Psychologists’ Role in Treating Persons with a Chronical Illness

• 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).
• Eighty percent (80 percent) of older adults have at least one chronic condition and 50 percent have at least two (Center for Disease Control, 2009).
• Chronic illness is currently the cause of 7 out of 10 deaths nationwide each year. Heart disease, cancer and stroke account for more than 50 percent of all deaths each year (CDC, 2009).
• Depression is one of the most common complications of chronic illness. It is estimated that up to one-third of individuals with a serious medical condition experience symptoms of depression. In fact, the rate of depression among individuals who have suffered from a heart attack is between 40 percent and 65 percent (Cleveland Clinic, 2012).
• 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).
• The medical care costs of people with chronic illnesses represents 75 percent of the $2 trillion in U.S. annual health care spending (IOM, 2012).
• 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):

Annual Medical Expenditures for Adults with a Specific Chronic Condition, with and without a Mental Health Condition

	Cost without Mental Health Condition	Cost with Mental Health Condition
Average Adult	$1, 913	$3,545
Adult with Chronic Condition
Heart Condition	$4,697	$6,919
High Blood Pressure	$3,481	$5,492
Diabetes	$4,172	$5,559

Chronic illness is a pervasive, often distressing condition that may cause significant psychological changes and 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, D.C.

• 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., & Smith, T.W. (Eds). 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.

• Center for Disease Control. Chronic Disease Prevention and Promotion. Retrieved on Feb., 4, 2009

• Cleveland Clinic. Chronic Illness and Depression. Retrieved on June 22, 2012

• 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.

• Institute of Medicine. (2012). Living Well with Chronic Illness: A Call for Public Health Action. 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.