Towards Better Mental and Physical Health: Preventing and Managing Concurrent Mental and Physical Conditions – A Scoping and Rapid Realist Review

Background

Physical and mental health co-morbidities are common, however, little is known about their prevalence, incidence, associated healthcare-related costs, shared etiology, prevention and management. A better understanding of how to prevent, screen, diagnose, and treat common physical and mental health co-morbidities can lead to the development of improved and sustainable health system approaches for diverse populations.
This report provides a synthesis of current international knowledge about physical and mental health co-morbidities, including information, where available, about how they intersect with sex/gender and how their characteristics may vary across priority and equity-seeking populations such as immigrant, refugee, ethnocultural and racialized (IRER) communities, First Nations, Inuit and Métis, the 2SLGBTQ+ community, and linguistic minorities. The non-communicable diseases (NCDs) discussed in this report include arthritis, cancer, cardiovascular disease, chronic respiratory diseases, dementia, diabetes mellitus, epilepsy, frailty, Huntington’s disease, inflammatory bowel disorders, kidney disease, metabolic syndrome, obesity, and Parkinson’s disease. The mental health comorbidities discussed with these NCDs include depressive and anxiety disorders, bipolar and related disorders, schizophrenia spectrum and other psychotic disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders, substance use and addictive disorders, or feeding and eating disorders. In addition, common mental health symptoms that are comorbid with NCDs, such as depression and anxiety, are discussed. Finally, a rapid realist review that drew upon selected interventions from the literature was conducted to better understand what strategies are considered for different people and the mechanisms to explain why they were effective. Highlights and Recommendations
Based on the synthesis of more than 800 research documents, a number of conclusions and recommendations arise from this review that are aimed at practitioners, policy-makers, decision-makers, and researchers.

Policies

• All of the physical and mental health comorbidities highlighted have shared biological, psychosocial, and environmental etiological pathways. Policies and preventive programming that target these pathways, particularly psychosocial and environmental targets, are recommended. These should aim to address resource allocation to mental health promotion, screening and monitoring practices, and interventions.
• Policies aimed at life course, population health, and mental health promotion have the potential to prevent or delay the development of physical and mental health conditions. Policy targets should include food environments, healthy eating, food security, physical activity, affordable childcare, affordable housing, social assistance, employment, as well as health and income equity.

Programs, Education, and Services

• Interventions that are comprehensive, integrated, tailored, and based on shared decision-making will help to address the multiple underlying factors contributing to physical and mental health comorbidities. These practices can reduce health system costs by shifting resources towards health promotion and prevention, reducing reliance on acute care, facilitating health care continuum transitions, and fostering health system sustainability.
• As part of integrated health services, stepped-care models show potential to further optimize care for those with physical and mental health comorbidities and reducing health care costs. Stepped care refers to the delivery of care intensity that is matched to the complexity of the health issue. To facilitate the delivery of these approaches, supportive administrative and reimbursement structures are needed that are inclusive of allied health professionals who can work collaboratively with other practitioners to best support the end-user’s physical and mental health needs.
• Collaborative care models need to target human capacity and technology to optimize service provision. These approaches need to be inclusive of all health disciplines, including substance use disorder experts.
• Public health campaigns which help to dispel myths and stigma associated with having chronic conditions could minimize potential of mental health impacts. Exemplars of positive messaging and images could include showing individuals with health conditions leading healthy productive lives and working effectively with their health care team.
• While primary care provides the foundation for physical and mental health care services, there is a need to better integrate these approaches with social services to address the multi-faceted complex needs of those with mental and physical health comorbidities. These services need to be accessible to all, particularly groups which face barriers to access such as those residing in rural and remote communities.

Research

• Health research that can better inform practice, programming, and policy includes ongoing exploration of the determinants of health condition comorbidities, optimal delivery and integration of health and social services, and examining policy alternatives to optimize population mental health interventions, or a co-intervention (pulmonary rehabilitation).
• Future research should include individuals with lived experiences of physical and mental health comorbidities, their families, and carers.