Integrating mental health with other non-communicable diseases

Mental disorders often coexist with other non-communicable diseases and they share many risk factors. Dan Stein and colleagues examine the evidence for an integrated approach Mental health and wellbeing are central to reducing the global burden of non-communicable diseases (NCDs). The World Health Organization’s mental health action plan for 2013-20 emphasises this, and last year UN member states expanded their focus on the big four NCDs and risk factors to a five-by-five approach that includes mental disorders and environmental contributors (box 1).12 Box 1 ### Five-by-five approach to tackling NCDs #### Disease types #### Risk factorsRETURN TO TEXT Cardiovascular diseases, diabetes, cancer, and respiratory diseases commonly co-occur with both common mental disorders (such as depression and anxiety disorders) and severe mental illnesses (such as schizophrenia and bipolar disorder). In addition, risk factors for NCDs such as tobacco use, unhealthy diet, physical inactivity, and harmful alcohol use commonly cluster in people with mental disorders. We summarise evidence on these overlaps in order to support the call for including mental health in strategies for reducing NCDs. We also provide evidence for explicitly considering childhood adversity as an environmental risk factor. We emphasise findings from the World Mental Health Surveys, a unique international dataset comprising more than 100 000 respondents in more than 20 countries.34 Epidemiological studies have found significant associations—within and across countries—between cardiovascular diseases and common mental disorders.56 In the World Mental Health Surveys, odds ratios for the association of heart disease with mental disorders were 2.1 for mood disorders, 2.2 for anxiety disorders, and 1.4 for alcohol misuse or dependence across countries. A dose-response association was seen between increasing number of mental disorders and heart disease, and there were strong associations between …