Chronic Disease and Mental Health

Comorbidity

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Suffering from a Chronic Disease?
Don’t Neglect Your Emotional Well-Being
Fall 2007

You’ve just been delivered a blow and life as you’ve known it has been turned upside down. Your doctor has informed you that you have a chronic illness, a medical condition lasting more than three months. Whether you’ve been diagnosed with diabetes, heart disease, multiple sclerosis, cancer, asthma, or another chronic condition, the emotional turmoil exacted may be a roller coaster ride. Denial, sadness, depression and/or anger are common responses to a chronic disease diagnosis. Managing these emotions will affect your ability to cope with the disease and improve your quality of life.As many as 50 percent of individuals with chronic illnesses are estimated to have some sort of behavioral health issue, according to a recent study commissioned by United Behavioral Health, one of the GIC’s major mental health benefit managers. The prevalence of depression, anxiety, and substance abuse in the population with chronic conditions is two to three times that in the general population:


Chronic Medical Condition	% treated for depression/anxiety	% with depression/anxiety
Arthritis	7.1%	32.3%
Hypertension	5.5%	30.5%
Chronic pain	5.9%	61.2%
Diabetes Mellitus	5.2%	30.8%
Asthma	6.8%	60.5%
Coronary Artery Disease	5.7%	48.2%
Cancer (malignant)	5.7%	39.8%
Source: 2006 Milliman, Inc. research study of U.S. health care data

Depressive symptoms, such as significant weight loss or gain, sleep disturbance, low energy, apathy, and poor concentration, mimic symptoms of the chronic condition or side effects of medications for the disease. As a result, they go unidentified or may not be treated. Getting help for your emotional needs is critical for avoiding and minimizing complications of your medical condition, and will help you comply with the medication and lifestyle modifications prescribed by your doctor. Patients’ and their caregivers’ stress can wear down the cardiovascular system, immune system, and gastrointestinal system, contributing to an increased risk or worsening of heart disease, migraines, asthma, diabetes, ulcers, cancer, and general health deterioration.If you are experiencing any of the following, for two weeks or more, consult your physician or mental health professional. (Note: If you have thoughts of suicide, seek help immediately!):

Persistent sad or anxious mood
Loss of interest or pleasure in ordinary activities, especially those that used to give you pleasure
Decreased energy or fatigue
Sleep disturbances
Feeling helpless, hopeless, or worthless
Loss of appetite, weight loss or gain
Difficulty concentrating
Excessive crying

Your health plan can refer you to a mental health professional if you wish to see one. Your doctor will assess your emotional state carefully and review your personal and family health histories. If the depressive symptoms are the direct result of your physical illness or of side effects of medications, your doctor may adjust or change your treatment regimen for the other illness. If depression is a separate health problem, your doctor may refer you to a mental health professional, who can prescribe antidepressant medications and provide psychotherapy or other treatments.If you are a member of any of the Commonwealth Indemnity Plans or Navigator by Tufts Health Plan, take advantage of United Behavioral Health’s Employee Assistance Program benefits, which can help you with stress related to financial or legal ramifications of your illness. If you are in another GIC health plan, contact your plan to find out what types of mental health service resources are available. Support groups for your medical condition, either in person or in online chat rooms, offer another valuable source of information and support. Ask your doctor or mental health provider for the names of reputable support groups for your condition.

Medical Conditions May Lead to Sadness, Frustration and Hopelessness
(winter 2003)

If you have a chronic illness, you have a higher risk than the general population for depression. Common symptoms of depression include:
· Ongoing sad mood
· Loss of interest or pleasure in activities you once enjoyed
· Significant change in appetite or weight
· Oversleeping or difficulty sleeping
· Loss of energy
· Feelings of worthlessness or guilt
· Recurrent thoughts of death or suicide

A 1990 study published in General Hospital Psychiatry study estimates that depression occurs in over 40% of high medical care users, and anxiety occurs in 22%. Chronic pain conditions, including rheumatoid arthritis, back and pelvic pain, and irritable bowel syndrome frequently correspond with feelings of depression, anxiety and alcohol abuse. This study found the following prevalence of depression with the corresponding medical conditions. Depression for the general population is 17.3%:

Condition	With Depression
Arthritis	25.3%
Cancer	30.3%
Diabetes	22.7%
Coronary Heart Disease	34.6%
Chronic Lung Disease	30.9%
Neurological Disorders	37.5%
Parkinson's	40.0%
Stroke	30%-60%

If you or someone you care about has one of these medical conditions, seek help immediately if you experience signs of depression. HMO members -- talk to your primary care physician for a referral to a behavioral health expert. Indemnity and Navigator by Tufts Health Plan members -- contact United Behavioral Health for assistance (enter 10910 as your access code).