The Intersection of Mental Health and Chronic Disease
Receiving a diagnosis of a chronic illness can be life-altering. Along with the day-to-day physical symptoms of the illness, emotions such as sadness, grief, and denial, as well as an added financial burden, can follow a diagnosis.
A patient who is diagnosed with diabetes, for example, will be instructed to visit several specialists each year, including an endocrinologist, ophthalmologist, and podiatrist. But rarely are patients referred to a mental health specialist as part of their treatment plan.
Roughly 37 million Americans have diabetes, and they are 2 to 3 times more likely to develop depression than people without diabetes. But only 25%–50% of diabetics with depression get diagnosed and treated.
“It’s a big issue,” says Joseph Gallo, MD, MPH, a professor in Mental Health whose research focuses on the intersection of physical and mental health. “There’s ample clinical and epidemiologic evidence that shows the risk for depression is higher among those who suffer from chronic illnesses.”
Diabetics who have depressive symptoms have a 46% increased risk for all-cause mortality than diabetics who are not depressed. “It’s not an exaggeration to say that diabetes and depression together are a deadly combination,” says Gallo.
Diabetes is just one chronic illness associated with depression. According to the CDC, 51% of Parkinson’s patients, 42% of cancer patients, 27% of diabetes patients, 23% of cerebrovascular patients, 17% of cardiovascular patients, and 11% of Alzheimer’s patients also have depression.
But a gap exists in the medical care field where the emotional dimension of a patient is often overlooked. In a 2020 issue of The American Journal of Geriatric Psychiatry, Gallo explains that depression can lead to poor self-care, excess disability, and increased mortality. “So much of managing multiple conditions requires self-care on the part of the person, and depression can make caring for oneself difficult,” says Gallo. “It has a big effect on things like diabetes control.”
According to the American Diabetes Association, diabetics dealing with depression show poorer glycemic control, decreased physical activity, higher obesity, and potentially more diabetes end-organ complications and impaired function.
Yet getting treatment for depression can be challenging. Many physicians aren’t trained to speak to patients about depression, and many patients either lack awareness of their mental health state or don’t feel comfortable enough to bring it up. But, even if patients were to end up visiting a mental health specialist, psychologists may not have the background to understand the particular mental health challenges that come with living with chronic illness.
Part of the solution, says Gallo, is to destigmatize depression. If depression were perceived as other medical conditions, there would be more prevention around it. “You don’t think about preventing heart disease by only looking at people who have heart attacks,” says Gallo.
While there is a growing recognition of the connection between mental and physical health, effectively treating chronic illness requires a stronger integration of mental health, primary care, and specialty care services.
“Depression management should not be secondary to the management of ‘organic’ disease,” Gallo writes in a 2017 issue of The American Journal of Geriatric Psychiatry. “We always have to consider the emotional health of patients, especially when there are multiple conditions to manage.”
Grace Fernandez is a communications specialist in the Office of External Affairs at the Johns Hopkins Bloomberg School of Public Health.
