Mental health

What is mental health?

Mental health is so broad and encompasses so many factors and areas of study that it is difficult to give a brief, clear and concise definition. According to the World Health Organization (WHO) definition, “mental health is a state of well-being in which an individual realizes his or her capabilities, can cope with the normal stresses of life, can work productively, and can make a contribution to his or her community” [1]. It includes emotional, psychological and social well-being, affecting how we think, feel and act. Although they are often used in the same way, having poor mental health and having a mental illness are not synonymous. Thus, a person can have poor mental health without being diagnosed with a mental illness, whereas a diagnosed person can experience periods of physical, psychological and social well-being [1]. In other words, mental health is not just about the presence or absence of a condition or illness but everything that contributes to that state of individual well-being.

How did the concept of mental health originate?

The concept of mental health and the medical discipline has a reasonably recent origin dating back to the middle of the 20th century when the WHO and the World Federation for Mental Health (WFMH) were founded in 1948. Previously, studies associated with this field were very scarce and isolated, with no established basis or treatment protocols established by a specialized committee or association [2], [3]. The term Mental Hygiene was used, but more than a medical discipline, it was a movement for the improvement of conditions in the treatment, study and consideration of mental diseases and conditions, initiated by Adolf Meyer and Clifford Beers in 1908 after publishing A mind that found itself [4], a book based on Beers’ own experiences after spending time in three psychiatric hospitals. From that moment on, Mental Hygiene began to have a more significant presence in society and among professionals, encouraging greater awareness of the need to create associations and committees in the sector, culminating in the consolidation of the concept and discipline of mental health, as well as international associations specializing in it, such as the WFMH. 

The current reality of mental health, explained with numbers:

– What is the prevalence of mental health disorders?

According to Headway2023, a WHO-supported project that aims to reflect the reality of mental health in Europe and thus establish plans for action and improvement, more than one person in six is affected by a mental health problem in Europe today, and one in 4 people in the world will be affected by a mental or neurological disorder in their lifetime [5], [6]. This figure is given by the recognized cases, as mental health problems are substantially and systematically underreported, especially when compared to physical disorders or are a priori mild cases, which untreated eventually lead to significant health problems. Mental health problems rank second among disabling noncommunicable diseases in Europe, behind musculoskeletal conditions, accounting for 15% of the factors contributing to disability in the European population. Anxiety and depressive disorders are the most common (5,529 and 4,367 cases per 100,000 inhabitants, respectively) (Figure 1). These data translate into a 3.7% mortality related to mental disorders in Europe, with suicide being the sixth leading cause of mortality in the population under 70 years of age and the fourth in the population under 20 years of age, with an average of 12 suicides per 100,000 inhabitants in 2019 [6].

Figure 1. Prevalence of mental health disorders in Europe in 2019. Values reflected are per 100,000 population. Source: Headway2023.

– Mental health and the pandemic

According to WHO, mental health problems have increased since the beginning of the pandemic, mainly related to high levels of anxiety and stress [7]. Social isolation, fear of contagion, uncertainty, chronic stress and economic difficulties related to the pandemic are the main factors that may have contributed to the development or exaltation of depressive disorders and increased suicide rates [6], [8]. For example, in Spain, these data are alarming, with almost 11 suicides per day during 2020 becoming the leading cause of unnatural death and the year with the highest number of cases in the country since there is a record (1906) [8]-[10]. 

– Mental health expenditures

The total costs of mental illness are estimated at more than 4% of GDP (more than 600 billion euros) in the European Union [11]. 

Importance of mental health

Both physical and mental health are equally important factors of overall health. Moreover, both affect each other, as several studies suggest. Poor mental health can lead to significant physical health problems. On the other hand, physical conditions, especially chronic ones, can lead to serious mental health problems. An example is the relationship between patients with depression and predisposition to diabetes, heart disease and stroke [12]. In short, we could summarize the importance of well-being with the well-known expression mens sana in corpore sano, evoking the importance of having a balance between mental and physical health to maintain well-being and try to lead a full life [13], [14]. Maintaining good mental and physical health will bring us, among many other advantages, a more remarkable ability to cope with complicated situations by reducing stress, have a better self-image and self-confidence to develop our full potential, improve healthy social relationships, increase productivity and, ultimately, a higher quality of life [11].

Factors that can influence mental health.

Mental health is not influenced by only one factor but is the result of a multitude of environmental, social, biological and psychological factors [15]. These include socioeconomic background, adverse childhood and social experiences, chronic health conditions, genetic predisposition, family history, and lifestyle, including diet, physical activity, and substance use [6], [11], [16]. 

Detection

It is often difficult to understand when there is evidence of poor mental health. Likewise, it can be challenging to know what is normal and not when dealing with emotions. Therefore, it is essential to carry out self-care of mental health and well-being, to be able to detect in time when we need to work to improve it or ask for external help and go to a specialized therapist to help us obtain the necessary tools to do so. Several signs warn of the need to work on improving our mental health, among others [15]:

• Imbalances in eating and sleeping.
• Feelings of helplessness and frustration.
• Social isolation.
• Apathy and continued irascibility.
• Continuous fatigue.
• Sudden changes of mood that affect social relationships.
• Recurrent negative thoughts.
• Inability to carry out daily tasks.

Prevention – mens sana in corpore sano

Mental and physical health are closely related, and a balance between them is ideal for maintaining wellness and enjoying a full life. Various forms of self-care to promote mental health could be the following:

• Trying to maintain a positive attitude. For example, assuming, channelling and overcoming negative emotions.
• Maintaining and taking care of social relationships.
• Learning to say “no” to those tasks or situations that involve negative emotions to get away from them.
• Working on developing skills to cope with difficult situations.
• Practice relaxation and meditation techniques (mindfulness). These activities have been shown to relax breathing, decrease muscle tension and blood pressure, and release stress.
• Take care of your physical health:
  • Get proper rest.
  • Eat a healthy diet. 
  • Exercise regularly.

On the other hand, institutions have a significant role to play in improving mental health at the social level through various actions: increasing health resources for mental health to increase access to professionals by the population, awareness campaigns and de-stigmatization of mental health problems, greater control of harassment at all levels, etc. [5], [6], [17]-[19].

Mental health and genetics

The role of genetic factors in mental health is somewhat secondary. Although the number of studies associating specific genetic variants with some disorders has grown in recent years, it is still too early to understand in-depth the connection between genetics and mental health due to the complexity and breadth of what it consists of. Currently, through genetics, it is only possible to predict the risk of developing only certain mental disorders, such as schizophrenia, included in our health test. Although the role of genetic testing in detecting mental health problems is very limited, it can indirectly help to guide our bodies to a higher state of individual wellbeing and thus help to maintain good mental health. For example, our nutrigenetics and sports tests, together with the help of specialized professionals, can help us intelligently organize a balanced and healthy diet and an exercise routine adapted to our conditions based on our genetic profile. On the other hand, with the skin test, we will know the characteristics of our skin, which allows us to adapt a facial routine by performing a personalized beauty treatment. Finally, the pharmacogenetics test includes drugs oriented to the treatment of certain mental disorders, among others, to know which are the most suitable in case of needing treatment.