A difficult combination: chronic physical illness, depression, and pain

At present 41% of adult males and 43% of adult females report a long-term illness, and this figure is increasing as our population ages.1 Long-term conditions have been at the centre of UK health policy since the mid-1990s, and managing increasing numbers of people with increasingly complex long-term conditions within a limited healthcare budget is one of the major challenges currently facing the NHS, and in particular general practice. Overall, depression affects around 20% of patients who have a chronic physical health problem. This is two to three times the prevalence of depression in those with good physical health.2 Severity of depression is influenced by the number and severity of symptoms, as well as the degree of functional impairment. Patients with chronic disease together with depression tend to have poorer outcomes. For example, it has been shown that depression is a risk factor for increased morbidity and mortality in patients with diabetes, and that insulin resistance is more common in patients with diabetes and depression than diabetes alone.3 For …