CHÉOS Scientist, Dr. Joseph Puyat, wanted to understand the association between chronic health conditions and depression care, a question which is not clearly answered in the existing literature.

Dr. Joseph Puyat

The prevalence of depression is relatively high in the general population, around 1 in 20, but it is much more common in people with chronic health conditions, as high as 1 in 5. In these cases, depression can be a result of the associated stresses and changes due to a chronic health condition. Conversely, the physiological and behavioural changes that can result from depression may increase a person’s chances of developing a chronic health condition. Whatever the cause of the co-occurrence, this combination can have serious consequences for health and quality of life.

“The existing literature is quite mixed,” said Dr. Puyat. “Some researchers have found that chronic health conditions do impact depression care, maybe because physicians might prioritize the management of a health condition over depression.”

To approach his question, Dr. Puyat used provincial administrative data from B.C. to look at people who received a diagnosis of depression in 2012. Specifically, data for general doctor visits, visits specifically for mental health, counselling/psychotherapy sessions, and antidepressant therapy use were compiled. Diabetes, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, asthma, cerebrovascular disease (CVD), and ischemic heart disease were chosen as the chronic health conditions in question.

The research team, which included CHÉOS’ Dr. Hubert Wong, had some unanticipated findings. The results showed that people with chronic health conditions received higher levels of mental health care for all the variables included in the study except antidepressant therapy and GP mental health visits, compared to people with depression alone.

“The results are more reassuring than worrying,” noted Dr. Puyat. “The quantity of services accessed by people with chronic conditions in B.C. is just as good as those with depression alone.”

“The lower use of antidepressants by people with depression and chronic conditions may be because clinical guidelines are not so clear on how to handle these patients,” said Dr. Puyat. “On the other hand, people with some chronic conditions, like CVD, are not prescribed antidepressants as often due to known adverse reactions to these medications.”

In keeping with this logic, the results of the study show a trend towards lower use of all depression-related health care among people with CVD. Unexpectedly, people with both diabetes and depression were less likely to visit their GP for mental health concerns.

“In general, the results suggest that we can stop worrying about whether people with depression and chronic health conditions are accessing mental health services,” said Dr. Puyat. “However, there are some specific conditions where the use of these services may be outside the norm and that could be looked at more closely.”

This paper, published in Psychiatric Services, is the final project from Dr. Puyat’s PhD dissertation. His previous work focused on the gap in treating mental illness and the impact of B.C.’s physician incentive program.

Puyat JH, Kazanjian A, Wong H, Goldner E. Comorbid chronic general health conditions and depression care: A population-based analysis. Psychiatric Services. 2017 May 1 epub ahead of print. doi:10.1176/