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Chronic illness can be difficult to accept and sometimes a struggle to

live with on a daily basis. Depression, a common comorbidity of chronic disease, can contribute to its severity. Additionally, as people age, they become more likely to have multiple chronic conditions, which can place an even greater burden on their psyche. Both awareness and recognition of the symptoms of depression, therefore, are important in treating older patients with chronic illnesses. The overarching goal of this newsletter is to provide information and guidance to health care professionals in order to improve outcomes for patients with chronic conditions.

Chronic Diseases Associated with DepressionStudies have shown that very often, people diagnosed with chronic diseases have an increased risk of developing depression or anxiety. In addition, the more illnesses patients have, the higher their risk of depression. Dealing with a chronic disease is a very stressful situation and can be associated with physical pain, disability, disfigurement, and fear of death. It is therefore no surprise that people with chronic illnesses can also experience depression and anxiety. As shown in the table below, the prevalence of depression ranges from approximately 10% to 40% depending on the chronic disease.

Chronic Disease Prevalence of Depression

Cardiovascular disease 20-25%

Diabetes 15-20%

Stroke 20-25%

Parkinson’s disease 15-20%

Alzheimer’s disease 10-15%

Cancer 25%

Multiple Sclerosis 40%

A difficulty associated with recognizing depression among patients with chronic conditions is that symptoms of the chronic disease may be similar to those typical of depression; these include fatigue, lack of appetite, and poor concentration. Additionally, some people may see depression as a normal part of aging.

Common Signs of DepressionSigns and symptoms typically associated with depression include:

� Depressed mood � Significant weight changes � Sleep disturbances � Difficulty concentrating � Lack of emotion � Feelings of worthlessness,

guilty, hopelessness � Thoughts of suicide or death � Decreased participation in

daily activities

Treatment for DepressionThe typical treatments for depression, such as pharmacological and behavioral therapies, can also be used for depression related to chronic diseases. In addition to the problems it directly causes, depression also has negative effects on the patient’s overall medical health and can impact adherence to treatment regimens. Successful treatment of depression can result in improvements of the overall medical condition of the patient, as well as improved outcomes. However, in some instances, depression can be directly affiliated with the chronic illness itself, whereby improvements in one’s medical condition can help reduce the symptoms of depression. It should be noted that some medications can cause depression and may need adjustment to rectify the situation.

Other Mechanisms to Help Reduce Depression While anti-depressants and cognitive therapy can help reduce the symptoms of depression, there are also several non-medical ways to treat depression. In addition, educating patients about their disease and self-management can decrease their depression by improving the symptoms of their chronic disease. Several of these methods will be discussed below.

Strategies to Improve Depression in Patients with Chronic Illness

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and overall outcomes. These include an unwillingness to take on responsibilities or face adversity; anxiety; and, of course, depression. Self-esteem can also influence a patients ability to self-treat (eg, self-administration of insulin injections) and to be more self-reliant.

Methods to help boost a patient’s self-esteem include:

� Listen in an understanding and non-judgmental manner

� Assist in getting help for low self-esteem

� Provide encouragement; be supportive

� Acknowledge successes, no matter how small

� List the person’s positive attributes

Self-efficacy refers to the belief about how well one can accomplish a task or, in the case of chronic illness, reduce symptoms. A lack of self-efficacy can result in an unwillingness to self-manage both the medical condition and related depression, which can ultimately result in poor outcomes.

One mechanism by which self-efficacy can be improved is through education. Health care professionals are prime candidates for educating patients about their chronic illnesses and the best ways to reduce symptoms. In addition, teaching patients about proper medication administration or how to properly use physical supports can help to increase patients’ beliefs that they can

successfully self-manage their diseases. It is also important for patients to have evidence that others are successfully dealing with their chronic conditions. Here, again, participation in disease-specific support groups can help patients find encouragement.

ConclusionsMillions of Americans suffer from chronic illnesses, with many patients having more than one chronic condition simultaneously. The pressure, stress, and life changes that accompany chronic diseases can lead to depression, especially among older patients who have more co-morbidities and less support. The severity of a chronic disease and that of depression share a reciprocal relationship, whereby as symptoms of depression decrease, so too do the symptoms of the chronic illness. Therefore, it is important for health care professionals to be aware of the symptoms of depression and methods to help combat it.

Depression ResourcesAmerican Psychiatric Association www.psych.org

American Psychological Association www.apa.org

National Institute of Mental Health www.nimh.nih.gov

Mental Health America www.mentalhealthamerica.net

Social SupportSocial support, or encouragement from family and friends, can provide patients with chronic diseases with a feeling of inclusion and belonging. These feelings can help to deter feelings of loneliness and helplessness which can be associated with many chronic conditions. Family and friends can provide both psychological support, and physical assistance to those with chronic diseases. Having someone “on your side” can help boost the desire to get better, adhere to treatment regimens, and participate in everyday activities of life.

For older patients who may not have a spouse or living family members or friends, social support can be found within the community. Support groups are typically available for many of the more common chronic illnesses, as well as for depression. These may be located and/or accessed through a local hospital, church, YMCA, or community center. Community centers may also have programs specific for older people, such as art or luncheon groups, which promote social networking, and can help reduce loneliness, and provide social activities for the patient.

Personal Coping ResourcesWhen speaking of personal coping mechanisms, we are referring to the concepts of self-esteem and self-efficacy.

Self-esteem refers to a person’s belief or feelings about him or herself. Some studies have shown that self-esteem can positively affect depression in patients with cancer or arthritis. Low self-esteem is associated with several characteristics which can influence medical treatment