Chronic Illness

Chronic Illness and Mental Health: Exploring the Connection

Nearly half of all adults in the United States are living with at least one chronic illness. These persistent health challenges create immense discomfort and affect a person’s physical well-being. Additionally, they have profound effects on mental health. Studies show that individuals with chronic illnesses are significantly more likely to experience mental health issues such as depression and anxiety, complicating their overall care and quality of life.

Prevalence

Chronic illness is a long-term health condition that limits everyday activities or requires continuing medical care. According to the Centers for Disease Control and Prevention (CDC), around 129 million Americans experience at least one major chronic illness, such as heart disease, cancer, diabetes, or hypertension. These medical conditions are associated with five of the top ten most common causes of mortality in the United States, even though the majority of them are preventable and curable.

A large proportion of the population today has multiple chronic illnesses (known as multimorbidity), with 42% having two or more and 12% having five or more.

Chronic diseases have been progressively growing over the last 20 years, and this trend is projected to continue as the U.S. population ages. The population of Americans 50 and older is anticipated to increase significantly—by around 61%—by 2025. Among this age group, the number of people living with at least one chronic illness (like heart disease or diabetes) is expected to nearly double.

Impact on Daily Life

Chronic illnesses can profoundly disrupt a person’s daily life. Many chronic conditions restrict a person’s mobility and independence, requiring significant lifestyle changes, such as regular medication, dietary adjustments, home modifications, caregiving services, and frequent medical appointments. The ongoing nature of chronic illness can lead to emotional stress, affecting relationships, work, and overall quality of life. Understanding these challenges is crucial for providing proper support.

Impact on Mental Health

Living with a chronic illness may lead to depression and grief over the loss of a person’s previous lifestyle, health, and independence. Many chronic conditions limit daily functioning. For example, a person may struggle with dressing, cooking, eating, and other tasks they previously found easy and natural. This can cause an individual to feel frustrated, helpless, and ashamed as they become more or entirely dependent on others for their activities of daily living.

The constant management of symptoms, along with frequent medical appointments, can become overwhelming and exhausting. Many patients also feel disappointed or frustrated with their medical care, especially if progress is slow or uncertain.

Over time, the person may become irritable or short-tempered, lashing out at loved ones out of shame or embarrassment over their perceived loss of independence. They might also withdraw from family and friends, avoiding gatherings where they fear their limitations will be noticed.

Chronic Conditions Associated with Anxiety and Depression

Depression and Coronary Heart Disease (CHD)

Research shows that depression is prevalent in approximately 15–30% of patients with coronary heart disease. The presence of depression in these patients significantly worsens clinical outcomes, including an increased risk of mortality and poorer recovery post-heart attack.

Diabetes and Depression

Depression occurs two to three times more frequently in patients with diabetes, with the vast majority of cases going undiagnosed.

Research shows that people with prediabetes or undiagnosed diabetes are more likely to experience depression than those with normal blood sugar levels. This risk is even higher in those who have been diagnosed with diabetes, with depression rates up to three times higher in individuals with type 1 diabetes and twice as high in those with type 2 diabetes compared to the general population. Interestingly, this link between diabetes and depression points to a two-way relationship. Depression can also increase the risk of developing type 2 diabetes by 60% by leading to unhealthy lifestyles such as poor diet, lack of physical activity, and weight gain, as well as through physiological changes like increased inflammation and insulin resistance, which can disrupt blood sugar regulation.

Additionally, about 40% of people with type 1 or type 2 diabetes experience anxiety. Depression and anxiety can exacerbate diabetes by reducing adherence to therapy, worsening quality of life, and raising the risk of complications and mortality.

Chronic Pain as a Trigger for Anxiety and Depression

Chronic illnesses are frequently accompanied by persistent pain. For people living with chronic diseases, this constant pain not only exacerbates physical discomfort but also significantly contributes to the development of mental health issues, such as depression and anxiety. The chronic nature of these conditions creates a cycle of pain and emotional distress, further diminishing the quality of life and making the management of the disease more challenging.

Chronic diseases increase the likelihood of depression, partly due to the severe pain they often cause. Certain demographic groups, such as women, those with lower education levels, unmarried individuals, rural residents, and those currently employed, are more vulnerable to depression when dealing with chronic diseases and pain. These findings emphasize the importance of effective pain management in reducing the risk of depression in these patients.

Other Chronic Conditions Contributing to Anxiety and Depression

Autoimmune conditions such as lupus, chronic fatigue syndrome, fibromyalgia, and dysautonomias (including Postural Orthostatic Tachycardia Syndrome, or POTS) are all linked to significant emotional distress that can lead to depression and anxiety.

These conditions often involve persistent physical symptoms like chronic pain, extreme fatigue, trouble sleeping, dizziness, tremors, and muscle weakness or stiffness, which can severely impact daily functioning and quality of life.

For instance, research consistently shows that systemic lupus erythematosus can cause a wide range of neuropsychiatric symptoms, with the central nervous system being the most affected. People with systemic lupus erythematosus often experience neurological and psychiatric issues, referred to as neuropsychiatric lupus (NPSLE). About 30% of these neuropsychiatric problems are directly caused by lupus. An individual may experience cognitive dysfunction, headaches, mood disorders, anxiety, depression, seizures, and even psychosis.

These symptoms usually show up around the time lupus first appears and can include conditions affecting the brain and blood vessels or even psychotic episodes. The reasons behind NPSLE are linked to both inflammation in the brain and restricted blood flow, making it a serious health issue.

The constant struggle to manage these symptoms, along with the uncertainty and unpredictability of flare-ups, can lead to feelings of frustration, hopelessness, and social isolation.

How We Can Help

People managing anxiety and depression in the context of chronic illness should not face these challenges alone. Here’s how we can assist:

Pharmacological Treatment: We can prescribe medications to help manage associated mood symptoms, such as depression or anxiety.

Lab Testing: We’ll perform necessary lab tests to rule out any underlying medical conditions that could be contributing to or worsening your mood symptoms.

Therapy: We offer various forms of treatment or can refer you to specialized therapists to address the emotional and psychological aspects of living with a chronic condition.

Holistic Care Coordination: Our approach ensures that we work together with your medical treatment team to coordinate care for the treatment of psychiatric symptoms. We aim to make your mental health symptoms more manageable, improving your overall quality of life.

Remember—seeking professional help is crucial when experiencing mental health symptoms. Therapists, psychiatrists, counselors, and support groups can offer guidance and support tailored to individual needs. Seeking help is a sign of strength, and prioritizing mental well-being is essential for a healthier and happier future.