Psychologists’ Role in Treating Chronically Ill Persons

• Chronic illnesses are health conditions that either have symptoms on a constant basis or flare up episodically, such as:  diabetes, heart disease, pulmonary problems, hypertension, mental disorders, stroke, cancer and obesity (Bedroussian, 2007).

• In the U.S., there are 162 million people who have one or more chronic conditions ---- that is more than  one in three Americans (Bedroussian, 2007).

• Eighty percent (80%) of older adults have at least one chronic condition, and 50% have at least two (Center for Disease Control (CDC), 2009).

• Chronic illness is currently the main cause of both death and disability nationwide. Heart disease, cancer and stroke account for more than 50% of all deaths each year (CDC, 2009).

• Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early death related to chronic diseases (CDC, 2009).
  

• Chronic diseases are among the most prevalent, costly and preventable of all health problems (CDC, 2009).

• In 2003 the combined economic cost of treatment and lost productivity related to chronic health was $1.3 trillion dollars (Bedroussian, 2007). 

• A study by The Milken Institute concluded that life-style changes such as reducing obesity and smoking, disease prevention, and early detection of disease could reduce the number of illnesses by 40 million cases and save $1.6 trillion from 2003 to 2023 (Bedroussian, 2007).

• The cost of medical treatment for patients with chronic illnesses (e.g. heart conditions, high blood pressure, diabetes) is significant and the cost increases when a mental health problem is also present, as referenced by the chart below (MEPS, 2003):

Chronic illness is a pervasive, often distressing condition that may cause significant psychological changes, which may impact one’s psychological adjustment.  According to a report by the Institute of Medicine (2008), people with a chronic illness need help to learn how to:

• Cope with the intense, sometimes debilitating, emotions related to their illness.

• Change behaviors in order to minimize the impact of their disease and maximize treatment protocol.

• Manage the disruptions their illness may cause to their work, school, and family life.

• Psychologists provide important psychosocial and behavioral health services to patients.

  • A recent report from the Institute of Medicine (2008) defines psychosocial health services as psychological and social services and interventions that enable patients, their families, and health care providers to optimize biomedical health care and to manage the psychological, behavioral, and social aspects of illness and its consequences so as to promote better health.

• Psychologists have many different roles in the management, treatment and study of chronic illness (Stanton et al, 2007).  These include:

  • Health Service Provider: Psychologists provide mental and behavioral health services to chronically ill patients (e.g., psychological assessment, intervention, and consultation) 
     
    Teacher: Psychologists provide education and training regarding the psychosocial influences of chronic illness on health, which helps patients develop better self-care and self-management skills to decrease the impact of disease and prevent future health complications.

  • Researcher: Psychologists conduct research and participate in studies on chronic illness that advance knowledge in the area of prevention, treatment, and rehabilitation, which is essential to patients’ successful management of their illness 

Alliance for Health Reform. Issue brief. (June 2001).  America's Most Ignored Health Problem: Caring for the Chronically Ill. Washington, DC.

Bedroussian, A., DeVol, R. An Unhealthy America: The Economic Burden of Chronic Disease Charting a New Course to Save Lives and Increase Productivity and Economic Growth. Milken Institute. October 2007

Belar, C.D., & Geisser, M.E; Nicassio, P. M. (Ed); Smith, T. W. (Ed). Managing chronic illness: A biopsychosocial perspective (pp. 33-57). Washington, DC, US: American Psychological Association (1995)

Center for Disease Control. Healthy Aging: Improving and Extending Quality of Life Among Older Americans. At A Glance. (2009). National Center for Chronic Disease Prevention and Health Promotion.

Chronic Disease Prevention and Promotion. Center for Disease Control. Retrieved on February 4, 2009 from: http://www.cdc.gov/nccdphp/

Institute of Medicine. (2008). Adler, N.E. & Page, E.K. (Eds). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: The National Academies Press.

Medical Expenditure Panel Survey (MEPS) Agency for Healthcare Research and Quality, Rockville, MD. 2003

Stanton, A. L., Revenson, T. A. &Tennen, H. Health Psychology: Psychological Adjustment to Chronic Disease. Annual Review of Psychology, Vol. 58, January 2007.