Depression and Comorbid Health Conditions

Comorbid Health Conditions

Not surprisingly, depression shares a bidirectional relationship with other chronic health conditions (Katon, 2011). Depression is associated with behaviors and physiology that increase the likelihood of developing chronic disease, and these factors may also account for depression complicating the management of chronic illnesses. Further, the negative impact to health associated with chronic disease may lead to depression (Katon, 2011). Patients with serious illnesses may experience decreased quality of life, increased physical disability, and increased chance of mortality due to depression. Further, patients with ‘physical’ illness are at an increased risk for depression, especially with the presence of environmental or biological risk factors (Kang et al., 2015). 

Chronic painHeart Disease

Forty percent of people with coronary heart disease also have depression (Dickens, 2015). In the U.S., coronary heart disease is the most frequently identified type of heart disease (Centers for Disease Control and Prevention, 2019). The shared relationship between depression and heart disease has been explained through a variety of pathways, including chronic inflammation, dysfunction in the autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis, as well as platelet and serotonin pathway dysfunction (Sher et al., 2010). In general, patients with heart disease and depression demonstrate poorer adherence to medication, take longer to return to normal levels of activity socially and at work, and have worse quality of life (Nair et al., 2012). Environmental factors also play a role in that limited social support and depression independently predicted poor outcomes for patients with heart disease (Compare et al., 2013). Research that has examined whether depression treatment improves outcomes for patients with heart disease is limited (Carney & Freedland, 2016). While more research is needed, some evidence suggests managing depressive symptoms may improve prognosis and decrease the probability of adverse cardiovascular events (Carney & Freedland, 2016; May et al, 2017).   

Chronic Pain

Interestingly, chronic pain, depression, and heart disease all demonstrate shared genetic linkage, and the relationship among these diseases remained significant after adjustment for environmental factors (van Hecke et al., 2017). Patients with chronic pain can be difficult to treat in healthcare settings. These patients frequently demonstrate strong resistance towards changing behaviors contributing to their poor quality of life, and treatment gains are likely to be difficult to realize. Depressed patients with comorbid chronic pain were more likely to have recently attempted suicide, and also demonstrated less improvement from antidepressant treatment compared to depressed patients without chronic pain (Roughan, 2021). People with depression and chronic pain may have a dampened reaction to endogenous opioids, which may explain their increased likelihood of long term opioid use (Sullivan, 2018). Cognitive behavior therapy, medication, and alternative treatments such as ketamine have demonstrated effectiveness in managing patients with both depression and chronic pain (IsHak, 2018). 


A number of etiological pathways have been proposed to explain the bidirectional relationship between obesity and depression, many of which involve systems with integral roles in maintaining homeostasis in the body (Milaneschi et al., 2018). Inflammation  plays a critical role in both diseases (e.g., Chaves Filho, 2018 et al.; Patist et al., 2018). However, a review of population-based studies found differences in the strength of the relationship that was dependent on whether depression or obesity served as the predictor variable. The presence of obesity predicted depression 80% of the time, much more strongly than depression predicted obesity, at 53% of the time, a relationship that was moderated by the participant’s sex (Faith et al., 2011). The research appears to be inconclusive in regards to the strength and directionality of the relationship between depression and obesity. For example, another study reported contradictory results, finding that the risk for a person with depression developing obesity was 58%, versus 55% risk of an obese person developing depression (Luppino et al., 2010). Additional research is needed to further clarify the nature of this particular relationship as well as identify any additional moderating factors.


The coexistence of diabetes alongside depression carries stiff consequences for patients. A review of existing research found that comorbid depression and diabetes correlated with decreased metabolic control, treatment adherence, productivity, and quality of life, as well as increased complications, healthcare utilization, disability, and mortality risk (Egede & Ellis, 2010). In one study frequency of occurrence of comorbidity was approximately 200% greater than chance prediction, and each resulted in poorer outcomes than would be predicted by the other condition alone (Holt et al., 2014). Research suggests a moderating effect of both specific type of diabetes and sex. Depression occurred with 300% greater frequency in people with type 1 diabetes and nearly 200% greater frequency in people with type 2 diabetes. Further, women both with and without diabetes were more likely to have a depression diagnosis (Roy & Lloyd, 2012). Similar to other disorders, diabetes and depression share inflammation as well as HPA axis and sympathetic nervous system dysfunction (Champaneri et al., 2010).


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Roughan, W. H., Campos, A. I., García-Marín, L. M., Cuéllar-Partida, G., Lupton, M. K., Hickie, I. B., Medland, S. E., Wray, N. R., Byrne, E. M., Ngo, T. T., Martin, N. G., & Rentería, M. E. (2021). Comorbid chronic pain and depression: Shared risk factors and differential antidepressant effectiveness. Frontiers in Psychiatry, 12, 643609. https://doi.org/10.3389/fpsyt.2021.643609

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van Hecke, O., Hocking, L. J., Torrance, N., Campbell, A., Padmanabhan, S., Porteous, D. J., McIntosh, A. M., Burri, A. V., Tanaka, H., Williams, F. M., & Smith, B. H. (2017). Chronic pain, depression and cardiovascular disease linked through a shared genetic predisposition: Analysis of a family-based cohort and twin study. PloS One, 12(2), e0170653. https://doi.org/10.1371/journal.pone.0170653

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