Elsevier

Clinical Psychology Review

Volume 28, Issue 8, December 2008, Pages 1426-1446
Clinical Psychology Review

Integrating co-morbid depression and chronic physical disease management: Identifying and resolving failures in self-regulation

https://doi.org/10.1016/j.cpr.2008.09.002Get rights and content

Abstract

Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.

Section snippets

The effects of depression management on disease

Several researchers have suggested that depression causes or exacerbates chronic physical disease. Evidence for the causal link also has been drawn from studies that have identified either major depression or elevated depressive symptoms as a risk factor for the development of chronic diseases such as coronary heart disease (Rugulies, 2002, Wulsin and Singal, 2003). Further, several studies suggest that depression predicts mortality in samples of patients with myocardial infarction (Bush et

The effects of disease management on depression

Prior theory and research suggest that the presence of chronic physical disease causes the onset or exacerbation of depressive symptoms and major depression. This hypothesis is supported by studies demonstrating that the presence of chronic physical disease predicts the onset of major depression or an increase in depressive symptoms over time (Aneshensel et al., 1984, Bruce and Hoff, 1994, Cole and Dendukuri, 2003). In addition, several studies demonstrate that the presence of chronic disease

Management of co-morbid conditions as self-regulation failure

So why do treatments for depression generally fail to significantly influence disease outcomes and disease management programs generally fail to significantly improve mood? In 1993, the Agency for Health Care Policy and Research (AHCPR, 1993) published and disseminated practice guidelines for integrating depression screening and treatment into primary care settings. Yet there is a mounting literature suggesting that depression treatment is not integrated into medical care, and it is now well

Integrating depression and chronic disease management

The present research illuminates the central dilemma faced by patients managing co-morbidity: utilizing two separate, self-regulatory goals (i.e., manage disease, manage depression) is problematic. Often, the management of chronic disease and depression overlap or conflict at the level of lower-order actions or behaviors. Patients rely on subjective cues (e.g., mood, energy level, pain) rather than objective indicators of well-being (e.g., blood pressure). Focusing on subjective cues can

Discussion

This review highlights the inconsistent findings from studies examining whether treating depression improves disease outcomes and whether chronic disease management improves depressed mood. We propose that disease management may contribute to the underregulation and misregulation of depression management and vice versa. When individuals attempt to manage one aspect of their co-morbid condition, they may assign too much priority to these particular self-regulatory goals, thus interfering with or

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      However, the review noted that improvement of glycaemic control required further research, since treatments targeted at depression alone did not improve diabetes outcomes. This corroborates other findings that interventions targeted at solely treating depression fail to improve physical outcomes, or vice versa [44–47]. Notable among these studies utilising the CCM for the treatment of people with diabetes was the Pathways Programme study [45,47], which incorporated a motivational interviewing counseling-style approach to support patients with problem solving and goal setting for people with comorbid diabetes and depression.

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    Order of authorship between the first and second authors was determined by a coin-flip. Funding for this project came, in part, from the National Institute of Mental Health, R21 MH066106-01A1 for the Group Treatment for Depression in Heart Failure to Michael Friedman and from the National Institute of Health / National Institute on Aging, R24 AG023958 for the Center for the Study of Health Beliefs and Behaviors to Howard Leventhal and Elaine Leventhal. We thank Melanie Cohen for her assistance in reviewing the literature and Brian Detweiler-Bedell for his input throughout the writing process.

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