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Stress, Depression Negatively Impact Chronic Disease Management

A new study has found that psychological distress may negatively impact a patient's chronic disease management more than his or her actual illness.

By Nathan Boroyan

- Depression, stress, and other mental health conditions may negatively affect a patient’s chronic disease management capabilities more than the disease itself, according to a study published in Quality of Life Research.  

Mental health and chronic disease management

The study highlights the need for integrated clinical and behavioral healthcare and the opportunity for primary care providers to learn more about the role of mental health in overall population health management.  

The research team used quality of life and psychological health metrics to examine how chronic illness and psychological distress impacted the overall well-being of a non-clinical sample of 1,424,307 participants (separated into five age groups) between May 2005 and January 2012.

The study included both patients with no history of chronic health issues and patients suffering from pulmonary conditions, cardiovascular disease, chronic pain, cancer, diabetes and cerebrovascular conditions.

Results of the study showed that depressive feelings were correlated with lower quality of life (QOL) and health-related quality of life (HRQOL) scores.  Further, results suggested that psychological distress impacts a person's’ quality of life as much, or more, than having a chronic condition such as diabetes.

"Our research further solidifies the need for caregivers and doctors to understand the mental state of patients in order to achieve the desired health outcome," said study co-author Dr. Shawn Mason, director of research & analytics at Johnson & Johnson Health and Wellness Solutions, which sponsored the study.

With the exception of cancer, all other medical conditions were associated with lower overall perceived well-being.  Patients over the age of 75 were more likely to experience high QOL impacts of poor mental health than younger patients.

The effects of nearly all chronic medical conditions decreased across the lifespan of the sample population. Pulmonary disease was the only condition in which the effects increased with age.

The study also found that chronic pain had the largest impact on daily activities and work performance.

"If the healthcare system can continue to evolve to address chronic pain, the importance of both medical and psychological factors must be applied with consideration for both patient care and finances,” said Mason.

The authors noted that previous studies have shown stress management improves chronic conditions.

In fact, the first Director-General of the World Health Organization (WHO), Dr. Brock Chisolm, asserted that mental healthcare is directly linked to physical well-being.

While evolving care quality improvement guidelines encourage primary care providers to screen for psychological conditions such as depression, challenges still exist when it comes to assessing high-risk mental health patients and providing access to affordable and effective treatment.

For example, in 2012, Harvard Business School professor Michael Porter estimated that primary care providers recognize and identify just half of all patients’ mental illnesses, and only half of those patients are offered medication for their condition.

Additionally, the cost of mental health deters patients from seeking treatment. According to the Agency for Healthcare Research and Quality (AHRQ), mental health disorders were the most expensive condition of 2006, more costly than cancer, heart disease and asthma.

Effective population health management becomes even more complicated by the fact that patients with chronic conditions such as diabetes, cardiovascular disease and cancer experience high rates of depression.

"Our study further suggests that with a negative perceived quality of life, patients are less likely to take an active role in managing their health," said Johnson & Johnson Health and Wellness Solutions president Len Greer. "This is problematic because failing to follow screening recommendations or medication regimes, as well as not seeking treatment when necessary, may contribute to worsening health."

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