Chronic illness and mental health — what caregivers and providers should know

Living with a chronic illness — such as cancer, diabetes, or heart disease — puts stress not only on the body but also on a patient’s mental health. What are the unique challenges that put patients with a chronic illness at risk of developing a mental illness? Read on to find out.

How does chronic illness affect mental health?

Patients with chronic illness are more likely to develop anxiety disorders and depression. According to the Anxiety and Depression Association of America (ADAA) , the increase in hospitalization, excessive worry, or hormonal changes of a chronic illness raises the chance of developing a mental health condition.

Common chronic illnesses that affect mental health

The Centers for Disease Control and Prevention (CDC)  defines chronic illnesses as conditions that last one year or more, need ongoing medical attention, limit daily life activities, or both.

Cancer

About 25% of cancer survivors have persistent mental health conditions and other psychological and social (psychosocial) disorders.1

Chronic obstructive pulmonary disease (COPD)

For patients with COPD, depression is the second most common self-reported comorbidity, and panic disorder is approximately 10 times higher than in the general population.2

Diabetes

People with diabetes are up to three times more likely to have depression, and only 25% to 50% get diagnosed and treated.3

Heart disease

Mental health disorders — such as depression, anxiety, and post-traumatic stress disorder (PTSD) — can develop after cardiac events, including heart failure, stroke, and heart attack.4

How can caregivers recognize mental health issues?

Suppose a loved one or someone you’re caring for is showing a change in behavior or personality, such as not being interested in things they used to like. In that case, you may need to help them assess their symptoms and seek professional help.

Although some medications used to treat chronic illness can affect mood and behavior, a significant change in their behavior, attitude, thinking, and their daily functioning may signify a coexisting mental health disorder.

How can doctors do a better job of recognizing mental illness in patients?

Providers — primary care physicians, nurse practitioners, physician’s assistants, and specialists — should look beyond the physical symptoms and ask about changes in mood, anxiety, or thinking.

"A patient may struggle with such issues but will not bring them up unless asked. Our priority is to recognize that behavioral factors exist and to ask the right questions."

 

- Dr. Gary Proctor, Regional Chief Medical Officer of Carelon Behavioral Health

There are also standard screening tools for depression and anxiety that can be routinely administered, just like other medical screening tools. Asking the right questions about alcohol, drug, and prescription medicine abuse is also recommended, as those struggling with chronic medical illnesses sometimes turn to alcohol or other substances to deal with their conditions.

Methods that help providers screen for and treat mental health disorders

New technologies and care models have emerged to help make screening for mental health conditions easier for providers and patients. A few examples of them are:

Collaborative care model

Under the collaborative care model, the primary care doctor is responsible for the patient’s whole health and addresses mental health with the help of a consulting psychiatrist. The psychiatrist guides and educates them on the most appropriate treatment. Collaborative care teams can also include behavioral health care managers, counselors, and other mental health professionals.

Telehealth

A telehealth, or virtual visit, connects people with their doctor by internet or phone. Telehealth is convenient, leads to more people keeping their appointment, and is often a good choice for those who:

  • Live far away from healthcare services and specialists.
  • Have time or access limitations.
  • Have transportation or physical mobility issues.
  • Benefit from regular monitoring for a long-term health condition.

Computer-assisted cognitive behavior therapy (CCBT)

In CCBT, the patient goes through training modules, answers questions, and completes activities based on their responses while the clinician monitors their progress. Results of a clinical trial published in the Journal of the American Medical Association found that CCBT reduced depression significantly more than treatment-as-usual (TAU) practices.5

Treating the mind and the body

Treating mental illnesses — with medication, psychotherapy, or a combination of the two — can help improve the physical symptoms of a chronic illness. In the same way, making sure the physical symptoms are under control can help improve mental health conditions.6

Need to find behavioral health services? The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online resource for finding mental health treatment facilities and programs in your state. Visit the Behavioral Health Treatment Services Locator  to learn more.

  1. National Institute of Health — National Cancer Institute: Meeting Cancer Survivors’ Psychosocial Health Needs: A Conversation with Dr. Patricia Ganz (accessed May 2023): cancer.gov. 
  2. Wang J, Willis K, Barson E, Smallwood N: The complexity of mental health care for people with COPD: a qualitative study of clinicians’ perspectives. NPJ Prim Care Respir Med (July 2021): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298614/#CR6. 
  3. Centers for Disease Control and Prevention: Diabetes and Mental Health (accessed May 2023): cdc.gov. 
  4. Centers for Disease Control and Prevention: Heart Disease and Mental Health Disorders (accessed May 2023): cdc.gov. 
  5. Wright JH, Owen J, Eells TD, et al.: Effect of Computer-Assisted Cognitive Behavior Therapy vs. Usual Care on Depression Among Adults in Primary Care: A Randomized Clinical Trial. JAMA Netw Open (February 2022): https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788926 
  6. National Institute of Mental Health: Chronic Illness and Mental Health: Recognizing and Treating Depression (accessed May 2023): nimh.nih.gov.

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