Behavioral Matters: Breaking the Cycle—Depression and Chronic Medical Conditions

DMEC Staff@Work, Resources

Did you know that depression is a risk factor for developing a chronic condition, and that having a chronic condition is a risk factor for developing depression? Both issues increase the risk of developing the other. Depression is common among people who have diabetes and cardiovascular disease, among other chronic conditions.

Comorbid depression, the co-occurrence of depression with physical disorders in the same person, worsens the prognosis and lengthens the recovery period for the medical condition—a challenge for primary care physicians and specialists. Affected people have greater functional impairment and exhibit more symptoms of the medical condition.

Patients with chronic conditions have a harder time adhering to medication and treatment plans when they are also depressed, making it more difficult for them to make dietary changes and lifestyle modifications to improve their conditions. Depression can decrease motivation and the energy needed to perform self-management behaviors, and the risk of noncompliance with medical treatment regimens are three times greater for depressed patients1. Treating the medical condition can produce side effects that worsen the psychiatric condition. At the same time, treating the psychiatric condition can compromise the treatment of medical conditions. For example, some psychiatric medications cause weight gain, a risk factor for diabetes.

All of this contributes to decreased quality of life and productivity, and increased disability and medical costs. Also, people with depression have a two to four times increased risk of death due to natural causes associated with the medical condition1.

Health care professionals can break the cycle by integrating medical and depression treatment. This integrated care model has proven to be effective, although not widely used. Integrated care programs are designed to improve quality and lower medical costs for patients by:

  • Helping them understand diagnoses and treatment options
  • Coaching to manage chronic conditions
  • Reminding them about missed prescription refills, office visits or routine tests
  • Working with other specialists and facilities to coordinate care

Another critical component to breaking the cycle is screening for depression. Given the rate of depression associated with chronic medical illnesses and its impact on outcomes and compliance with treatment programs, screening for depression needs to become a routine part of any office visit.2

The results: Patients who are treated as part of an integrated program increased general functioning, which in turn, predicted more favorable outcomes in areas such as self-care. Overall, patients in integrated programs, combining personalized medical and depression treatments, improved both outcomes2. That’s a cycle worth promoting.


  1. Goodell S, B Druss, E Reisinger Walker. Mental Disorders and Medical Comorbidity. Robert Wood Johnson Foundation. The Synthesis Project. Policy Brief 21:1 – 5. 2011.
  2. Rosenthal M. The Challenge of Comorbid Disorders in Patients With Depression. Journal of the American Osteopathic Association. Supplement 4. 103 (8):S10 – S15. 2003.

By Douglas A. Nemecek, MD, MBA, Chief Medical Officer, Cigna Behavioral Health. This article first appeared in the February 2014 issue of @Work magazine.

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