Managing depression in people with long term conditions

Chris Dickens

Professor of Psychological Medicine

Peninsula College of Medicine and Dentistry

Long term condition – LTCs LTCs such as coronary heart disease and diabetes affect 17.5

millions throughout the UK – almost 1 in 3 of the general population

Account for – about 60% of all deaths– Account for about 70% of all healthcare expenditure

Reducing the health burden and costs attributable to LTCs is a priority for economies of many developed countries.

Depression in people with LTCs Depression affects about 5% of the UK population

Prevalence much higher in people with LTCs– 10 to 50% have clinically significant depression– Another 10-50% have other common mental disorders and sub-

syndromal distress

Depression is associated with worse medical outcomes– Double mortality and morbidity – 50% increase in use of urgent healthcare

Depression treatments are required for LTC patients– To improve emotional quality of life– Possibly to improve medical outcomes

Depression in LTCs Depression is under-detected and under-treated in people

with LTCs– Only about 20% as likely to receive appropriate depression

treatment compared to depressed physically healthy individuals

My research is about – understanding the causes and effects of depression people with

LTCs– Devising novel ways of treating depression in people with LTCs

Findings to date The natural history of depression in people with LTCs is complex

– Depression can predate LTC, be caused by general psychosocial difficulties and contribute to the onset of the LTC

– Depression can arise in the context of the LTC in response stresses specific to the LTCs

Depression is associated worse medical outcome – risks associated vary depending on the timing of the onset of depression.

Adverse emotional reactions to LTC are be predicted by a persons concerns and understanding about their illness, but also by the amount they worry about their illness.

Treatment of depression is advocated, though barriers to treatment exist at the level of the patient, the healthcare practitioner, the healthcare system

Existing treatments are not very effective in LTCs– SMD for CBT in CHD = 0.28, similar for DM and COPD

Future directions Treatment for depression is advisable in people with LTCS but:

– How can we develop psychological therapies that address the specific needs of people with LTCs – that improve depression but are acceptable to patients?

– How can such treatments be delivered in a way that overcomes barriers?

– Can such treatments be delivered by non-specialists in primary care?– Can such treatments should be effective across different LTCs?– Does treating depression improve health behaviours?– Does treating depression improve medical outcomes?

If you are interested in doing research into any of these areas, please come and speak to me……..

Thankyou