In the US, there is a large number of individuals who suffer from chronic illness.  Chronic illness is a blanket term used to describe a variety of conditions that present themselves over time, are long-lasting, and cannot be cured.  Statistics show that almost half of the US population, or 133 million people, suffer from at least one type of chronic illness and the numbers are continuing to rise.1  This presents an ever-growing issue for not only the physical health of individuals, but for mental health outcomes as well.  When individuals receive a diagnosis for a chronic disease, the news is life-altering and overwhelming.  Having a diagnosis for chronic illness usually means that individuals have to make a variety of changes to their lives.  From dietary changes to new medications and other day-to-day activities being changed and tailored to treat their condition, chronic illness is an exhaustive undertaking, and it is not uncommon for  negative emotions to follow a diagnosis.  Emotions such as anger, denial, frustration, and sadness can overwhelm a person, and this can lead to issues with mental health.  In this blog, we will discuss the complicated, reciprocal relationship between chronic illness and mental health.  How does one affect the other?  Does one cause the other to worsen?

Why are Chronic Illnesses on the Rise?

Even though over half of Americans are already suffering from at least one chronic illness, that number is on the rise.  Experts predict that the number will jump from 133 million individuals to 170 million before the end of 2030.1 This can be worrisome for mental health reasons, but chronic conditions can also decrease a person’s length of life, quality of life, and increase the risk of other chronic diseases such as nerve and kidney disease.  The alarmingly quick rise of chronic illness in the US is creating a significant burden on the cost of healthcare services.  Research shows that 3 out of every 4 dollars health care dollars are spent on people with chronic conditions, and individuals with chronic conditions make up 90% of prescription drug use, are more likely to be hospitalized, and have longer hospital stays when compared to those without chronic illness.1

Some of the most common types2 of chronic conditions in the United States include:

  • Heart disease
  • High blood pressure
  • Heart failure
  • Cancer
  • Stroke
  • Respiratory disease
  • Diabetes
  • Alzheimer’s disease
  • Pneumonia
  • Kidney disease

Despite its widespread diagnosis across the United States, a number of chronic illnesses are actually quite preventable.  Individuals with poor health behaviors increase their risk of developing a chronic condition, but improvements to lifestyle choices can lower risk.  The CDC suggests that improving a poor diet, daily physical activity, and eliminating smoking could prevent up to 80% of heart disease and stroke, 80% of type 2 diabetes, and 40% of cancer.  In addition, early detection of chronic conditions is extremely helpful as it can prevent the condition from progressing into an uncontrollable, more unpredictable illness.  However, nearly two-thirds of the American population is overweight or obese, and the number of overweight adolescents are on the rise.  Being overweight or obese is a risk factor for heart disease, diabetes, and a variety of other diseases.  In addition, more than half of Americans do not get enough exercise to meet health goals, 1 in 4 Americans do not do any type of physical activity during their leisure times at all, and 1 in 4 Americans do not consume the recommended amount of fruits and vegetables in a day.

The promising news is that reversing these poor health habits is doable.  Though it will take a significant amount of effort, individuals can improve their odds at developing a chronic condition through increasing their physical activity, improving nutritional choices, and reducing tobacco and substance abuse. Treating symptoms before conditions manifest or early on in the diagnosis can be very beneficial to individuals all over the country and may help the rising number of chronic illnesses in the US.

Connection between Chronic Illness and Depression

Now that we have discussed a little more about chronic illness, how does it relate to mental illness?  When a person is diagnosed with a chronic illness, there are a number of new doctors, specialists, and interventionists who are onboarded to help them control physical symptoms. Chronic conditions take a lot of adjustment and additions to be well controlled. However, mental health is not usually one of the main concerns that is addressed when a person becomes diagnosed with a chronic illness. Left off that new treatment plan is typically a mental health counselor or professional.  The onset of a chronic disease is overwhelming, and it can be very saddening for people to accept that their daily activities have to change and new routines have to form as a result of a chronic illness.  It is completely normal for individuals to experience some kind of sadness or even ‘mourning’ of their former life, but when this sadness persists for longer than 2-3 weeks, that individual might develop depression, and the need for a mental health professional is present.

Unfortunately, individuals with chronic illnesses are at a higher risk of developing depression and other mental health conditions.  In the US, there are about 37 million people who currently have diabetes, and research shows that they are 2-3x more likely to develop depression than individuals without diabetes.3 Even with these high numbers, only 25% to 50% of diabetic people with depression are diagnosed or treated, and diabetics with depression have a 46% increased risk for mortality when compared to diabetics who are not depressed.3  The American Diabetes Association also states that diabetics who have depression have decreased physical activity, higher rates of obesity, poorer glycemic control, and impaired function compared to diabetics without depression.4 Beyond diabetes, other chronic illnesses also put individuals at risk for depression.  There are several factors that put people at a higher risk for developing depression.  You can read more about these risk factors at another one of our blogs at Remedy, linked here. Two of the most common risk factors include a personal or family history of depression and family members who have died by suicide.  However, having a chronic illness has its own set of risk factors that may put an individual at a higher risk for developing depression. For example, chronic illnesses such as Parkinson’s disease and stroke can cause physiological changes to the brain, and research shows that it may be related to the development of depression.5 Individuals may be more likely to develop depression after being diagnosed with a chronic condition, whether it be due to the frustration and sadness at adjusting to a new type of life or due to new medications used to treat their conditions that trigger depression.

The rate of developing depression in conjunction with a chronic disease depends on the illness. Below6 is a list of chronic conditions comorbid with depression:

  • 50% of patients with Parkinson’s
  • 42% of patients with cancer
  • 39% of patients with neurological disorders
  • 17% of patients with cardiovascular disease
  • 11% of patients with Alzheimer’s disease

Which causes which?

Do mental health issues cause chronic illness or does chronic illness cause mental health issues?

Well, the truth is that chronic illness and mental health issues can affect one another reciprocally. Studies show that 50.6% of those who have mental disorders also have a chronic medical condition.7  Epidemiological studies have determined that there is a strong link between mental health and physical health, suggesting that the relationships between depression and chronic disease can equally affect one with another.  Therefore, a depressive disorder could precipitate a chronic disease and vice versa.  Individuals with depression have an increased risk for developing cardiovascular disease, stroke, pain, diabetes, and other chronic conditions.  While the exact reason for these risk factors is unclear, it may be due to the fact that individuals with these illnesses do not have the best access to care.  In addition, they may not have enough time or resources to care for their holistic health.  Looking for the proper doctors to treat a variety of symptoms, taking prescribed medications, making time for exercising and eating healthily can all contribute to this issue.

In addition, there may be physiological components to depression that may increase the risk for developing a chronic condition.  For individuals with depression, research has shown that they may suffer from increased inflammation, fluctuations to heart rate, blood circulation, abnormalities in stress hormones, and negative metabolic changes that may put their physical health at risk.5  In addition, individuals with schizophrenia are more likely to develop chronic illnesses like diabetes or obesity due to the symptoms of their mental illness making it less feasible to maintain a healthy lifestyle.  The trouble of having a chronic or mental illness is the vicious cycle that it can put an individual through.  A person with depression may feel less motivated to sleep well, eat well, or take care of themselves which can lead to chronic illness.  On the other hand, chronic illness can take so much energy and motivation to control that it may lead to depressive symptoms.  With this connection, it is important for individuals with either or both types of conditions to seek professional help that treats both components as related entities, not separate.  Understanding that one condition can affect the other may be the first step in treating symptoms and helping individuals feel more in control of their lives.

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