The link between chronic illness and depression is complex. Many long-term illnesses can increase the risk for developing mental health difficulties, but the reverse is also true: people with depression are more likely to develop certain physical chronic illnesses.

It is normal to feel intense emotions in challenging situations. People who receive a diagnosis of a chronic illness may feel sadness, anger, or even grief. These feelings may come and go over time, and do not necessarily mean a person has depression.

However, if someone feels numb, worthless, or struggles to enjoy activities they once found pleasurable over a period of 2 weeks or more, this could be a sign of depression.

In this article, we will look at the connection between depression and chronic illnesses, including statistics, the factors that contribute to both, and ways people can cope.

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Chronic illnesses are mental or physical health conditions that last longer than 1 year and require ongoing medical attention, limiting of daily activities, or both.

An estimated 48 million Americans are living with various chronic diseases. Some common examples include:

  • migraine
  • arthritis
  • diabetes
  • cardiovascular disease
  • autoimmune diseases

Depression is also a chronic illness. It causes persistent feelings of sadness, apathy, or hopelessness, and prevents someone from finding pleasure in activities they once enjoyed. Depression can also cause physical symptoms, such as fatigue, appetite changes, and sleeping too much or not enough.

Depression and physical illnesses both impact each other. The relationship between the two is bidirectional, which means that a person’s physical health can influence their mental health, and vice versa. Researchers are still learning about how this relationship works.

In 2017, over 19 million Americans had at least one major depressive episode in the previous year. The prevalence of depression in those with chronic illness varies by condition. In the United States, depression affects:

Receiving a diagnosis of a chronic condition, and managing the condition long-term, can involve major life changes. Depending on the circumstances, a chronic illness may alter a person’s daily routines, their ability to work, their personal relationships, their plans for the future, or how they see themselves.

Depending on the condition, a chronic illness can also impact someone’s ability to engage in activities that previously benefitted their mental health, such as exercise, socializing, hobbies, or sex. Any of these changes can be emotionally challenging, and as with any major life event, they may contribute to symptoms of depression.

For some, these symptoms may decrease over time as someone adapts to their illness. In others, they may not. Living with both depression and a chronic illness can make it harder to adapt to change, to manage each condition, and may make symptoms worse. However, by treating depression, these things can get easier.

The reasons why some develop depression while others do not are not entirely clear. Some of the potential psychological risk factors include:

  • the level of stress or anxiety someone feels about their condition
  • feeling lonely or isolated
  • having a family history of depression

The experience of developing or receiving treatment for a chronic illness can also be traumatic. A traumatic event can include any situation that causes severe stress. Some symptoms of depression, like low mood and loss of interest in things someone once enjoyed, are also symptoms of post-traumatic stress.

Learn more about psychological trauma.

In addition to their impact on mental health, chronic illnesses may also contribute to depression due to their impact on how the body works. For example, illnesses that affect hormones, neurotransmitters, or brain function can cause depression as a symptom.

Some medications that are useful for treating physical illnesses can also affect a person’s mood. Some common examples include corticosteroids, beta-blockers, and stimulants.

However, the reverse may also be true. Evidence suggests that depression causes physiological changes that may make physical illness more likely. An older 2012 study notes that depression can:

  • lower heart rate variability
  • raise cortisol levels
  • affect metabolism
  • affect the hypothalamic-pituitary-adrenal axis, which is involved in the body’s stress response

Any of these changes could potentially contribute to a physical illness.

A person’s social, cultural, and economic circumstances have a significant influence on their health, as does their environment. This can affect chronic illness in a number of ways.

Economic cost

People with any ongoing mental or physical condition can face several financial challenges, including:

  • the expense of medical appointments, prescriptions, or procedures
  • lower personal income if someone has to spend more time away from work
  • lower household income if family members take time away from work to care for a sick relative

This disproportionately affects the people who are most likely to have chronic conditions, who are least likely to be able to access or afford healthcare, or both.

Learn more about health inequity.

Accessibility

Attending medical appointments can be physically difficult for people with chronic illnesses, particularly if they have fatigue, pain, or need help getting around. For some, this may add to the stress of managing the condition, which may impact mental health.

Conversely, if someone has depression, they may struggle to keep up with appointments, or to seek help when they have symptoms. This may mean doctors do not detect the early signs of another condition before it becomes chronic.

Difficulty with self-care

Having a physical or mental health condition can make caring for oneself more difficult. Depending on the circumstances, a person may forget to take medications, have a harder time cooking or eating balanced meals, or staying active. This may raise the likelihood of developing another illness.

Depression is a common condition, but it is important to know that it does not have to be part of living with a physical illness. Depression is treatable, and with support for a person’s physical and mental well-being, they may be able to gain better quality of life, and find ways to participate in the things they enjoy.

If possible, a person may want to consider:

  • Mental health treatment: A therapist with experience treating clients with chronic illnesses can give someone a safe space to talk about how they feel. They can also help someone learn how to manage their emotions, which in some cases, could have a positive impact on physical symptoms. To reduce the symptoms of depression, a doctor may also prescribe antidepressants.
  • Occupational therapy: An occupational therapist is someone who helps people with health conditions adapt their routines and surroundings to their needs. This may involve strategies for managing daily tasks, advice on mobility aids, or advice on workplace adaptations.
  • Support groups: Online or in-person support groups can help people feel they are not alone. They can also be a good way to learn from others who have been through similar experiences.

If a person is experiencing severe depression, or thoughts of death or suicide, they should contact a medical professional as soon as possible.

Chronic illness and depression have a bidirectional relationship. People with chronic illness often experience mental health difficulties, such as depression. But depression also appears to make physical illness more likely.

The reasons for this are complex, and involve a combination of biological, psychological, and socio-environmental factors. However, while some health conditions are long-term, depression does not have to be. Effective treatment and support for chronic conditions is available.