February is American Heart Month, it is a time to raise awareness about heart health and urge those around you to prevent heart disease [1]. Here at Breaking Taboo, we would like to take a moment and discuss the connection between mental health and heart health. Previously, the connection was seen as strictly behavioral. Behavioral in the sense that people were turning to binge eating, drinking and smoking when feeling down [3].

But currently, research is showing that aside from behavioral there could be physiological connections too [3]. “The biological and chemical factors that trigger mental health issues also could influence heart disease [3].”

The statistics are showing that “people with depression have a 40% higher risk of developing cardiovascular and metabolic diseases than the general population. People with serious mental illness are nearly twice as likely to develop these conditions [4].”

Recently, there was an article in Harvard Health that discussed the head-heart connection [2]. According to this article, new research suggests that, people with depression or anxiety are more prone to developing cardiovascular disease.

Harvard Health conducted a research study where 221,000 people ages 45 and older without any history of heart disease were included [2]. They were given a short mental health questionnaire to assess their distress. There was an average follow-up of more than four-and-a-half years were “people who had reported high or very high levels of depression and anxiety were more likely to have had a heart attack or stroke than people without those symptoms.”


The following is the Kessler psychological distress test that was used in the previously mentioned study:

Assess your distress

The Kessler psychological distress scale is a list of 10 questions used to identify people who need further assessment for anxiety or depression. People can select answers ranging from 1 to 5: 1 (none of the time); 2 (a little of the time); 3 (some of the time); 4 (most of the time); 5 (all of the time).

During the past four weeks, about how often did you feel

___ depressed?
___ nervous?
___ so nervous that nothing could calm you down?
___ restless or fidgety?
___ so restless that you could not sit still?
___ tired out for no good reason?
___ that everything was an effort?
___ so sad that nothing could cheer you up?
___ hopeless?
___ worthless?

Scoring: 15 or lower = low; 16–21= moderate; 22–29 = high; 30–50 = very high


So what does this study conclude? “These findings do not necessarily mean that psychological distress causes heart disease. Instead, both may arise (at least in part) from the same underlying mechanisms, says Dr. Jill Goldstein, a professor of psychiatry and medicine at Harvard Medical School and Executive Director of the Women, Heart and Brain Global Initiative at Massachusetts General Hospital [2].”

Psychological distress not only accelerates the onset of heart disease but it also gets in the way of practicing prevention [5]. So, the bottom line is while we are trying to increase our physical activity and changing our diets, we must also learn to take into consideration what our emotions and thoughts are.
Preventative Practices:


Recommendations from the American Psychological Association:

Although heart disease is a serious condition that requires constant monitoring, there are many things you can do to reduce your risk for cardiovascular problems and live a full, active life, even if you should suffer a heart attack [5].

• Talk to your doctor. No two people are alike, and some treatment or risk reduction strategies may be inappropriate or even harmful if you attempt to do too much too quickly [5].


o Key screening tests for monitoring cardiovascular health [6]:

 Blood pressure- Each regular healthcare visit or at least once per year if blood pressure is less than 120/80 mm Hg.
 Fasting Lipoprotein Profile (cholesterol)- Every 4-6 years for normal-risk adults; more often if anyone has elevated risk for heart disease and stroke.
 Body Weight- During your regular healthcare visit.
 Blood Glucose- At least every 3 years.
 Smoking, physical activity, diet- Each regular healthcare visit.

• Avoid trying to fix every problem at once, if possible. Focus instead on changing one existing habit (e.g., eating habits, inactive lifestyle). Set a reasonable initial goal and work toward meeting it [5].


o Set “SMART goals [7]:
 Specific- What do you want to happen?
 Measurable- How will you know that you accomplished what you wanted to do?
 Attainable- Is this goal something you can really accomplish?
 Realistic- Is your goal too hard or too easy to achieve?
Timely- Do you have a definite time frame to complete your goal?


• Don’t ignore the symptoms of depression. Feelings of sadness or emptiness, loss of interest in ordinary or pleasurable activities, reduced energy, and eating and sleep disorders are just a few of depression’s many warning signs. If they persist for more than two weeks, discuss these issues with your heart doctor. It may be that a psychologist working in collaboration with your physician would be beneficial [5]. Depression is not the end of the world, even if it may sometimes feel like it. Here at Breaking Taboo, we encourage people to be open and authentic about their feelings while providing the education necessary to move forward. We encourage you to get help if the below signs and symptoms resonate with you.


o If, you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression [8]:

 Persistent sad, anxious, or “empty” mood
 Feelings of hopelessness, or pessimism
 Irritability
 Feelings of guilt, worthlessness, or helplessness
 Loss of interest or pleasure in hobbies and activities
 Decreased energy or fatigue
 Moving or talking more slowly
 Feeling restless or having trouble sitting still
 Difficulty concentrating, remembering, or making decisions
 Difficulty sleeping, early-morning awakening, or oversleeping
 Appetite and/or weight changes
 Thoughts of death or suicide, or suicide attempts
 Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment


• It is important to note that learning how to manage stress effectively is most important. In life, we will always have stressors, and so trying to avoid stress can be a maladaptive coping mechanism. Identify the sources of stress in your life and look for ways to reduce and manage them. Seeing a professional like a psychologist to learn to manage stress is helpful not only for preventing heart disease, but also for speeding recovery from heart attacks when used along with structured exercise programs and other intensive lifestyle changes [5].


o How to identify stress: there can be psychological signs, emotions signs, physical signs and behavioral signs [9]:

Psychological signs:
 Inability to concentrate or make simple decisions
 Memory lapses
 Becoming rather vague
 Easily distracted
 Less intuitive & creative
 Worrying
 Negative thinking
 Depression & anxiety

Emotional signs:
 Tearful
 Irritable
 Mood swings
 Extra sensitive to criticism
 Defensive
 Feeling out of control
 Lack of motivation
 Angry
 Frustrated
 Lack of confidence
 Lack of self-esteem

Physical signs
Aches/pains & muscle tension/grinding teeth
 Frequent colds/infections
 Allergies/rashes/skin irritations
 Constipation/diarrhea/ IBS
 Weight loss or gain
 Indigestion/heartburn/ulcers
 Hyperventilating/lump in the throat/pins & needles
 Dizziness/palpitations
 Panic attacks/nausea
 Physical tiredness
 Menstrual changes/loss of libido/sexual problems
 Heart problems/high blood pressure

Behavioral signs
 No time for relaxation or pleasurable activities
 Prone to accidents, forgetfulness
 Increased reliance on alcohol, smoking, caffeine, recreational or illegal drugs
 Becoming a workaholic
 Poor time management and/or poor standards of work
 Absenteeism
 Self-neglect/change in appearance
 Social withdrawal
 Relationship problems
 Insomnia or waking tired
 Reckless
 Aggressive/anger outbursts
 Nervous
 Uncharacteristically lying


• Enlist the support of friends, family, and work associates. Talk with them about your condition and what they can do to help. Social support is particularly critical for overcoming feelings of depression and isolation during recovery from a heart attack [5].

• If you feel overwhelmed by the challenge of managing the behaviors associated with heart disease, consult a qualified psychologist. He or she can help develop personal strategies for setting and achieving reasonable health improvement goals, as well as building on these successes to accomplish other more ambitious objectives. A psychologist can also help clarify the diagnosis of depression and work with the physician to devise a suitable treatment program [5].


This article is meant to be an educational and informational piece. If you are concerned about your health, you should discuss with your healthcare provider. Discuss how you are feeling both emotionally (mentally) and physically. Your primary care provider may refer you to a mental health professional for medication and/ or therapy.

You should monitor heart health not only during this month but every day, especially for those who are dealing with already existing heart health.


~ Jasneelam Kaur, MPH

Edited by ~ Serena Sun, Founder


[1] https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-month
[2] https://www.health.harvard.edu/heart-health/the-head-heart-connection-mental-health-and-heart-disease
[3] https://www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing/mental-health-and-heart-health
[4] https://www.nami.org/learn-more/mental-health-by-the-numbers
[5] https://www.apa.org/helpcenter/heart-disease
[6] https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/heart-health-screenings
[7] https://breaking-taboo.org/general-posts/new-year-new-you-lets-break-the-taboo/
[8] https://www.nimh.nih.gov/health/topics/depression/index.shtml