According to Mental Health America, depression affects more than 19 million Americans every year (1). Around the clock access to compassionate, competent CCM coordinators is an essential benefit for patients who suffer from depression. Symptoms of clinical depression can be triggered by other chronic illnesses common later in life, such as Alzheimer’s disease, Parkinson’s disease, heart disease, cancer and arthritis (1), all of which fall under the two or more chronic conditions required for Chronic Care Management. CCM coordinators should assess for signs and symptoms of depression thoroughly and intervene with education pertaining to chronic illnesses and mental health care resources.
Recognizing Signs and Symptoms of Depression
Depression symptoms vary, which is why it is imperative that Chronic Care Management coordinators recognize changes in a patient’s usual daily activity and interest level. In addition to routine telephonic communication, a Chronic Care Management patient should complete a depression screening to help monitor and measure the severity of depression. A PHQ-9 assessment is brief and useful to reflect the following occurrences:
- Feelings of sadness, tearfulness, emptiness or hopelessness
- Loss of interest or pleasure in most or all normal activities
- Tiredness and lack of energy
- Changes in appetite
- Anxiety, agitation or restlessness
- Feelings of worthlessness or guilt
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Trouble thinking, concentrating, making decisions and remembering things
- Slowed thinking, speaking or body movements
Chronic Care Management should be assisted with initiating goals to reduce depression symptoms such as, but not limited to, implementing healthy sleeping habits, following a daily routine, and/or improving nutrition management.
Depression Triggered by Chronic Illnesses
Chronic illnesses can affect activities of daily living which can lead to a loss of independence in Chronic Care Management patients. Coordinators should promote chronic illness education with online tutorials, local educational classes, and consistent communication of home care and lifestyle modifications. CCM recipients should be assisted with recognizing their current habits and developing alternative ways (e.g. implementing medication management systems and setting goals) to improve their wellbeing. Research on chronic illnesses and depression indicates that depression rates are high among patients with chronic conditions:
- Heart attack: 40%-65% experience depression
- Coronary artery disease (without heart attack): 18%-20% experience depression
- Parkinson’s disease: 40% experience depression
- Multiple sclerosis: 40% experience depression
- Stroke: 10%-27% experience depression
- Cancer: 25% experience depression
- Diabetes: 25% experience depression
- Chronic pain syndrome: 30%-54% experience depression(2)
Chronic Care Management enrollees should be more involved in their care and have less experiences of depression, as a result of increased treatment plan compliance and medication adherence.
Resources for Mental Health Assistance
With only forty-two percent seeking help from a health professional (1), mental health providers and support groups should be located, under provider instructions, for Chronic Care Management patients. In a survey completed by Mental Health America, thirty-eight percent of adults aged 65 and over believe that depression is a “health” problem (1). If suffering from depression, older adults are more likely than any other group to “handle it themselves (1).” Mental health benefits for Chronic Care Management patients with depression should be confirmed so that eligible resources are used as steps towards patient independence and mood improvement. Coordinators should encourage CCM patients to express their feelings and concerns with family members, caregivers, and providers. Caregivers and family members will also benefit from learning alternative methods/strategies for caring and supporting Chronic Care Management patients living with depression. Depression symptoms and resources for depression may reflect some of the following:
- Isolation, refer to social/group activity
- Change in eating habits, implement balanced meal options
- Feeling of guilt, schedule an appointment with a mental health provider
- No interest in daily activity, set a daily routine with activities of interest
- Low energy, initiate exercise regularly
Depression intervention and education provided by Chronic Care Management coordinators should improve comprehensive patient care and morale.
- Mental Health America. Mental Health America. [Online] 2016. [Cited: October 12, 2016.] http://www.mentalhealthamerica.net/conditions/depression-older-adults-more-facts.
- WebMD. WebMD. [Online] 2005-2016. [Cited: October 12, 2016.] http://www.webmd.com/depression/guide/chronic-illnesses-depression#1.