Health issues: Severe physical ill health can lead to depression and other mental illness.

The idea

Health is not only the absence of disease but a state of physical and mental wellbeing. Severe physical ill health can cause mental illness because long-term pain, disability, loss of independence, social isolation and uncertainty about the future place sustained stress on a person. For example, a patient with severe arthritis may become depressed after months of limited mobility and reduced contact with friends. The reverse also occurs: depression can reduce self-care, appetite and willingness to seek help, worsening physical health. This two-way link means doctors assess both physical and mental health together, and it explains why treating only the physical symptoms may not fully restore a patient's health.

What earns the marks

• States that health includes both physical and mental wellbeing, not merely the absence of disease.
• Explains that severe or long-term physical illness can act as a trigger or risk factor for depression and other mental illnesses.
• Gives a plausible mechanism, such as chronic pain, disability, loss of independence, social isolation or worry about the future.
• Uses a specific example, such as severe arthritis, cancer or a long-term heart condition, linked to depression.
• Recognises that the relationship can be two-way, because mental illness can also worsen physical health.
• Concludes that effective care may need to address physical and mental health together.

Common mistakes and how to put them right

• Writing that physical illness directly causes mental illness in every patient.

  Put it right: It increases the risk or can lead to mental illness, but not all patients become depressed.

• Treating mental illness as less real or less important than physical illness.

  Put it right: Both are genuine health conditions that affect wellbeing and can interact.

• Describing only the effect of mental illness on physical health and ignoring the stated direction.

  Put it right: Answer the statement by explaining how severe physical ill health can lead to depression and other mental illness.

Exam tips

• Use the phrase 'can lead to' rather than 'always causes' to show that the link is a risk, not a certainty.
• Include one named physical condition and one named mental illness, then explain the link between them in a single sentence.
• If asked to suggest why a patient is depressed, refer to specific consequences of the physical illness such as pain, reduced mobility or loss of independence.