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  1. Home
  2. Books
  3. Depression and Physical Illness
  • Cited by 27
Publisher:
Cambridge University Press
Online publication date:
September 2009
Print publication year:
2006
Online ISBN:
9780511544293
DOI:
https://doi.org/10.1017/CBO9780511544293
Subjects:
Psychiatry and Clinical Psychology, Medicine, Psychiatry
Information

Book description

Depression and physical illness are intimately related. Depressed mood is thought to contribute to the development and progression of some illnesses, while physical illness can in turn increase the risk of depression. This book provides a critical overview of the evidence linking depression with several major health conditions, including coronary heart disease, diabetes, cancer, chronic pain, disability, chronic fatigue and obesity. It also explores the biological and behavioural processes underlying the association, discussing the role of neuroendocrine, immunological and inflammatory pathways, and the relationship between depression and health behaviours such as smoking, physical activity and adherence to medical advice. It combines a thorough analysis of the clinical, biological and epidemiological data with guidance to health professionals and patients on how to manage depression in people suffering from physical illness, pointing the way to an integrated approach to health care.

Reviews

'I recommend this book highly to all mental healthcare professionals … I would recommend this book to other medical specialists - on checking the contents of the latest editions of several prominent textbooks of medicine, I could find no reference to the role of depression despite the overwhelming evidence presented in Depression and Physical Illness.'

Source: British Journal of Psychiatry

'…a useful resource for those interested in depression.'

Source: Journal of Psychosomatic Research

'… this book is well worth considering. It gives helpful guidance to health professionals of all kinds on improving the health care of patients suffering from a wide range of disorders.'

Source: Journal of Mental Health

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Contents

Contents
  • 1 - Depression in the medically ill
    pp 3-18
    • By Francis Creed, Department of Psychiatry, University of Manchester, Manchester, UK, Chris Dickens, Department of Psychiatry, University of Manchester, Manchester, UK
  • View abstract

    Summary

    Depressive disorder is the most common psychiatric disorder among patients attending primary care worldwide. This chapter indicates the ways in which different definitions and different modes of measurement used in previous research can affect the prevalence of depression. It examines the prevalence of depression in different groups and reviews the few studies that have examined the incidence of depression in the medically ill. In published studies, the prevalence of depression in the medically ill ranges between 15% and 61%. A self-administered questionnaire is required to screen a large population of physically ill patients and may be used as the first stage of a two-phase survey, which includes research interviews to determine the actual cases of depressive disorder. Cross-sectional studies demonstrate a close association between depressive disorders and physical illness in population-based studies. Finally, the chapter explains the effect of depression in terms of health-related quality of life and healthcare costs.
  • 2 - Psychosocial factors, depression and illness
    pp 19-50
    • By Stephen Stansfeld, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, London, UK, Farhat Rasul, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, London, UK
  • View abstract

    Summary

    This chapter describes the evidence for social and psychological factors playing a role in the aetiology of depression. Apart from gender differences, the most fundamental association between social factors and depression is the relationship with socioeconomic position (SEP) and the level of social disadvantage this connotes. Life events have been studied as the classical social risk factor for depression. The chapter focuses on depressive disorders and also includes landmark studies that have used the broader categories that illustrate the role of psychosocial variables. Two psychological mechanisms have been postulated for the beneficial effect of social relations on mental health: support has a direct effect on wellbeing; and the buffering hypothesis, whereby support moderates the impact of stressors on the risk of depression. Ethnicity is considered to be a key explanatory concept within the context of health variations in mental illness.
  • 3 - Depression and the development of coronary heart disease
    pp 53-86
    • By Andrew Steptoe, Department of Epidemiology and Public Health, University College London, London, UK
  • View abstract

    Summary

    This chapter focuses on the role of depression in the development of coronary atherosclerosis and in the aetiology of coronary heart disease (CHD). It evaluates the strength and consistency of the association between depression and future CHD and describes the biological processes that are probably involved. The chapter reviews the existing evidence from longitudinal observational studies that depression and depressive symptoms are associated prospectively with CHD in initially healthy adults. Three studies have used computed tomography (CT) to assess coronary artery calcification, a more direct measure than carotid thickness of the intima-medial layer (IMT) of coronary disease. The chapter outlines the different pathways that may translate depressive emotional experience into CHD. A number of behavioural factors contribute to CHD, including cigarette smoking, certain patterns of alcohol consumption, eating behaviour and physical activity. It is known that psychological stress provokes acute haemostatic responses in healthy individuals and in patients with CHD.
  • 4 - Depression and prognosis in cardiac patients
    pp 87-108
    • By Heather S. Lett, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA, Andrew Sherwood, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA, Lana Watkins, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA, James A. Blumenthal, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
  • View abstract

    Summary

    Depression is disproportionately prevalent among cardiac patients, with estimates of Major depressive disorder (MDD) of about 15% in patients following acute myocardial infarction (AMI) or coronary artery bypass graft (CABG), and an additional 20% with either minor depression or elevated levels of depressive symptoms as measured by questionnaires such as the Beck Depression Inventory (BDI). This chapter describes the evidence that depression is a risk factor in patients with established Coronary heart disease (CHD) and suggests potential mechanisms underlying the relationship between depression and adverse outcomes. It focuses on evidence that depression in patients with existing CHD poses a risk for increased morbidity and mortality. A number of biobehavioural mechanisms have been hypothesised to underlie the relationship between depression and CHD. Cross-sectional studies have demonstrated increased levels of Creactive protein (CRP) and other inflammatory markers in patients with depression and with other CHD risk factors, such as the metabolic syndrome.
  • 5 - The management of depression in patients with coronary heart disease
    pp 109-124
    • By Robert M. Carney, Behavioral Medicine Center Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA, Kenneth E. Freedland, Behavioral Medicine Center, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
  • View abstract

    Summary

    Depression has been found to increase the risk of further medical morbidity and even mortality in coronary heart disease (CHD) patients. There are four major classes of antidepressant medications: tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs) and second-generation heterocyclic antidepressants. Despite the availability of effective antidepressant medications, psychotherapy continues to play an important role in the treatment of depressive disorders. Cognitive-behavioural therapy (CBT) is a structured short-term treatment that focuses on modifying depressogenic thoughts and beliefs, solving current problems and increasing the frequency of productive and pleasurable activities. Interpersonal psychotherapy (IPT) focuses on solving interpersonal problems as a way to overcome depression. Numerous controlled and uncontrolled studies have found certain types of exercise to effectively reduce depression. There is evidence that a variety of pharmacological agents, especially in the SSRI class of antidepressants, can safely relieve depression in patients with CHD.
  • 6 - Depression and physical disability
    pp 125-144
  • View abstract

    Summary

    This chapter describes the link between depression and physical disability. This link is a process whereby depressive symptoms and physical dysfunctions interact to cause a progressive downward spiral in health status. Many cross-sectional studies conducted among older and younger samples and in community-dwelling, clinical and institutionalised samples have demonstrated that physical disability is associated with increased depressive symptoms. Several prospective studies have found that physical disability is a risk factor for the development of depression. Several longitudinal studies have found evidence for a detrimental effect of depression on physical disability over time. Certain behavioural risk profiles in depressed people may explain their higher risk for adverse health consequences. Increased smoking and alcohol consumption are well-documented in depression. Depressed people differ from their non-depressed peers in various psychosocial factors. The majority of intervention studies conducted in the area of depression involve pharmacotherapy in order to examine effects on depressed mood.
  • 7 - Chronic pain and depression: twin burdens of adaptation
    pp 145-164
  • View abstract

    Summary

    The gate-control theory posited three dimensions of pain: a sensory-physiologic dimension, a motivational-affective dimension and a cognitive-evaluative dimension. A number of psychosocial models of the pain-depression relationship followed in the footsteps of gate-control theory and further emphasised the importance of psychological processes in the experience of chronic pain. The first proposed pathway for the relationship between depression and chronic pain is that depression is responsible for the onset or maintenance of pain in individuals who suffer from both sets of symptoms. The consequence hypothesis views depression as secondary to chronic pain. The relationship between chronic pain and depression has often been explained within a cognitive-behavioural framework. Antidepressant medications are used widely in chronic and neuropathic pain conditions for their antinociceptive effects. The mounting evidence for the implication of multiple systems in the experience of and recovery from depression and pain provides a wide array of intervention possibilities.
  • 8 - The interrelationship of depression and diabetes
    pp 165-194
    • By Dominique L. Musselman, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA, Angela Bowling, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA, Natalie Gilles, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA, Hannah Larsen, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA, Ephi Betan, Georgia School of Professional Psychology, Atlanta, GA, USA, Lawrence S. Phillips, Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
  • View abstract

    Summary

    The World Health Organization (WHO) highlights that approximately 150 million people worldwide have diabetes mellitus. This chapter reviews the pathophysiological alterations related to glucose intolerance in depressed patients and the beneficial effects of depression treatment upon glycaemic control. Antidepressant agents have been recognised to affect glucose concentration. Understanding the bidirectional relationship between depression and diabetes, including the sociocultural, biological and psychological pathways of influence, is ultimately critical to the treatment and prevention of diabetes. Education, functional impact of diabetes and financial stress may contribute the most to depression and anxiety in patients with diabetes early in their disease. Gender differences also exist, which may interact with socioeconomic factors. Psychological distress often can be reduced through the use of cognitive-behavioural therapy (CBT). Effective treatment of depression in patients with type 1 or type 2 diabetes may normalise neuroendocrine and immuno-inflammatory hyperactivation, facilitate adherence to diet and exercise, and improve glycaemic control.
  • 9 - Depression and chronic fatigue
    pp 195-210
    • By Peter D. White, Department of Psychological Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, London, UK
  • View abstract

    Summary

    This chapter reviews fatigue as a symptom, and explains some of its syndromes which include chronic fatigue syndrome and vital exhaustion. Prolonged or chronic fatigue is significantly less common than the symptom of fatigue, and there has been uncertainty about the existence of a chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME). Many studies demonstrate the close association between mood disorders, especially depressive illness, and CFS. Vital exhaustion comprises unusual fatigue, loss of energy, increased irritability and feelings of demoralisation. Apart from the stronger evidence for the importance of infections in the aetiology of fatigue more than depression, there are important pathophysiological differences as well. The hypothalamic-pituitary-adrenal (HPA) axis is down-regulated in CFS and up-regulated in melancholic depressive illness. CBT and graded exercise therapy are useful treatments of both mood disorders and CFS. The syndromes of fatigue and depression share symptoms, which leads to easy misdiagnosis and inflated comorbidity.
  • 10 - Cancer and depression
    pp 211-237
    • By Alice E. Simon, Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London, UK, Steven C. Palmer, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadephia, PA, USA, James C. Coyne, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadephia, PA, USA
  • View abstract

    Summary

    Recent advances in the detection and treatment of cancer have led to longer survival times. This chapter discusses the prevalence of depression among cancer patients, the identification and treatment of depression among cancer patients and the relationship between depression and cancer incidence, progression and survival. It proposes that the prevalence of depression in patients with cancer has been overestimated, although the diagnosis and treatment of cancer are associated with depression for some people. The chapter argues that the greatest challenge in the management of depression in cancer patients is ensuring the adequacy of the delivery of treatment within the confines of these competing demands, rather than the lack of efficacious treatments. Finally, available data suggest a lack of support for speculations that depression causes cancer or directly accelerates its progression, but depression remains an additional disease burden and threat to quality of life.
  • 11 - Depression and obesity
    pp 238-262
    • By Lucy Cooke, Health Behaviour Unit Department of Epidemiology and Public Health, University College London, London, UK, Jane Wardle, Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London, UK
  • View abstract

    Summary

    The most common research strategy in the literature is to examine simple associations between obesity and depression. Friedman and Brownell published a seminal review examining the psychological correlates of obesity. This chapter summarizes the findings of earlier reviews and presents a more detailed examination of recent research into associations between obesity and depression in both community-based and clinical samples. It also includes tables covering the principal studies in the field since the publication of Friedman and Brownell's review. The chapter focuses on studies of individuals seeking treatment for obesity, although a parallel literature has investigated weight status in clinically depressed individuals. More recent studies of obese patients have generally confirmed the older literature in finding large excesses of lifetime prevalence of depression and current depression as measured by the Beck Depression Inventory (BDI) or the Brief Symptom Inventory (BSI).
  • 12 - Inflammation, sickness behaviour and depression
    pp 265-279
    • By Robert Dantzer, Integrative Neurobiology, Université Victor Segalen Bordeaux 2, Bordeaux, France, Nathalie Castanon, Integrative Neurobiology, Université Victor Segalen Bordeaux 2, Bordeaux, France, Jacques Lestage, Integrative Neurobiology, Université Victor Segalen Bordeaux 2, Bordeaux, France, Maite Moreau, Integrative Neurobiology, Université Victor Segalen Bordeaux 2, Bordeaux, France, Lucile Capuron, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
  • View abstract

    Summary

    The prevalence of depression in medically ill patients is high, ranging from 5% to 20% versus 3-5% in the general population. This chapter provides an alternative perspective on the intricate relationships that exist between depressive disorders and a large number of chronic medical pathologies. It proposes that alterations in mood occurring in somatic patients reflect the neural consequences of the molecular and cellular events that play a pivotal role in the evolution of the disease. Pro-inflammatory cytokines produced by peripheral innate immune cells play a key role in the development of the local and systemic inflammatory responses. The chapter highlights that when the innate immune system is activated, the brain forms a molecular and cellular image of the peripheral inflammatory response. In motivational terms, fear competes with sickness and, in behavioural terms, fear motivated behaviour takes precedence over sickness behaviour.
  • 13 - The hypothalamic–pituitary–adrenal axis: cortisol, DHEA and mental and behavioural function
    pp 280-298
    • By Ian M. Goodyer, Developmental Psychiatry Section, Department of Psychiatry, Cambridge University, Cambridge, UK
  • View abstract

    Summary

    Steroids are an extensive family of chemical agents distributed widely in the brain. They include the classical stress hormone cortisol, oestradiol, testosterone and progesterone, aldosterone and dehydroepiandrosterone (DHEA). The hypothalamic-pituitary-adrenal (HPA) axis is the neurochemical system through which the release of cortisol is regulated. Prospective studies of human infants can be carried out delineating both the glucocorticoid genetic variation and early rearing environment and examining both the HPA axis stability and behavioural patterns of function. Research has implicated a role for infant exposure to adverse experiences in the formation of HPA axis sensitivity. Animal studies have reported a substantial non-genetic effect of adverse maternal rearing practices on the development of chemical coding systems for behaviour, including HPA axis, hypothalamic and extra-hypothalamic corticotropin-releasing hormone, monoaminergic and gamma-aminobutyric acid (GABA)/benzodiazepine systems. Children, adolescents and young adults with severe conduct disorders have been shown to have remarkably suppressed cortisol levels compared with controls.
  • 14 - Depression and immunity: biological and behavioural mechanisms
    pp 299-320
    • By Michael Irwin, Cousins Center for Psychoneuroimmunology, UCLA Neuropsychiatric Institute, University of California, Los Angeles, Los Angeles, CA, USA
  • View abstract

    Summary

    Depression has a huge impact on individuals and society, with a lifetime prevalence of over 15%. This chapter deals with a research conducted on the relationship between depression and immunity. It overviews the clinical importance of depressive disorders for mortality risk. A hallmark of major depression is dysregulation of the hypothalamic-pituitary adrenal (HPA) axis and the over expression of cortisol. The chapter examines the various immune alterations that occur during depression and discusses the role of autonomic, neuroendocrine and behavioural mechanisms. It discusses the factors that moderate or mediate the effects of depression on natural killer (NK) activity. Changes of NK activity were related to changes in depressive symptom severity. The chapter further considers the clinical implications of immune changes in depression for several medical disorders. In addition to the biological mediators of immune changes in depression, examination of health status and behavioural factors is needed in clinical psychoneuroimmunology.
  • 15 - Smoking and depression
    pp 321-347
    • By Jon D. Kassel, Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA, Benjamin L. Hankin, Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC, USA
  • View abstract

    Summary

    Cigarette smoking remains the most preventable cause of illness and death in society today. This chapter explores the links between smoking behaviour and depressive symptoms. It highlights some of the major findings from the literature and addresses several conceptual and methodological issues that one believes are critical to gain a better understanding of smoking-depression associations. The chapter presents the case that delineating the nature of smoking-depression relationships calls for research that goes beyond simple description of cross-sectional correlational data. It reviews several conceptual models such as predisposition model, consequence model, spectrum model and pathoplasticity model that may lend them to further elucidation of the processes underlying associations between smoking and depression. The chapter also highlights several potentially important moderators of the smoking-depression link. Finally it offers thoughts on future research directions for this important area of inquiry.
  • 16 - Depression and physical activity
    pp 348-368
    • By Andrew Steptoe, Department of Epidemiology and Public Health, University College London, London, UK
  • View abstract

    Summary

    The psychological benefits of physical activity have been trumpeted for many years by enthusiasts. This chapter discusses the evidence linking physical activity, depression and medical problems. It discusses the associations between physical activity, depression and depressed mood in clinical and population studies. The chapter evaluates the impact of changes in depression and physical activity. Such changes can be evaluated in two ways: assessing the effects of treating depression on physical activity levels, and assessing the influence of physical training interventions on depression. It suggests that understanding of the potential role of exercise training in the management of depressed mood in medical patients requires an evaluation of converging evidence from different types of study: population and clinical observational studies, randomised trials and experimental studies. The chapter describes three methodologically sound studies to illustrate the impact of increasing physical activity on depressive symptoms.
  • 17 - Depression and adherence to medical advice
    pp 369-394
    • By Douglas A. Raynor, Department of Psychology, State University of New York, Geneseo, NY, USA, Rena R. Wing, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA, Suzanne Phelan, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA
  • View abstract

    Summary

    Depression has emerged as one of the few promising predictors of treatment adherence among medical patients. This chapter discusses the research evaluating the relationship between depression and adherence to medical regimens. It considers methodological issues in the assessment of adherence and depression. The chapter reviews the empirical studies that have examined whether depressed individuals have poorer treatment adherence. Several studies have addressed adherence in patients infected with human immunodeficiency virus (HIV). The chapter focuses on the relationship between depression and adherence and identifies key studies that address the question of whether adherence mediates the relationship between depression and health outcome. There are two predominant approaches to measuring depression: interview and self-report. Research on depression and adherence is increasing rapidly. It is important that future research on this topic be designed with greater methodological sophistication.
  • 18 - Integrating clinical with biobehavioural studies of depression and physical illness
    pp 397-408
    • By Andrew Steptoe, Department of Epidemiology and Public Health, University College London, London, UK
  • View abstract

    Summary

    This conclusion presents an overview of concepts covered in the preceding chapters of this book. The book integrates clinical with biobehavioral studies of depression and physical illness. It addresses the relationship between depression and specific conditions, including coronary heart disease (CHD), diabetes, cancer, chronic pain and obesity. The research detailed in the book makes it clear that the relationships between depression and physical illness are complex. The relationships between depression, illness and biological and behavioural processes are best represented as a system rather than in simple causal chains. Numerous methodological issues have been discussed in the book that is significant in particular fields of clinical and basic research. A central reason for studying depression in medical illness is to discover methods of improving patient care. One of the hopes of behavioural and psychosomatic medicine has been that psychological or lifestyle interventions influences physical disease processes and prolong life.

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