The Role of Depression in Chronic Disease Management: An Analysis of the U.S. Behavioral Risk Factor Surveillance System

Introduction: Depression is a major comorbidity among people with chronic diseases such as diabetes, hypertension, and asthma. The relationship between depression and chronic disease management is complex and not well understood. The objective of our study was to assess the role of depression in effective chronic disease management. Methods: The study used data from 491,773 respondents participating in the 2013 Behavioral Risk Factor Surveillance System. Chronic conditions were compared for adults with vs. without a self-reported medical history of depression. The odds of reporting no past year physician-led preventive care (physician follow-up, annual eye exam, A1c checks, and foot exam) and no past year patient self-care practices (medication adherence, blood glucose monitoring and watching or reducing salt intake) among those with depression were calculated. A multivariate logistic regression model was used to account for interaction and confounding effects, and adjusted odds ratios were reported. Results: A significantly higher proportion of those with vs. without depression had diabetes (15.1% vs. 9.2%; p=<0.0001), hypertension (41.8% vs. 30.5%; p=<0.0001), asthma (24.3% vs. 11.9%; p=<0.0001), and chronic obstructive pulmonary disease (14.3% vs. 4.7%; p=<0.0001). Using a multivariate adjusted model, we found adults with diabetes had twice the odds of not having their feet checked by a professional in the past year if they had depression, especially if they were under 44 years of age (OR = 2.0, 95% CI, 1.41, 2.85). Conclusion: Adults with depression have a higher prevalence of chronic disease, but are less likely to report physicianled preventive care practices. Screening and effectively managing depression in primary care can improve patient outcomes among those populations and enhanced collaboration with behavioral health care professionals may be needed to improve patients' quality of life and reduce chronic disease management costs.