Psychosocial Impact of Depression in Chronic Illness

Question: Discuss about the Psychosocial Impact of Depression in Chronic Illness. Answer: Introduction: In this article, Nabi et al., (2011) described a research study, which aimed to examine the trajectories of depressive episodes, and the hypertension probabilities that are associated with the trajectories over a period. The authors used a longitudinal study data taken from the Whitehall II study to examine the socioeconomic gradient among the civil servants. The authors gathered data regarding the prevalence of depressive episodes, trajectory group and risk of hypertension among the 35-55-year-old civil servants in 20 London based departments through questionnaire and clinical examination. The key findings of the study are that the risk of hypertension increases with age more rapidly among the participants who experienced more episodes of depression as compared to the low level of episodes of depression. This study suggests that the psychological distress has an impact on the physiological effects. Depression is manifested as a complication due to the prevalence of chronic diseases having a cause and effect relationship that limits the mobility and independence. The main limitation of the research was that the respondents who did not include the unemployed and blue-collar workers which limited the general population representation. The depressive symptoms associated with hypertension included the cognitive manifestations. In the article, Nahon et al., (2010) describe a research to study the psychological and socioeconomic factors that have an impact on the inflammatory bowel disease (IBD) regarding the risk factors adhered to the treatment. The aim of the authors was to analyse the characteristics of IBD associated with depression and anxiety. The authors conducted a two-step online survey on Association Francois Aupetit, the French IBD patients association through questionnaire from December 2008 to June 2009. In the second step, 4000 patients were provided with the questionnaire including the goals of the study mentioned in the survey. The results showed that among all the participants, 181 patients were highly depressed and 689 patients were anxious associated with the severity, flares and non-adherence to treatment. This large cohort study shows that there is a high prevalence of depression and anxiety among the IBD patients. There is social exclusion among the people who are suffering from chroni c diseases as it affects their quality of life. The limitation of the research is that the study is conducted in a selected population of the patients who belong to the IBD French association. Therefore, the results obtained cannot be generalized to the completely French population of IBD patients. In the article, Pouwer et al., (2011) describe a study to show the co morbid depression prevailing in the patients with chronic illness like type 1 and type 2 diabetes. Also, the research also studied the effectiveness of web-based cognitive behavioural therapy for the patients with depression and emotional distress. A randomized, controlled trial was conducted in Netherland among 255 adult diabetic patients who had elevated symptoms of depression. The primary outcomes of the research were the symptoms of depression and the emotional distress was the secondary outcomes associated with diabetes and glycemic control. The results showed that depression and emotional distress prevails among the patients with type 1 and 2 diabetes. The results also depicted that there were clinical improvement and reduction of anxiety and emotional distress after the one month follow up of CBT. The rigors to diabetic management are stressful and affect their daily activities leading to depression and poor quality of life. The limitations of the study are that the web based CBT intervention is not accessible for the elderly population and the one-month follow-up was small to access the effectiveness of the intervention. The results of the above studies show that there is a prevalence of depression, anxiety and emotional distress among the patients suffering from chronic illness. The chronic diseases like inflammatory bowel diseases, diabetes and hypertension have a detrimental effect on the patients life. It hampers the quality of life of the patients living with the disease and poses a risk for psychosocial distress. Apart from affecting the body systems, these chronic diseases intensify pain and isolate the people suffering from chronic illness. All these factors shape the experiences of the patients suffering from chronic diseases and enable the nurses to engage in the assessment and in providing holistic approaches to nursing practice. The psychological interventions like cognitive behavioral therapy are effective in reducing the patient associated depression and emotional distress related to the chronic diseases. The implications for nursing practice involve the screening of the anxiety and depression, providing psychosocial support, self-management interventions and by providing appropriate professional support. It is important to improve the recognition rates that are imperative for the nurses in providing the appropriate psychosocial support to the patients with chronic illness. The holistic nursing practices include the prompt diagnosis of the level of depression and understanding and knowledge of the basic aspects of the problem. There is also a requirement of non-pharmacological techniques that helps the patient to cope up with anxiety and make the patient reciprocate. In nursing practice, there is also a requirement of interventions that helps the patient to manage anxiety and depression through verbal and non-verbal communication. The coping strategies and interventions adopted by the patients can also be helpful for the patients suffering from chronic disease-related depression and anxiety. Apart from cognitive behavioral therapies, psychosocial interventions (PSI) like educational theories also provide support to the patients suffering from chronic disease-related depression. The holistic nursing practice should inculcate interventions that assume the complex interplay between the environmental, biological and sociological factors and the ambient depression that prevails in the chronic illness. A team-based collaborative approach for the patients with chronic illness where the nurses and the healthcare professionals should provide patient-centered care model that ensures satisfaction, improved functioning and better quality of life. The engagement and assessment of the outcome, familys assessment and support, psychosocial management that includes coping strategy enhancement, training in problem solving and approaches to self-management and techniques like motivational interviewing with medication management are some of the PSIs in nursing practice. References. Nabi, H., Chastang, J. F., Lefvre, T., Dugravot, A., Melchior, M., Marmot, M. G., Singh-Manoux, A. (2011). Trajectories of depressive episodes and hypertension over 24 years. Hypertension, 57(4), 710-716. Nahon, S., Lahmek, P., Durance, C., Olympie, A., Lesgourgues, B., Colombel, J. F., Gendre, J. P. (2012). Risk Factors of Anxiety and Depression in Inflammatory Bowel Disease. Inflamm Bowel Dis, 18(11), 2086-2091. Pouwer, F., Cuijpers, P., Riper, H., Snoek, F. J. (2011). Web-Based Depression Treatment for Type 1 and Type 2 Diabetic Patients. Diabetes Care, 34, 320-325.