Mend the Mind and Mind the “MCC”

1001 Editorial—Parthasarathy et al. The World Health Organization (WHO) has stated that mental illnesses are the leading causes of disability worldwide and account for 37% of healthy years lost from non-communicable diseases.1 Non-communicable diseases—such as cardiovascular disease, chronic respiratory disease, cancer, diabetes, and mental health conditions—are estimated to result in $47 trillion loss, which, in turn, accounts for 75% of the global Gross Domestic Product [GDP]).2 Depression alone is expected to be responsible for one-third of health years lost to disability from mental illness.1,2 Mental illnesses such as depression and physical ailments such as ischemic heart disease are examples of 17 chronic conditions that coexist in at least one in four Americans and such co-location is termed multiple (two or more) concurrent chronic conditions (MCC).3 MCC accounts for approximately 66% of total health care expenditures in the U.S. that is spent on 27% of Americans.3 Importantly, combinations of MCC, such as co-occurrence of coronary artery disease and depression may have synergistic interactions and lead to worse health outcomes of individuals with such serious mental illnesses due to poor attention to treatment adherence and disease understanding.4 It naturally follows that the participants of the Grand Challenges in Global Mental health identified the need for integrating the treatment of mental disorders with chronic disease care and suggested redesign of healthcare systems.5 In this issue of SLEEP, Jae-Min Kim and colleagues6 report having successfully integrated treatment of a mental health condition (i.e., depression) in patients with a common medical condition (i.e., acute coronary syndrome), and demonstrated both the high prevalence of depression in patients with acute coronary syndrome and that sleep outcomes can be improved through treatment of depression. They should not only be commended for an arduous and well done study in such a challenging population, but also for setting the stage for coordinated care across mental and physical health domains. In this study of Kim et al., both sleep and depression were evaluated within two weeks of the acute coronary syndrome episode, which is much earlier than that in other similar studies of sleep and depression in patients with ischemic EDITORIAL