Impact of major depression on chronic medical illness.

The study by Walker et al. 111 emphasizes the profound impact that current depressive and anxiety disorders may have in patients with chronic medical illness. Walker et al. found that patients with inflammatory bowel disease (IBD) and current DSM-III-R depressive and anxiety disorders, compared with patients with IBD without current psychiatric illness, suffered from significantly more gastrointestinal symptoms, nongastrointestinal medically unexplained symptoms such as headache or dizziness, and perceived themselves as significantly more disabled by their emotional symptoms, controlling for severity of inflammatory bowel disease. This editorial will initially review the expanding research database that has shown that patients with acute medical illness have a high incidence rate of major depression and patients with chronic medical illness have a high prevalence rate of comorbid major depression. Evidence will also be reviewed which shows that patients with comorbid affective disorder and chronic medical illness have 1) increased ambulatory visits and medical costs; 2) increased functional impairment and decreased quality of life; 3) increased somatic symptoms and problems habituating to chronic aversive symptoms of medical illness; 4) more problems following self-care regimens (such as adherence to medications, diet, and quitting smoking); and 5) increased rates of mortality.