries if they could. Often, life in the home country has changed, which can make people feel alienated when they go back.

In many cases, these medical doctors form listservs with their classmates and continue exchanging e-mails remembering the old days. I receive these kinds of e-mails just about every day from former classmates from medical school. Very often, a sense of emptiness prevails within them.

I suspect that many of these doctors undergo brief periods of depression and other mood changes. However, a large number of them develop a phase of denial and a sense of pseudodetachment.

I have not been able to find anything in the literature that examines the extent to which mental health professionals can help lift the nostalgia among international physicians.

Considering our expertise, however, I'm sure that we psychiatrists have the skills to help.

This appears to be a fascinating area for research, particularly in light of the growing numbers of international medical graduates practicing in the United States, for example (N. Engl. J. Med. 2004;350:2435–7).

I wouldn't be surprised if someday we develop a nostalgia-related diagnostic entity in the psychiatric classification system.