The association of depression and anxiety with medical symptom burden in patients with chronic medical illness
Abstract
Background Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses.Methods MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes.Results Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures.Conclusions Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.
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In patients with chronic medical conditions, behavioural health issues are even more common and costly.
“In the subset of patients with chronic medical conditions, behavioural health issues are even more common and costly.6–8”
Only a minority of people with major depressive disorder receive treatment.
“Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.”
From The Costs of Depression (2012) · cites this paper as [134]
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- Authors
- Katon, W., Lin, E. H. B., & Kroenke, K.
- Affiliations
- University of Washington (US)
- Group Health Cooperative (US)
- Indiana University (US)
- Corresponding author
- Katon, Wayne
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2007-03
- Volume
- 29
- Issue
- 2
- Pages
- 147-155
- ISSN
- 0163-8343 (ISSN-L)
- OpenAlex
- W2024439382
- Cited by
- 965
- References
- 89
- Citations by year
- 2026: 31 · 2025: 31 · 2024: 33 · 2023: 43 · 2022: 56 · 2021: 50 · 2020: 47 · 2019: 49 · 2018: 68 · 2017: 53 · 2016: 55 · 2015: 62 · 2014: 70 · 2013: 55 · 2012: 53
- FWCI
- 7.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (K08MH069741, MH 071268, R01MH071268, MH069741, MH-067587, R01MH067587)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, anxiety, chronic disease, somatic symptom burden, comorbidities, diabetes mellitus, coronary artery disease, congestive heart failure, asthma, chronic obstructive pulmonary disease, osteoarthritis, rheumatoid arthritis, primary care patients
- MeSH terms
- Adult, Anxiety, Chronic Disease, Depression, Female, Health Status, Humans, Male, Surveys and Questionnaires, Comorbidity, Cost of Illness
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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