HEMATOLOGICAL DISORDERS AND MENTAL HEALTH: PSYCHOSOCIAL AND NEUROBIOLOGICAL INTERCONNECTIONS

Abstract

The hematological conditions, such as hereditary hemoglobinopathies to malignant leukemia’s, pose a considerable challenge that goes beyond the domain of physiological pathology to the ultimate psychological and societal torment. This review summarizes the existing literature to study the two-way interaction of blood diseases with mental health, in particular with reference to the biological and psychosocial processes causing psychiatric comorbidity. There is biological evidence that shows that hematological patients have clinical signs of anxiety, and mostly have depression, which are direct antecedents of clinical depression, anxiety, and fatigue of the central nervous system. These results are aggravated by stressors induced by treatment, including the neurotoxicity caused by chemotherapy and the high stakes of bone marrow transplantation. The psychosocial aspects of patients are burdened with such factors as social stigma, the economic burden of life-long therapies, and serious educational and job loss. These problems are exacerbated by the absence of integrated psycho-oncology support in developing countries such as Pakistan and the cultural stigma of a dual diagnosis. The review ends with the conclusion that the only way forward on the task of improving patient-reported outcomes is multidisciplinary change towards integrated care. Regular psychiatric assessment with validated instruments such as the PHQ-9 and HADS is critical to the early identification. Moreover, it is essential to integrate low-cost lifestyle changes and family-level counseling into routine hematological care to improve the quality of life of this risk group.