1. The Role of Depression in Effective Chronic Disease Management
Sujit Kumar Kotapati, MD, LaTonya Bynum, BS, CHES, Rajalakshmi Cheerla, MD, Appathurai Balamurugan, MD, MPH
RESULTS
DISCUSSION
BACKGROUND
Twenty three percent of survey respondents were diagnosed with depression.
Higher proportion of those with chronic diseases were diagnosed with depression than those without these chronic diseases (with and without diabetes (31.0% CI (26.2, 35.8) and 22.2% CI (20.4, 23.9)); with and without asthma (39.4% CI (34.0, 44.8)and 20.6% CI (18.9, 22.3)); and those with and without hypertension (26.0% CI (23.5, 28.5) and 21.2% CI (19.1, 23.3) respectively).
There were no differences in physician-led preventive care practices and self-care practices among those with and without depression.
Depression is an important factor in chronic disease management.
Depression is more prevalent and contributes to morbidity in patients with chronic medical conditions such as diabetes, asthma, and hypertension.
Depression may be an independent risk factor for increased morbidity in patients with chronic diseases, as it can limit rehabilitation and recovery.
Physician-led preventive care and patient self-care practices among patients with chronic diseases such as diabetes, asthma and hypertension may differ by depression status.
The purpose of our study is to assess the role of depression in effective chronic disease management.
To our knowledge, this is the first study to use the population-based BRFSS survey data to assess the role of depression in effective chronic disease management in Arkansas.
We found that depression status differs among patients with or without chronic diseases such as diabetes, asthma and hypertension.
Depression affects both physician-led preventive care and patient self-care practices.
RECOMMENDATIONS
Table 1. Physician-led preventive care practices among people who have chronic diseases with and without depression
Screening and effectively managing depression in primary care can improve patient outcomes among those with chronic diseases.
Further analysis using multivariate models to assess the role of depression in chronic disease management (confounder vs. effective modifier) is imperative.
METHODS
The BRFSS is a state-based, random-digit dialed telephone survey of the non-institutionalized civilian population 18 years of age and older.
The core section of the 2013 Arkansas BRFSS survey include one question to assess depression: “Have you ever been told that you have a depressive disorder, including depression, major depression, dysthymia or minor depression?”
Physician-led preventive care (physician follow-up, annual eye exam, A1c checks, and foot exam) and patient self-care practices (medication adherence, blood glucose monitoring and watching or reducing salt intake) among those with and without depression.
SAS 9.3 was used to assess the association between depression and preventive care and self-care practices related to chronic disease management.
REFERENCES
George, M., Harper, R., Balamurugan, A., Kilmer, G., & Bynum, L. (2011). Diabetic Retinopathy and Its Risk Factors in a Population-Based Study. Journal of primary care & community health,
Katon, W. J., Lin, E. H., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., & McCulloch, D. (2010). Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine, 363(27),
Lin, E. H., Katon, W., Von Korff, M., Rutter, C., Simon, G. E., Oliver, M., ... & Young, B. (2004). Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes care, 27(9),
Table 2. Patient self-care practices among people who have chronic diseases with and without depression