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24 April 2006
Researchers have found that comorbid depression in people with chronic physical disorders has a significant impact on healthcare seeking, disability, and work absence.
"Our findings fit well with the clinical observation that patients with multiple physical symptoms or poor health are more likely to have an underlying mental health disorder and that formal screening of mental disorders in such patients may be particularly fruitful," say Murray Stein (University of California at San Diego, USA) and colleagues.
The researchers examined the impact of depressive illness and chronic physical conditions on functional status and healthcare use in 130,880 respondents of a Canadian, population-based cross-sectional survey.
Major depressive disorder (MDD) in the past 12 months was assessed by structured interview, while physical disorders, activity reductions, role impairment, and work absence were measured by self-report.
Six physician conditions were included in the analysis: asthma, arthritis, back problems, chronic obstructive pulmonary disease, heart disease, and diabetes.
After taking into account sociodemographic characteristics, alcohol dependence, and chronic physical illness burden, the researchers found that patients with chronic physical conditions and comorbid MDD were almost twice as likely to use healthcare services as those with physical conditions but not MDD.
The presence of MDD also significantly increased both the likelihood of being disabled in the previous 2 weeks and of being absent from work, by around two fold.
Stein et al note in the journal Psychological Medicine that the impact of MDD was seen across each of the six chronic conditions examined, and that the strongest associations were seen for work absence.
"Our findings… along with similar observations of particularly poor functioning among persons with comorbid physical and mental health disorders, underscore the need to develop and test interventions that can more comprehensively meet the needs of the many persons in the community who suffer from combined physical and mental illness," say the investigators.
They recommend investing further effort in investigating the usefulness of "routinely embedding depression identification and management techniques within chronic disease management programs."
Source: Psychol Med 2006; 36: 587–596
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