The Impact of Mental Health Comorbidities on Physiotherapy Treatment

As a physiotherapist, understanding the relationship between mental and physical health is integral to providing effective treatment. Mental health comorbidities, or the presence of two or more disorders occurring in the same person, can have a significant impact on the way we diagnose and create a client’s treatment plan.

Common Mental Health Comorbidities

Mental health disorders are the leading cause of disability worldwide (World Health Organization, 2022). Some of the most common mental health comorbidities seen in physiotherapy clients can include:

Anxiety disorders

Depression

Post-traumatic stress disorder (PTSD)

Substance abuse disorders

Eating disorders

Researchers have found that the presence of these conditions can lead to worsened physical symptoms, poor adherence to treatment plans, and lower overall quality of life (Katon et al, 2002).

The Impact on Diagnosis

A physiotherapist’s ability to accurately diagnose a client’s physical ailment is impacted by their mental health status. Clients with anxiety disorders, for example, may exhibit somatization (bodily symptoms caused by anxiety), leading to the increased need for screening to rule out a physical driver of pain (Gelenberg, 2000). Depression can also cause fatigue and lethargy, which may be mistaken for poor physical health. This is why here at Kneaded Care Wellness our physiotherapist’s take the time to understand their client’s mental health history to make an accurate diagnosis.

The Impact on Treatment

Treatment plans for clients with mental health comorbidities must take into account the potential for resistance or lack of adherence to physical therapy. Anxiety disorders, for example, can cause avoidance behaviour, making it challenging for clients to stick to an exercise regimen. Depression can also make it difficult for clients to maintain motivation and find pleasure in physical activities.

We consider these challenges when creating a treatment plan to ensure they are safe, effective, and likely to be adhered to by the client. A multidisciplinary approach, involving collaboration with our other clinicians helps to ensure that our treatment is tailored to the individual's overall health needs.

Here are some reasons why physical therapy may be beneficial for individuals with mental health comorbidities:

Stress Reduction: Physical therapy often involves exercises and activities that can help reduce stress. Physical activity stimulates the release of endorphins, which are natural mood lifters. Regular exercise can promote relaxation and help individuals better manage stress and anxiety.

Improved Mood: Engaging in physical therapy can lead to an improved mood. Exercise has been shown to enhance the production of neurotransmitters like serotonin and dopamine, which are associated with feelings of happiness and well-being. This can be particularly helpful for people dealing with depression.

Enhanced Self-Esteem: Achieving physical therapy goals and making progress in physical fitness can boost self-esteem and self-confidence. For individuals struggling with mental health issues, a sense of accomplishment can be empowering.

Mind-Body Connection: Physical therapy can help individuals develop a greater awareness of their body and how it responds to stress and tension. This mindfulness can extend to better recognizing and managing mental health symptoms.

Pain Management: Some individuals with mental health problems also experience chronic pain. Physical therapy techniques can address physical pain issues, potentially alleviating a source of stress and discomfort that may exacerbate mental health conditions.

It's essential to remember that while physical therapy can be a valuable adjunct to mental health treatment, it should not replace other evidence-based therapies or treatments prescribed by mental health professionals. People with mental health issues should work closely with their healthcare team to develop a comprehensive treatment plan that addresses their unique needs and challenges.

-Alison Christensen, PT

References:

Gelenberg, A. J. (2000). Psychiatric and Somatic Markers of Anxiety: Identification and Pharmacologic Treatment. Prim Care Companion J Clin Psychiatry, Apr; 2(2): 49-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181205/

Katon, W. J., & Ciechanowski, P. (2002). Impact of major depression on chronic medical illness. Journal of Psychosomatic Research, 53(4), 859–863.

Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet, 370(9590), 851–858.

Scott, K. M., Lim, C., Al-Hamzawi, A., et al. (2016). Association of mental disorders with subsequent chronic physical conditions: World Mental Health Surveys from 17 countries. JAMA Psychiatry, 73(2), 150–158

Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry, 72(4), 334–341.

World Health Organisation. World Mental Health Report: Transforming Mental Health for All. World Health Organisation; Geneva, Switzerland: 2022. p. xiv. https://scholar.google.com/scholar_lookup?title=World+Mental+Health+Report:+Transforming+Mental+Health+for+All&publication_year=2022&