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Imagine you are a primary care physician who sees two people of the same sex, with similar height, weight, and age—each with similar elevated blood pressure readings. You prescribe them the same daily medication to lower and control their blood pressure. Given their physical similarities, it seems both would have a similar response to the medication. However, outcomes can change when behavioral health factors are added to the equation, as physical and behavioral health are intertwined.

Defining Behavioral Health

Behavioral medicine, often called behavioral health, is a medical specialty that applies behavioral theories and methods to the prevention and treatment of medical and psychological disorders. It is often used when treating substance abuse and mental health disorders.

A person’s behavioral health can influence their physical health. Consider how the following behavioral health factors could affect two people who are prescribed medication for high blood pressure.

The Impact of Substance Use

For the two people being treated, how would their health outcomes differ if one uses alcohol to manage their anxiety on a daily basis and the other doesn’t? How would treatment for an alcohol use disorder affect their blood pressure treatment?

Many factors, ranging from a person’s sex to their stress levels, affect the likelihood of substance use. According to the Centers for Disease Control and Prevention, adult men drink more than women, and men are nearly twice as likely to binge drink as women. In a report by the Blue Cross Blue Shield Association of their commercially insured consumers, 14% of caregivers use alcohol to cope with pressures associated with caregiving. Research shows even moderate alcohol use can raise blood pressure, so the physician may find that prescribed medication works to reduce blood pressure for only one of the people being treated. 

Using alcohol, tobacco, or drugs, even socially, impacts overall health, with substance use disorder having greater negative effects on both physical and mental health.

“We have to investigate behavioral health concerns to ensure we don’t miss an opportunity to treat those concerns as well as the related physical health concerns,” said Dr. Shantanu Agrawal, chief health officer for Elevance Health.

The Impact of Stressors and Worries

How much do daily stress levels impact these two individuals’ treatments? While everyone will experience periods of stress and worry throughout their lives, the presence of consistent or sustained stress and worry is known to lead to poorer health outcomes.

“The COVID-19 pandemic has been a major contributor to stress and worry,” said Cheryl Perkins, chief clinical officer for Beacon Health Options. “Stress and worry then manifest in a variety of ways in each of us—in many cases leading to more use of alcohol and other substances, and increasing anxiety and depression. This has an effect on our physical and mental well-being, which can lead to negative outcomes.”

The Impact of Mental Health

What’s the likelihood either individual discussed concerns about their mental health during their visit? Stigma associated with behavioral health can be a barrier to getting treatment. In a 2020 study of 24 million people, White people were more likely to discuss their mental health concerns with their doctor than Asian people were. That could be one reason why Asian people are three times less likely to be diagnosed with depression or anxiety. Such unmet behavioral health treatment needs can have profound impact on health outcomes.

Because depression increases the risk for physical conditions like diabetes, heart disease, and stroke, undiagnosed depression can have serious physical health consequences.

Has Your Initial Opinion Changed?

With limited information about people and their experiences, it’s easy to draw a simplified conclusion about the potential effectiveness of a treatment for two people with similar physical traits.

A whole-health approach that integrates behavioral and physical health can help inform personalized treatment plans that advance health equity and improve outcomes for each person.

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