All of us have heard the expression, “I am worried to death!” But is this merely a figure of speech, or is there any literal truth to such a statement? So let’s take a look at what science has to offer:
Multiple studies have shown that people who are lonely and depressed are over three times more likely to get sick and die prematurely—in contrast to people who are not depressed, and especially those who have a stronger sense of love, connection, and community. For example, one report disclosed that 6 months after a heart attack, people who were depressed were four times more likely to die than those who weren’t depressed. This was independent of the usual risk factors like cholesterol, blood pressure, weight, and even smoking. Consistent with that observation, there have been hundreds of studies showing that people who are lonely and depressed are many times more likely to get sick and die prematurely—from all causes as well as heart disease—when compared with those who have a strong sense of love, connection, and community. Such observations are consistent with studies that have shown that being married—at least happily—are actually good for your heart. In one recent survey out of New York University’s Lagone Medical Center, researchers found that married men and women had a five percent lower chance of cardiovascular disease compared to single people. We aren’t entirely sure why, but it’s possible that since marriages typically offer a person emotional support, physical and intellectual intimacy, as well as deeper social ties to family, they might improve overall health. Consistent with this concept, one study found that people in a bad marriage were actually more likely to experience negative cardiovascular effects, compared to people in good marriages. Thus it’s not necessarily about whether you’re married or not, it’s all about how happy it’s making you.
This raises the question of whether the adverse outcomes are due to the emotional disruption or to the poor lifestyle choices made by those who are depressed or nervous. It is true that some people who are lonely and distraught are more likely to do things that are self-destructive, for example, smoke excessively or fail to take medicines as prescribed. But these explanations seem to fall short of the real truth, as explained below.
There are ways that mental health issues can directly affect heart disease, as reflected in the growing belief that depression and anxiety are risk factors that are even more dangerous than others such as diet. Stress can increase hormones like adrenaline and cortisol, and can impact one’s blood pressure and heart rate in an unfavorable way. Moreover, people with depression have been found to have uncommonly sticky platelets, the tiny cells that cause blood to clot. In patients with heart disease, this can accelerate atherosclerosis (hardening of the arteries) and increase the chance of heart attack. Some studies suggest that treating depression makes platelets less sticky again.
Even animal studies have demonstrated that positive emotional support can foster better health. One study dealt with atherosclerotic rabbits. Rabbits were put on a high-cholesterol diet with the assumption that they would all get heart disease. The rabbits were stacked in cages up to the ceiling, and the ones up high got heart disease a lot more than the ones in the lower cages, which made no sense. What they found was that the lab technician, who was short, would come in to feed the rabbits and would play with the ones in the lower cages because she could reach them, and she would ignore the ones in the higher cages. The study was repeated with genetically comparable rabbits fed the same diet, and they randomly divided the rabbits into two groups. With one group they would take the rabbits out of the cages, play with them, and love them They found that the rabbits that were touched, talked to, petted, and played with had 60% less atherosclerosis than those that were ignored, even though their serum cholesterol levels, heart rate, and blood pressure were comparable.
Similar findings have been reported with male monkeys, for those that were stressed had significantly more extensive coronary artery atherosclerosis compared with a control group of monkeys that weren’t stressed, even though their cholesterol, blood pressure, blood sugar, weight, etc. were not different.
In medicine, we focus on what we can see and measure easily. We can measure cholesterol and blood pressure easily so we tend to focus on those things. The American Heart Association still doesn’t list emotional stress in their seven key modifiable risk factors. There is a saying that not everything that counts can be counted. In other words, not everything that is meaningful is measurable. We tend to focus on what is easily measurable, even though these psychosocial factors are probably as important—and in some ways, even more so. Scientists are getting more innovative at measuring these factors. In a recent study, researchers analyzed 148 million Twitter messages (tweets) across the United States and found that language patterns reflecting negative social relationships, disengagement, and negative emotions—especially anger—were risk factors for heart disease at a county level and were even more predictive than smoking, diabetes, hypertension, and obesity. In contrast, positive emotions and psychological engagement were protective.
Maintaining a positive attitude about treatment and holding the belief that our actions can have a beneficial effect on our own health are very important. A person’s attitude seems to have a powerfully favorable effect on their ability to make behavior and lifestyle changes that are often necessary to reduce the risk of having future health problems. A person’s attitude also influences the response to treatment.
So what can we do about these emotional problems, and can countermeasures alter one’s odds of survival?
Although treatments such as psychotherapy and drugs are often used to improve emotional status, the results of such measures are complicated and difficult to measure, leaving us in doubt about their individual effects on survival. Regular exercise, however, has been proven to reduce both depression and risk of disease. Various studies have shown that participation in exercise training programs was comparable to treatment with an antidepressant medication (a selective serotonin reuptake inhibitor) for improving depressive symptoms in older adults diagnosed with major depression. Exercise per se also offers significant protection against heart disease and many cancers as well. Included among the many benefits of regular exercise is the lessening of the likelihood of upper respiratory infections and reduction of the severity of symptoms if you do get one. The reason for this protection is unclear, but exercise’s demonstrated reduction of inflammation and its boosting of general immunity in the body may play a role.
Although it’s difficult to separate and determine the effects of pure emotional support on survival, it is highly likely that such countermeasures are effective. Regardless, however, combating depression and anxiety and promoting more social interaction that include love and respect are beneficial goals in themselves, making for a happier and healthier individual, and hopefully, a longer life as well!