High psychological morbidity associated with long term conditions

There is high psychological morbidity associated with each of the three conditions we have chosen to study. For example, rates of depression in patients with COPD are 2.5 times higher than controls, and the presence of diabetes doubles the odds of co-morbid depression compared to no diabetes. There is similar evidence for high psychological morbidity in rheumatologic disorders, including principal investigator’s previous studies.

 Poor Health Outcomes Associated with Psychological Symptoms

The presence of psychological symptoms in long term conditions is associated with poor health outcomes in all three conditions.  Depression has an adverse effect on quality of life in COPD diabetes and rheumatologic disorders. In diabetes, depression has been linked to poorer self care, and a self-sacrificing defence style has been associated with poor adherence to treatment.

Increased Health Expenditure Associated with Psychological Morbidity

The presence of psychological symptoms is associated with increased health care use and expenditure in long term conditions and those with depressive disorder are twice as likely to use emergency department services as those without depression. In diabetes, total health care expenditure is 4.5 times higher for individuals with depression than for those without depression.

 Perception of Illness is associated with outcome

Knowledge about and perceptions of illness are critical factors for optimal medication adherence in patients with long term conditions.  

Treatment of Depression Improves Outcome

In diabetes, treatment of depression produces an improvement in symptoms at no additional overall cost, as savings are made by reductions from in-patient medical costs and other forms of medical care. Improved self care of diabetes also reduces healthcare costs