Chronic disease – are the stats depressed?
Patients with a chronic condition and chronic depression are more likely to experience a decline in quality of life and have almost twice as many days of restricted activity or missed work because of illness1. The above can be attributed to the fact that depressed patients with chronic illness generally have a lower adherence to prescribed medical treatments2. This not only negatively impacts a patient’s recovery rate, but can worsen the severity of the chronic condition itself which in turn can deepen the depression. It is no surprise then that depression is associated with a 50% to 100% increase in health services use3 thereby worsening the overall burden of cost on the healthcare system.
In August of last year, Mariska van Aswegen, a representative of Pharma Dynamics, released the statement that managing a chronic illness can put you at a 25% to 33% higher risk of developing chronic depression as opposed to the average healthy individual, whose risk is at 10% to 25%.
To establish the relationship between patients with chronic illness and patients with chronic depression from a claim perspective, our data gurus looked at the claim data of over 245 000 patients that were being treated for one of the three most common forms of chronic illness namely: Hyperlipidaemia, Diabetes Mellitus and Hypertension. Of the data sample, only around 8 800 of the patients (about 4%) had relating claims with ICD-10 codes F32 and F33 for chronic depression.
Why is there a discrepancy in the claim data and published stats?
- The symptoms of chronic illnesses can mask/mimic the symptoms of depression, making it complicated to identify. Similarly, the side effects of some medicines can do the same thing.
- The management of any disease is demanding and may force concerns of depression out of the visit agenda. Alternatively, the patient may not mention symptoms unless prompted to, or may think the depression is a ‘normal’ side effective of chronic illness and try to manage it themselves.
- Patients may be getting treatment and receiving medication for depression but information is missing in the claim, such as the secondary diagnosis codes for the depression.
With chronic illness on the increase in South Africa, chronic depression will become a reality for more and more patients. The real question is: are we ready for this challenge? And does our primary healthcare system have the tools to ensure fast diagnosis and well managed prolonged care?
1. Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994;272: 1741-1748. [PubMed]
2. Boing A F, Melo G, Boing A C, Moretti-Pires R, Peres K, Peres M. Association between depression and chronic diseases: results from a population-based study. Faculdade de Saúde Pública da Universidade de São Paulo 2012: 7. [scielo.br/rsp]
3. Simon G, VonKorff M, Barlow W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry 1995;52: 850-856. [PubMed]