Mental health is the health of the whole body: How psychoneuroimmunology & health psychology can inform & improve treatment

Abstract

Background: Converging and accumulating evidence for the cross-communication among the nervous, immune, and endocrine systems, a field of study known as psychoneuroimmunology, implicates immunological dysfunction as a shared and common mechanism of both mental and physical illness. For example, psychiatric disorders like schizophrenia, bipolar disorder, major depression, and anxiety disorders have higher prevalence rates across a spectrum of autoimmune conditions compared to the general population. Additionally, subclinical immunological abnormalities are observed in a variety of psychiatric conditions, with chronic inflammation most extensively studied in the pathophysiology of depression. These observations blur the historical distinctions between mental and physical illness, yet clinical practice remains fragmented and primarily focused on differentially treating individual symptoms. Proposed thesis: Therapeutically targeting inflammation offers translational opportunities for integrating mental and physical healthcare, a key niche of the interdisciplinary field of health psychology. Conclusion: Utilizing a psychoneuroimmunological lens, health psychologists and clinicians can reconceptualize healthcare through integrative treatment approaches and advocacy for comprehensive policy-level reform at both the individual-level of care as well as community-wide prevention approaches. K E Y W O R D S health psychology, immune health, mental health, psychoneuroimmunology Mental and physical disorders are often conceptualized and treated as distinct diagnoses with unique etiologies, stemming from the mindbody dualism that underlies much of modern medical biology. 1 The emergence of psychoneuroimmunology, or study of the crosscommunication between the nervous, immune, and endocrine systems, is increasingly blurring the historical distinctions between mental and physical illness as converging and accumulating evidence suggests immune dysfunction and systemic inflammation are commonly observed across many psychiatric conditions. 2-4 Despite this growing body of scientific knowledge, clinical practice remains fragmented and primarily focused on differentially treating disparate symptoms. Psychoneuroimmunology provides a framework for integrating mental and physical healthcare, a key niche of the growing interdisciplinary field of health psychology. This paper describes some of the existing literature documenting the overlap between immune function and mental health and suggests potential clinical implications of a psychoneuroimmunological lens for both individual-level of care as well as community-wide approaches.

Literature Review: Immune System and Its Relation to Depression

“…Peripheral cytokines affect the central nervous system by affecting neurotransmitters or precursors of neurotransmitters. [4] Stress is a threat to psychological or physiological integrity. Cortisol is secreted when there is stress, this physiological response is important for maintaining the integrity of the organism in the short term, but if stress is prolonged, it will harm the organism.…”

“…When there is long-term stress, the stress response becomes chaotic and then causes a low-level inflammatory response that in the end, this condition can contribute to systemic inflammation and immune system dysfunction. [4] The immune system keeps the body safe from pathogens. Humoral and cellular immunity work together to provide protection in humans against pathogens both in the short and long term.…”

Applications of psychoneuroimmunology models of toxic stress in prevention and intervention efforts across early development

“…At an individual level, initial studies have shown that tailored diets may reduce the symptoms of toxic stress exposure at a downstream level ( Alessi and Bennett, 2020 ). For example, individuals with high omega-6 to omega-3 ratios in their diets have been found to produce greater levels of proinflammatory cytokines during stressful life events ( Kiecolt-Glaser et al., 2007 ; Maes et al., 2000 ).…”

“…Transdisciplinary treatment teams focused on inter-individual care may be a core component of delivering effective interventions for toxic stress exposure and would be ideal settings to test the feasibility of such a screening protocol. Finally, the adoption of policy-level changes to reduce environmental stressors affecting population health, such as the establishment of a universal basic income and universal healthcare, will be a critical next step ( Alessi and Bennett, 2020 ). PNI models could facilitate prevention and identification of youth at greatest risk for stress-related disorders, but further work is necessary to validate and scale these efforts.…”

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“…Alessi and Bennett 14 challenge our prevailing understanding of mental health which still is widely perceived within the frame of the mind–body dualism. They outline the interdependencies between our psychological experiences and our central nervous system mediated pathways on our immunological function.…”