Double Trouble: Does Co-Morbid Chronic Somatic Illness Increase Risk for Recurrence in Depression? A Systematic Review

Abstract

ObjectiveTo perform a systematic review, and if possible a meta-analysis, to establish whether depressed patients with co-morbid chronic somatic illnesses are a high risk “double trouble” group for depressive recurrence.MethodThe databases PubMed, EMbase and PsycINFO were systematically searched until the 4th of December 2012 by using MeSH and free text terms. Additionally, reference lists of retrieved publications and treatment guidelines were reviewed, and experts were consulted. Inclusion criteria were: depression had to be measured at least twice during the study with qualified instruments and the chronic somatic illness had to be assessed by self-report or by a medical professional. Information on depressive recurrence was extracted and additionally risk ratios of recurrence were calculated.ResultsThe search generated four articles that fulfilled our inclusion criteria. These studies showed no differences in recurrence over one- two- three- and 6.5 years of follow-up for a total of 2010 depressed patients of which 694 patients with a co-morbid chronic somatic illness versus 1316 patients without (Study 1: RR = 0.49, 95% CI, 0.17–1.41 at one year follow-up and RR = 1.37, 95% CI, 0.78–2.41 at two year follow-up; Study 2: RR = 0.94, 95% CI, 0.65–1.36 at two year follow-up; Study 3: RR = 1.15, 95% CI, 0.40–3.27 at one year follow-up; RR = 1.07, 95% CI, 0.48–2.42 at two year follow-up and RR = 0.99, 95% CI,0.55–1.77 at 6.5 years follow-up; Study 4: RR = 1.16, 95% CI, 0.86–1.57 at three year follow-up).ConclusionWe found no association between a heightened risk for depressive recurrence and co-morbid chronic somatic illnesses. There is a need for more longitudinal studies to justify the current specific treatment advice such as long-term pharmacological maintenance treatment for this presumed “double trouble” group.

Effect of chronic somatic diseases on the course of late‐life depression

“…In that study, investigation of a younger adult population (aged 18-65 years) showed that musculoskeletal diseases and diabetes had a negative impact on the course of depression at 2-year followup; however, there was no impact of overall somatic disease burden on the course of depression (Gerrits et al, 2013). In contrast to our findings, a recent review found no higher risk for recurrence of depression in the presence of somatic comorbidity (Kok et al, 2013). However, the results of that review should be interpreted with caution as only a few studies were included because most of them examined recurrence of depression in a somatically ill population only.…”

A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence

“…That is, the very process of going through an episode of depression produces a change in underlying causal factors that increase the risk of having future episodes. Possible causal mechanisms underlying the scarring hypothesis have been described for biological factors, such as genetics (Lok et al, 2013), the HPA axis (Lok et al, 2012), cognitive factors (implicit and explicit cognitive factors, Elgersma, Glashouwer, Bockting, Penninx, & de Jong, 2013) and stress-related factors (Beshai, Dobson, Bockting, & Quigley, 2011;Kok et al, 2013;Lok et al, 2013;Teasdale et al, 2000). This area is ripe for more rigorous tests.…”

Polypharmacy and Depressive Symptoms in U.S.-Born Mexican American Older Adults

“…Physical health, particularly self-rated health (SRH), chronic medical conditions (CMC), and activities of daily living (ADL), are associated with polypharmacy and depression [19][20][21]. Polypharmacy is also a consequence of being diagnosed with multiple conditions [6,7,10,18].…”

“…This means that these health indicators are strong determinants and correlates of polypharmacy [6,7,10,18]. Poor physical health (CMC, SRH, and ADL) and depressive symptomatology also have bidirectional associations [19][20][21]. As a result, there is a need to control for physical health (e.g., CMC, SRH, and ADL) in the studies that wish to understand the association between polypharmacy and depressive symptoms [6,7,10,18].…”