Mental Health in Healthcare – Threading the Needle from Provider to Patient: Sami Mansfield

“As professionals in cancer healthcare, we evaluate mental health issues, offer support, and assist patients during difficult times as they confront life-threatening diagnoses. Despite the possibility of cures, we acknowledge the enduring effects on mental well-being.

While we are always looking forward, what happens when we turn our gaze inward? Nevertheless, when it comes to our own mental health, the conversation often falls silent.

As May is Mental Health Awareness Month, we should reflect on the emotional toll of a cancer diagnosis for patients and the hidden mental health challenges faced by caregivers. When caregivers experience burnout and silent distress, are we missing a key opportunity for internal healing?

Although COVID has been widely blamed for the mental health crisis, did it merely expose an underlying issue that was ready to surface? The World Health Organization defines mental health as a state of well-being in which an individual recognizes their own abilities, can cope with the normal stresses of life, works productively, and contributes to their community.

Mental health encompasses more than the mere absence of mental illness; it embodies resilience, balance, and emotional strength. Grasping this comprehensive definition is essential for healthcare professionals, as they not only treat patients but also contend with high-pressure clinical situations that can affect their own mental health. (Ng, 2024)

Recent studies underscore the critical need to address mental health issues among healthcare workers. A systematic review and meta-analysis found that around 21.7% of these workers experience depression, 22.1% deal with anxiety, and 21.5% show symptoms of post-traumatic stress disorder. These statistics reveal a considerable mental health burden within the healthcare workforce, which requires urgent attention intervention. (Li, 2021)

This is not an isolated issue. Globally, the rising incidence of cancer is matched by increasing awareness of its psychological impact. Research consistently shows that cancer survivors are at heightened risk for anxiety, depression, and psychosocial distress. This is not just a localized phenomenon – evidence from studies in Europe, Asia, and North America indicates that addressing mental health in cancer care is essential for improving both survival rates and
quality of life.

While mental health conditions are often treated through traditional methods such as medication and therapy, there is increasing evidence that lifestyle factors significantly impact mental well-being.

While these strategies might seem less effective than medical treatments, a closer examination of both the interventions and the underlying science reveals their significant effectiveness.

1. Exercise: A Proven Antidepressant

Movement consistently reduces depression and anxiety symptoms. A landmark meta-analysis in JAMA Psychiatry found that even small amounts of exercise significantly lower depression risk, with greater effects in those engaging in moderate-to-vigorous activities. Additionally, reducing sedentary time presents an opportunity for all adults, from busy professionals with long EMR hours to patients feeling unwell who can utilize their devices. (Pearce, 2022)

Incorporate movement ‘snacks’ – short physical activities like sit-to-stands, a quick flight of stairs, or seated stretches. Set a timer to move for one minute every hour; even partial success with these reminders will make new habits more ingrained. Use exercise as a strategy: begin with small, planned movements, consider group activities for the community, or use YouTube at home for convenience. Join me for a fun new Five-Minute Friday every week on YouTube! Just five minutes of your time can brighten your day.

2. Nutrition: Fueling the Mind

Research increasingly highlights the link between diet and mental health. The SMILES Trial in BMC Medicine showed that a Mediterranean-style diet, high in whole foods, lean proteins, and healthy fats, significantly alleviated depression symptoms in individuals with major depressive disorder. (Jacka, 2017)

Beyond mood regulation, evidence suggests that these dietary patterns enhance cognitive functions like short-term memory and focus. A JAMA Network Open study found that high adherence to the Mediterranean diet was linked to better global cognition and decreased 7-year learning and memory decline. (FU, 2022)

Conversely, diets high in ultra-processed foods have been linked to cognitive decline. Research indicates that individuals consuming the highest amounts of ultra-processed foods experience a 28% faster decline in cognitive scores, encompassing memory and executive function, compared to those with lower consumption. (Gomes, 2023)

Example for Professionals: While we often consider nutrition recommendations regarding what to add, it is important to start with what can be removed. Strive to reduce moderate to highly processed foods. Although unsaturated fats are important, these calorie-dense foods should make up about one-third of your daily plate, while the rest should consist of a plant-predominant eating pattern that includes adequate protein, as well as fruits, vegetables, grains, beans, and lean animal proteins.

3. Sleep: The Foundation of Mental Resilience

Quality sleep is essential for cognitive function and emotional regulation. Research shows that poor sleep is both a symptom and a risk factor for mental health disorders like anxiety and depression. A study in Early Intervention in Psychiatry found that 76% of participants with serious mental illness reported poor sleep quality, highlighting the link between sleep disruptions and mental health challenges. (Aschbrenner, 2022)

Sleep deprivation disrupts hormonal balances, affecting appetite and metabolism. Lack of sleep raises ghrelin levels, increasing hunger, while reducing leptin, which signals satiety. This imbalance leads to higher appetite and cravings for high-calorie foods, contributing to obesity. Additionally, sleep loss elevates cortisol, a stress hormone that promotes abdominal fat storage. These changes negatively affect physical health and worsen mental health issues, creating a cycle of disruption and decline.

Sleep is elusive for many. Although strategies appear simple, modern life complicates them. A regular sleep routine, even on non-work days, along with a cool, dark environment are essential. The hour before sleep and the hour after waking are crucial for our circadian rhythm and should involve down-regulating activities or those that signal the start of our day.

4. Stress Management: Navigating the Mind-Body Connection

Chronic stress disrupts mental well-being and triggers systemic inflammation, contributing to anxiety, depression, and cognitive decline. Prolonged stress activates the hypothalamic- pituitary-adrenal (HPA) axis, increasing cortisol levels and pro-inflammatory cytokines like IL-6 and TNF-α. This response can impair brain function and structure, particularly in areas related to mood and cognition, raising the risk of mental health disorders.

Mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT) have demonstrated efficacy in mitigating psychological distress and reducing inflammation. (Tian, 2022)

Maintaining a regular gratitude practice, such as reflecting on one thing you are grateful for each day, is important. Additionally, utilizing breathwork is a powerful tool. Adults take around 22,000 breaths per day, and when we pause to intentionally hold our exhale longer than our inhale, we can actively lower our stress levels incrementally.

5. Social Connections: The Human Element in Healing

Loneliness and social isolation have been identified as significant risk factors for mental health decline. A study published in The Lancet Public Health revealed that strong social ties contribute to reduced anxiety, depression, and even lower mortality rates. (Santini, 2020)

Social isolation, on the other hand, is linked to poorer survival rates and higher mortality in cancer survivors. (Zhao, 2024; Holt-Lunstad, 2010)

Meaningful connections – whether through family, friends, support groups, or community engagement – can mitigate feelings of loneliness, improve mental health, and enhance overall well-being. Integrating strategies to boost social support into patient care can serve as a low-cost, high-impact intervention that significantly enhances quality of life and survival outcomes.

Encourage patients to engage in community-based programs or support groups. For those who are more isolated, virtual support networks can bridge gaps in connection.

6. Reducing Risky Habits: Breaking the Cycle of Self-Sabotage

Mental health challenges often lead individuals to seek coping mechanisms that provide temporary relief but harm long-term well-being. Those facing these issues might turn to alcohol, which can worsen depression.

Diets high in ultra-processed foods are linked to greater depression and anxiety risk due to their nutrient deficiency and disruption of gut microbiota, crucial for mood regulation. Research indicates that increased intake is associated with higher depressive symptoms. (Lane, 2022)

Furthermore, physical inactivity correlates with higher anxiety and depression rates. A BMC Public Health systematic review found that sedentary behavior significantly raises the risk of developing depressive disorder symptoms. (Wang, 2019)

Highlighting straightforward, actionable strategies from each pillar is a crucial opportunity to empower individuals to enact changes.

Conclusion

For healthcare professionals, recognizing the profound impact of lifestyle on mental health is a call to action. Addressing these six key pillars not only empowers patients but also strengthens clinical outcomes. By integrating lifestyle medicine into mental health care, we can unlock a powerful, comprehensive approach to healing.”

written by Sami Mansfield

Sami Mansfield is an exercise oncology and lifestyle medicine consultant with endless curiosity and persistence. As the founder of Cancer Wellness for Life, Sami has dedicated her career to empowering cancer survivors and clinicians through innovative, evidence-based programs that improve health outcomes while optimizing cost-efficiency.

Sami is a contributing author to groundbreaking guidelines, including the ASCO Guidelines on Exercise, Nutrition, and Weight Management, and has helped shape numerous state cancer control plans.

She is the current chair of the Cancer Member Interest Group for the American College of Lifestyle Medicine, where she drives forward initiatives emphasizing the connection between science and implementation. Her patient-facing programs like BUILD and My Lifestyle Shift have reached global audiences, transforming lives through the pillars of lifestyle medicine.

Read more posts featuring Sami Mansfield at OncoDaily.com.