Jaime Lewis (Host): It's an unsettling fact that heart disease is the leading cause of death in women. But when it comes to both prevention and treatment for heart disease, do you consider the impact of a woman's mental health on her heart health or vice versa? Whether facing a cardiac event or working to prevent one, there is a psychosocial aspect to ensuring total health and well being, including a woman's mental health.

Today, we're talking about this and more with Dr. Kenleigh McMinn, licensed clinical psychologist on the medical staff at Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital in Dallas. She is a champion of the Women's Heart Center and one of the multidisciplinary team members who have joined together in support of a program focused on women's heart health.

Welcome to HeartSpeak, the podcast from Baylor Scott and White Heart and Vascular Hospital in Dallas, Fort Worth, and Waxahatchee. I'm your host, Jamie Lewis. Welcome to the program, Dr. McMinn.

Dr. Kenleigh McMinn: Thank you so much for having me. I'm happy to be here.

Host: Same. Well, why is it important for women to consider their mental health when considering their heart health and vice versa?

Dr. Kenleigh McMinn: I think so often the mental component of our physical health is overlooked in general, I think especially as women. But there's research to show in particular that it's important for our heart health. More and more, there's research coming out that shows that not only does our heart health impact our mental health and that women tend to struggle more in both of those domains compared to men, but also that the reverse is true. That women who struggle with their mental health are actually at higher risk for developing cardiovascular disease and having cardiac events throughout their life. So, I think often in Medicine, we treat our brain as kind of something that's completely separate from the rest of our bodies, but forget that it's connected to everything else. And that's especially important when we're talking about our heart health.

Host: You touched on the fact that both men and women experience psychological changes, mental health challenges after heart events, but why do you suppose it affects women differently than it does men?

Dr. Kenleigh McMinn: The research seems to show that there's probably not just one specific reason why this happens and why there's this difference between men and women. Overall, women tend to have higher rates of depression and anxiety and some other mental health disorders than men do and then same for the responses after a cardiac event.

So, we think that it probably has to do with a combination of factors like biology. So, you know, women having different hormones that are involved, genetics can play a factor. So if you have a family history of any kind of mental health disorders, that places you at a higher risk. There's other just kind of psychosocial stressors that women tend to experience at higher rates than men.

Often, that's involved in being a caregiver, whether that's for children or for other family members. Women tend to experience more discrepancies and discrimination, and sometimes more exposure to different traumas, so there's a lot of different things that go into that and all of it seems to kind of be at play in contributing to this increased risk.

Host: Well, how do we as women typically process a diagnosis of heart disease? Is depression common after a heart diagnosis or an event, a cardiac event, for example?

Dr. Kenleigh McMinn: Absolutely. Depression and anxiety have both been shown to be common after a cardiac event, especially in women. So. It's true for men as well, but there tend to be higher rates in women across the board. There's a variety of research that shows kind of different numbers, but numbers of up to 40-60% of women after having some kind of cardiac event will endure some kind of depression or anxiety. And women who experience that depression and anxiety after a cardiac event tend to have more severe levels of it when compared to men.

Host: That is fascinating information. What kinds of steps do you recommend that a woman consider if she believes her mental health and wellness have been significantly impacted by a diagnosis or a procedure, a cardiac event? What type of therapy or treatment options might you recommend?

Dr. Kenleigh McMinn: I think that's the really great news that I certainly want people to hear is that these conditions are treatable. I think either before and or after a cardiac event, again, we want to think about prevention, not just responding to these events. So, I think, in general, I'm a little bit biased as a psychologist. I think anybody can benefit from having that mental health component as part of overall wellness. So if you are somebody who is maybe already struggling with anxiety or depression, making sure that you're treating that just like you are treating other aspects of your physical health, whether that's talking to a primary care doctor or a cardiologist, or anybody else that's involved in your care, letting them know that those are some areas that you might be struggling. You might be needing some more support if you don't have that already.

And then, same for after experiencing a cardiac event or having a new diagnosis, that's when it's also important to talk to your doctor and say, "Hey, I'm really having a hard time" or "I'm struggling with adjusting to this news or this event." Often Primary Care or Cardiology is a good place to get started because it can unfortunately be tough to access mental health care. There are a lot of barriers that are in place to that. So, that's why I usually recommend going with the medical route, since you already have established care.

Typically, they can provide referrals that can try to help with that. Like I mentioned earlier, anxiety, depression, adjustment, trauma, these things are treatable. So typically, psychotherapy is involved, like you mentioned. There are a number of different types of therapy that have been shown to be really effective. Things like cognitive behavioral therapy, acceptance and commitment therapy. But looking for a provider who's a licensed provider who has experience in evidence-based treatments is really important. Medications have also been shown to be effective. So, there are medicines for depression, medicines for anxiety, that can be taken in addition to medicines for your cardiac health. They don't always counteract each other. They can work together. Some people feel more strongly about one versus the other therapy versus medication. Some people do both in combination. But there's lots of different options out there for treatment.

Host: Well, it's one thing to go through this yourself, right? But it's another thing to watch someone you love go through it. So if someone suspects that a loved one has decreased or declined mental health after a cardiac event or a procedure or surgery, what should they do? How should they approach their loved one?

Dr. Kenleigh McMinn: That's so tough because again, like you said, it's really hard to see somebody else having a hard time, especially somebody that you care about. And it can be hard because you can't fix it for them, think what I tend to recommend is just starting small, and this doesn't have to just be, and often it isn't just a single conversation. Sometimes it's just kind of planting the seed, just asking them of, "Hey, you know, you've been through something really hard. How are you dealing with that? How is your mental health after all of this?" Or letting them know, "Hey, you just haven't kind of seemed quite like yourself since this happened," or "I've noticed these kinds of changes." Because sometimes when people are in the middle of struggling with depression or struggling with anxiety, they don't necessarily notice it. And so, having that perspective given to them from somebody else and knowing that it's coming from a really caring place, sometimes that really kind of opens the door to that conversation.

I think just letting people know that you're there for them, that you care about them, that you can be a listening ear and sometimes offering of, "Hey, do you need any help with trying to figure out how to deal with this?" Obviously, we don't expect you as a family member or a loved one or friend to be their mental health provider, but you can offer other things, offer your support, offer to listen, offer to go on a walk with them, offer to make them a meal, do things like that that show them that they're really cared about. And again, sometimes that opens the door to more conversation and maybe encouraging them to seek out additional support.

Host: Well, thank you for covering this topic that just doesn't get covered very often. We really appreciate you speaking with us today.

Dr. Kenleigh McMinn: Thank you so much for having me. I appreciate the opportunity.

Host: That's Dr. Kenleigh McMinn, clinical psychologist on the medical staff of Baylor University Medical Center and Baylor Scott and White Heart and Vascular Hospital in Dallas. For more information about women's heart health, contact the Women's Heart Health Center at Baylor Scott & White Heart and Vascular Hospital in Dallas at 214-820-7162. Again, that's 214-820-7162. And if you found this podcast episode helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Jamie Lewis. And this is HeartSpeak from Baylor Scott & White Heart and Vascular Hospital. Thanks for listening.

Baylor Scott and White Heart and Vascular Hospital, Dallas, Fort Worth, and Waxahachie, joint ownership with physicians.