Chronic Illness and Depression

Estimated reading time: 25 minute(s)

Feeling intense emotions, especially in stressful times, is extremely common. For example, people diagnosed with a long-term or chronic illness can feel anger, sadness, and grief. These feelings may come and go with time and do not necessarily indicate that a person has depression. However, if these feelings include symptoms like feeling worthless, numb, or no pleasure in any activity for at least two weeks or more, it could be because of underlying depression.

The relationship between chronic illness and depression has been under investigation for a long time. [1] Experts now have various justifications that confirm how and why a chronic illness diagnosis can make someone feel depressed and low. Understanding the connection and learning tips to break this association is imperative for victims to cope better and live a good quality of life.

Chronic Illness Depression: The Psychological Impact

Getting a diagnosis of a long-term illness and managing it constantly may require significant life changes. Based on circumstances, a chronic disease may completely alter the daily routines of a person in addition to their relationships, ability to work, self-perception, and plans. Moreover, depending on the type of chronic illness, it can also impact a person’s ability to engage in certain activities that directly affect mental health. These activities may include socializing, exercising, or intimacy. Any of such changes can be highly challenging to emotional health and can easily trigger depressive symptoms. Some examples of chronic diseases that may trigger depression include cancer, stroke, diabetes, and chronic obstructive pulmonary disease (COPD). [2]

For some people, these depressive symptoms are temporary and decrease over time as they adapt to their illness. However, others may take it more seriously and continue living with chronic illness depression. The co-occurrence of both issues can make it harder for a person to adapt and manage each condition individually. However, by managing depression, things can generally get easier.

Remember that not everyone diagnosed with a chronic illness develops depression. Some potential psychological risk factors that make a person vulnerable to developing depression include the following:

• Feeling isolated or lonely
• The level of anxiety or stress a person feels about their condition
• Family history of depression

The experience of acquiring a chronic illness or receiving treatment for it can be highly traumatic. Many people respond to this trauma by developing depression-like symptoms, such as low mood or losing interest in previously enjoyed activities.

Chronic Illness and Depression: The Role of Biological Factors

In addition to its impact on mental health, a chronic illness diagnosis can also lead to depression because of how it affects physical health. For instance, an illness can affect neurotransmitters, hormones, or certain brain functions, making depression more likely. Certain medications that help people control their chronic physical illness may also trigger depression as a symptom.  Some of these medications with mood-altering properties include beta-blockers, corticosteroids, and stimulants.

Experts now believe that the reverse may also be true for many people. For instance, depression sometimes causes specific physiological changes in the body, making physical illness more likely. Research indicates that a depressive disorder may:

• Raise the levels of cortisol
• Lower heart rate variability
• Impact the hypothalamic-pituitary-adrenal axis, which plays a role in regulating the body’s stress response
• Affect metabolism.

All of the changes mentioned above can put a person at a higher risk of acquiring a chronic physical illness.

Depression From Health Issues: The Role of Social and Environmental Factors

The social, economic, and cultural circumstances can greatly influence a person’s health in addition to their surrounding environment. These factors can, in turn, affect chronic illness in the following ways:

Economic Cost

People with ongoing physical or mental health conditions may face multiple financial challenges, such as the following:

• Lower household income, especially if the chronic illness is making a family member take time off from work to care for a sick relative
• Lower personal income if someone with a diagnosis of chronic disease has to take time off
• The expenses of prescriptions, procedures, and medical appointments

The abovementioned factors can disproportionately affect people who are more likely to suffer from chronic conditions, are less likely to access healthcare, or even both.

Accessibility

People with chronic illnesses often need to be closely monitored. However, many may struggle to attend medical appointments, especially if they have physical issues like pain, fatigue, or mobility issues. These factors may even add to the stress of disease management, which, in turn, affects their mental health.

Conversely, someone with depression may struggle to attend appointments regularly or get help when their symptoms worsen. This may delay their diagnosis by preventing doctors from detecting the early signs of a long-term condition.

Problems with Self-Care

A mental or physical health condition may make it difficult for a person to care for themselves. Depending on their unique circumstances, they may forget to take medications in time, struggle to stay active, or find cooking and eating healthy meals challenging. These issues may also increase their risk of acquiring another condition, such as depression.

Coping with Chronic Illness and Depression

Getting a diagnosis of a long-term health condition can be disorienting and frightening. Once a person moves beyond the initial shock related to the diagnosis, learning how to manage or cope with the daily stressors in life associated with the underlying illness can be helpful.

Every person is susceptible to the effects of stress. However, people living with long-term illnesses are more vulnerable to them. In addition to a person’s daily challenges, a chronic disease may add many new stressors. For instance, such a person may need to:

• cope with discomfort or pain coming from their symptoms
• learn to adjust to new limitations placed by the newly diagnosed condition
• take steps to manage the underlying chronic condition
• practice self-care to make the symptoms more manageable
• cope with feelings of confusion, frustration, or isolation related to the new diagnosis
• cope with the increased financial pressures

Despite the challenges mentioned above, improving the quality of life while minimizing the challenges of living with a long-term illness is possible. Consider the following treatment options to manage chronic illness and depression:

• Mental Health Treatment: An experienced therapist can work with people with chronic illnesses by providing them with a safe place to talk about their emotions and feelings. They can also help them manage their emotions to affect their physical health positively. In some cases, antidepressants may be prescribed to keep depressive symptoms under control.
• Support Groups: In-person or online support groups can help people avoid loneliness while giving them a platform to connect with people in similar circumstances and form a support group.
• Occupational Therapy: An occupational therapist is an expert who helps people with certain health conditions adapt to their new circumstances, routines, and surroundings as needed. This may include strategies to manage daily tasks, advice on workplace adaptations, and the need for mobility aids, etc.

If someone with chronic illness depression develops suicidal thoughts, contacting a medical professional at once is recommended.

FAQs

How common is depression in people with physical illness?

Statistics suggest that 19 million people experienced at least one major depressive episode in 2017. The prevalence of this psychiatric issue varies depending on the type of chronic illness a person suffers from. In general, depression affects:

• 51% of people with Parkinson’s disease
• 42% of people with cancer
• 27% of people with diabetes
• 23% of people with stroke, aneurysms, and other cerebrovascular conditions
• 17% of people with cardiovascular issues

What are the symptoms of depression in a person with chronic illness?

People struggling with chronic illness may develop the following symptoms of depression:

• Sadness
• Thoughts of suicide or death
• Loss of energy
• Loss of interest in day-to-day life
• Unhappiness with life
• Problems with concentration

Can managing relationships help me manage depression while living with a chronic illness?

Experts believe that relationship management is crucial for living with a chronic condition. Many chronic conditions can make a person have limited time and energy left to socialize. Moreover, many family members and friends may not understand a person’s challenges. In such circumstances, remember to focus on the relationships most important to you while letting go of the ones that add more stress than support to your routine.

References

1 Ma Y, Xiang Q, Yan C, Liao H, Wang J. Relationship between chronic diseases and depression: the mediating effect of pain. BMC psychiatry. 2021 Dec;21:1-1.

2 Li H, Ge S, Greene B, Dunbar-Jacob J. Depression in the context of chronic diseases in the United States and China. International journal of nursing sciences. 2019 Jan 10;6(1):117-22.