Chronic health problems and depression: what matters for patients
In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports on a study investigating the relationship between chronic health problems and depression. The findings highlights the importance of maintaining quality of life for people with complex health problems.
The importance of patientsâ€™ perceptions in avoiding depression from chronic illnesses
Rachel Katterl writes:
Patients with multiple chronic illnesses, otherwise known as multimorbidities, are a reality of daily practice for most primary care practitioners.
Estimates suggest that around a quarter of all Australians have multimorbidities, and this increases to around 80% of those over the age of 60. Despite this, research often shies away from investigating this topic beyond prevalence rates because it is such a complex problem.
Jane Gunn and her team at The University of Melbourne have recently tackled this challenge and published results from their diamond study.
The paper investigated the co-occurrence of depression and chronic physical illness in primary care settings. The team explored the link between depression symptoms and the number and type of physical illness and depression symptoms, including the role that the degree of impairment has in producing depressive states.
Importantly, the researchers addressed a common flaw in previous studies by controlling for the use of antidepressants, which may alleviate depression.
The authors discovered a dose-response pattern in the relationship between the number of chronic illnesses and depressive symptoms. That is, with each increase in the number of reported physical conditions, the odds of the patient experiencing depression symptoms likewise rose.
Compared to people with no physical illnesses, those with five or more conditions were four times more likely to show depressive symptoms. This pattern was evident irrespective of the illnesses in question, which ranged from dermatitis, to back problems, through to heart disease.
A second interesting finding related to patientsâ€™ experiences and perceptions of their health. Patientsâ€™ self rated health, as well as the functional limitations their illness imposed, appeared to have a mediating role on the depressive symptoms they experienced.
This study has a number of important implications. Firstly, it allows primary care practitioners to target individuals who are at high risk of depression, particularly individuals who are over the age of 60.
In addition, it clarifies our thinking about the relationship between physical health and mental health, but suggests that it is the health related quality of life that contributes to individuals experiencing depression, rather than physical illness per se.
This is promising, as chronic conditions cannot be cured, though with adequate management of their physical health people can continue to live fulfilled lives in the presence of otherwise debilitating illnesses.
â€¢ Rachel Katterl is Research Associate, Primary Health Care Research & Information Service
Gunn J, Darshini DR, Densley K, Pallant JF, Chondros P, Herrman HE, Dowrick CF (2012). The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Social Psychiatry and Psychiatric Epidemiology, 47, 175-184.
This article, which can be accessed at http://www.ncbi.nlm.nih.gov/pubmed/21184214, features in the 23 February 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php. The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php
Previous PHC RIS columns at Croakey