Provider Education Tool
Strategies to Improve
Depression in Patients
with Chronic Illness
C
hronic 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 Depression
Studies 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.
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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
Depression
Signs and symptoms typically associated
with depression include:
ŠŠ
ŠŠ
ŠŠ
ŠŠ
ŠŠ
ŠŠ
Depressed mood
Significant weight changes
Sleep disturbances
Difficulty concentrating
Lack of emotion
Feelings of worthlessness,
guilty, hopelessness
ŠŠ Thoughts of suicide or death
ŠŠ Decreased participation in
daily activities
Treatment for Depression
The 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.
Social Support
Social 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 Resources
When speaking of personal coping
mechanisms, we are referring to the
concepts of self-esteem and selfefficacy.
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
Provider Education Tool
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 selftreat (eg, self-administration of insulin
injections) and to be more self-reliant.
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 diseasespecific support groups can help patients
find encouragement.
Conclusions
Methods to help boost
a patient’s self-esteem
include:
ŠŠ Listen in an understanding
and non-judgmental manner
ŠŠ Assist in getting help for low
self-esteem
ŠŠ Provide encouragement; be
supportive
ŠŠ Acknowledge successes, no
matter how small
ŠŠ 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
Millions 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 Resources
American 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
© 2014 Prime Education, Inc. (PRIME®). All Rights Reserved.
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