Optimizing Outcomes for Patients with Depression and Chronic Medical Illnesses
Section snippets
Patient-level treatment issues
Although the risk of depression is higher for patients with all types of chronic medical conditions, the reasons for this association are not clear. The chronic nature of both depression and medical conditions strains the patient's sense of self, self-confidence, and social relationships. Depressed mood makes it difficult to be optimistic about the future and adherence to treatments for medical and affective conditions may be difficult and burdensome. A quantitative review demonstrated that
Empathy
Patients with depression and chronic medical conditions usually come to the office with an understandable sense of low self-worth and loneliness. In this situation, primary care physicians can provide an invaluable service by considering not only the technical aspects of diagnosis and treatment planning but also by attending to the affective component of the visit. Physicians characterized as empathic, interested in psychiatry, and curious about family and problems at home are more likely to
Depression and medical comorbidities at the healthcare system level
The question of how primary care physicians will be able to optimize medical care for patients with depression and chronic medical conditions remains. Competing demands and time constraints during visits make it difficult to address complex problems.69 Limitations on third-party coverage for mental illness, formulary restrictions, limited referral networks, lack of access to providers, and poor coordination of services between providers are additional system-level barriers that exist and may
Summary
Patients with depression and chronic medical illnesses are challenging to treat, but they are exactly the type of patient that can benefit from the expert care of a primary care provider. There is a growing body of evidence that chronic medical conditions and depression are interrelated and that treatment of one condition can affect the outcomes for the other.76, 77, 78, 79, 80 Primary care providers have the long-term perspective to understand how each condition is interrelated and affects the
Author disclosures
The author of this article has disclosed the following industry relationships:
Daniel E. Ford, MD, MPH, served as a consultant for Pfizer Inc.; and has received an honorarium from Forest Laboratories, Inc.
Acknowledgment
I thank Laurance Macke, MS, of Prescott Medical Communications Group for manuscript preparation assistance.
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The influence of comorbid chronic physical conditions on depression recognition in primary care: A systematic review
2015, Journal of Psychosomatic ResearchCitation Excerpt :In the context of a brief medical consultation and multiple conditions requiring time and attention, general practitioners (GPs) may prioritize concerns related to these CMCs over patients' emotional problems [10,17]. Recognizing depression can also be difficult when depressive symptoms mirror symptoms of physical disease (e.g. fatigue, weight loss) or when patients with CMCs emphasize their physical complaints during consultations [18,19]. Furthermore, practitioners may not diagnose depression if they believe that the patient is experiencing normal distress consequent to a CMC or if they perceive that applying a label or treatment will bring little benefit to an already vulnerable patient [20,21].
Chronic physical comorbidity burden and the quality of depression treatment in primary care: A systematic review
2015, Journal of Psychosomatic ResearchCitation Excerpt :Given such impacts, active treatment of depression in people with comorbid CMCs is recommended [9,10] and has been shown to be effective [11,12]. In primary care, patients with comorbid depression and CMCs are routinely encountered [13,14] though management of these patients is considered challenging [15]. Chronic medical comorbidity is widely thought to negatively affect depression treatment by creating competing demands that divert time and attention away from mental health problems during clinical consultations [16,17].
Depression and diabetes: The role and impact of models of health care systems
2012, Journal of Affective DisordersCitation Excerpt :Where health care is devolved to particular teams or individuals who have expertise or special responsibility for delivering care for a particular type of condition (such as diabetes and cardiac nurses in primary care) or type of therapy (such as psychiatrists managing medication or psychological therapists) or severity of disorder (primary and specialist physicians) there are threats to both continuity and co-ordination of care unless there is a clear care pathway in place and oversight by a particular professional or care manager. The person who remains best placed to co-ordinate this is the primary care physician (Ford, 2008). However, where there has been increasing emphasis on “disease management” in health policy such as in the United Kingdom (UK) Quality Outcomes Framework (see below), it is apparent that care for comorbid illness is increasingly perceived by both patients and professionals as fragmented (Bower et al., 2011).
Effect of current depression on the association of work-related asthma with adverse asthma outcomes: A cross-sectional study using the behavioral risk factor surveillance system
2012, Journal of Affective DisordersCitation Excerpt :Clinicians should be aware of the potential risk for poorer asthma control and increased utilization of emergency health services among persons with WRA and current depression. These results indicate that a large proportion of ever-employed adults with WRA could benefit from mental health screening and implementation of optimized treatment similar to models developed for patients with depression and other chronic illnesses (Ford, 2008). This work was performed and funded by the Centers for Disease Control and Prevention.
Depression as a Comorbidity to Diabetes: Implications for Management
2009, Journal for Nurse PractitionersDepression and anxiety in patients with hemophilia A and B
2024, International Journal of Psychiatry in Medicine
Statement of author disclosure: Please see the Author Disclosures section at the end of this article.
Dr. Ford has received grants from the National Institute of Mental Health (NIMH) and the Robert Wood Johnson Foundation on management of depression in primary care.