Chronic Illness and Depression; Improving Outcomes Through Knowledge and Treatment

Depression and chronic disease are closely related, chronic disease can exacerbate symptoms of depression and depressive disorder can lead to chronic disease.  (Chapman DP, 2005)

Depression in the elderly is not a natural, normal aspect of the aging process, and for those who suffer from both a chronic disease and depression, the course of both illnesses profoundly degrades quality of life and places an even heavier burden on health care resources.

Depression has been shown to negatively impact the course of chronic diseases including; arthritis, diabetes, cardiovascular and cerebrovascular diseases and Alzheimer’s disease. Unfortunately, depression is more common for those who have a chronic disease—two to three times higher, in fact. (Ali S., 2006) (Schleifer SJM-HM., 1989)  Identifying and treating depression in the elderly, especially those with a comorbid chronic disease is crucial to improving outcomes, ensuring participant quality of life and reducing health care expenditures; the primary goals of Adult Day Health Care Services.

Treating a chronic illness without addressing a participant’s mental health issues is like treating an infection with half the dose of an antibiotic and expecting it to resolve. (Amanda G. Sillars)

FINANCIAL COST

Depression alone is costly, it is associated with a 50-100% increase in health services usage and costs.  “Patients diagnosed as depressed had higher annual health care costs and higher costs for every category of care (e.g., primary care, medical specialty, medical inpatient, pharmacy and laboratory services)” (Simpn G Vonkorff M, 1995).  Studies have shown that patients with major depression tend to be high utilizers of general medical services (Simon, GE., 1992). Patients in the highest 10% of utilization of primary care services used 29% of primary care visits, 52% of specialty visits, 40% of hospital days and 26% of prescriptions. (Katon W., 1990)

HUMAN SUFFERING

Depression is clearly associated with a poorer prognosis and a more rapid progression of chronic illness.  (Glassman A, 1998)

Negative consequences of the interaction of chronic illness and depression include:

• All-cause mortality
• Impaired functional status
• Increased falls
• Unnecessary suffering
• Suicide (The 11th leading cause of death in the U.S.  Suicide rate is six-times higher among men over 85)
• Increased bone loss in women
• Decreased ability to adhere to medical regimen;
  • Diet,
  • Medication
  • Exercise regimen
  • Tobacco and alcohol usage

TREATMENT

Recognition and treatment are crucial; depression worsens the course of a chronic illness.  (Simon, 2001)

Providing treatment to the elderly who are depressed has been difficult as depressed elderly will often not seek out professional support, believing that depression is an integral aspect of the aging condition, embarrassment, difficulty in accessing appropriate mental health services and unfamiliarity with counseling approaches. By providing assessment and counseling as one of the services provided within an adult day setting, these concerns and difficulties are eliminated.

Screening for mental health disorders should be provided to all participants attending an Adult Day Health Care Center.  Treatment for those who are identified as depressed or have another mental health concern may include various modalities, although addressing any non-adherence issues will be a priority.  Cognitive-Behavioral Therapy has been shown to be effective in reducing symptoms of depression and other mental disorders.  Effective treatment of depression has been shown to reduce depressive symptoms and improve daily functioning, it has also been shown to have a positive effect on biologic indicators of disease severity or progression (Sharpe L, 2001)

Adult Day Service programs that offer mental health services are on the cutting edge of health care, potentially saving millions in health care dollars by addressing not only the physical health of participants suffering from chronic disease, but by understanding the exponential effects of co-morbid mental health complications and treating them appropriately with competent staff, such as licensed psychologists or clinical social workers.

Depression is clearly associated with a poorer prognosis and more rapid progression of chronic illnesses (Simon, 2001). Treatment of comorbid depression is imperative to ensuring positive outcomes and reducing health care expenditures for participants suffering from both depression and chronic disease.

References

Ali S., S. M. (2006). The prevalence of comorbid depression in adults with Type 2 diabetes: A systematic review and meta. Diabet Med., pp. 1165-1173.

Chapman DP, P. G. (2005). The vital link between chronic disease and depressive disorders. Preventing chronic disease.

Simon, GE.,(1992). Psychiatric disorder and functional somatic symptoms as predictors of health care use. Psychiatr med., pp. 10-59.

Glassman A, S. P. (1998). Depression and the course of coronary artery disease. Am J Psychiatry, pp. 4-11.

Katon W., V. K. (1990). Distressed high utilizers of medical care. Gen Hosp Psyciatry, pp. 355-362.

Schleifer SJM-HM., C. D. (1989). The nature and course of depression following myocardial infarction. Arch intern med., pp. 1785-1789.

Sharpe L, S. T. (2001). A blind, randomized, controlled trial of cognitive behavioral intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity. Pain, pp. 275-283.

Simon, G. E. (2001). Treating depression in patients with chronic disease. Western Journal of medicine, pp. 292-293.

Simpn G Vonkorff M, B. W. (1995). Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry, pp. 850-856.