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During National Psychology Week 12-18th November
Patients with chronic health issues, like diabetes, stroke and heart disease are at higher risk of developing depression, the difficulty is in recognising when typical symptoms, turn a dark corner, writes Kathryn Smith, Clinical Psychologist: Psychology Consultants
Chronic illness can be debilitating, particularly for patients experiencing ongoing pain. Feelings of being trapped with negative thoughts that influence mood, memory, function, sleep and appetite are quite common for chronic health sufferers.  However, it’s this unsavoury side order of chronic illness, that can have clinicians questioning; “Is this ‘normal’ or does my patient have depression”?
Taking into account the typical side effects of chronic illness, namely sleep disturbance, changes in appetite and avolition, the most reliable predictors of depression are anhedonia (lack of pleasure) and an inability to make future plans or look forward to something.
Extracting the right information from patients to make an accurate assessment of their mental state can be challenging, especially during a short consultation, when physical assessment is the focus. If a patient has expressed changes in their sleep and appetite and you also notice low mood, taking a few minutes to engage in a conversation about life in general, may allow the patient to open up and express how they are feeling emotionally.
Below are a few conversation starters that may help you make an assessment of their emotional and mental state.
1. “So, Bill, are you still enjoying your weekly bingo session at the RSL?” OR
“Jane, how’s your garden looking this spring, have you been enjoying the fruits of your labour”
SUBTEXT: Does the patient enjoy his/her usual activities that typically give him/her pleasure.
2. “Tom, tell me what you do for pleasure, what are your hobby’s/interests”.
SUBTEXT: Does the patient find it difficult to be interested in something/anything.
3. “Paula, have you got anything planned for Christmas or the holiday season. Is there anything you are looking forward to in the near future”?
SUBTEXT: Is the patient looking forward to anything?
Many people find it difficult to accept depression, and chronic health patients may resist strongly, reluctant to take on yet another illness. Unfortunately, denial is counterproductive and will only prolong the symptoms of depression and potentially worsen the chronic illness that the person is suffering from. Accepting depression as an illness and working towards managing it, like you would a physical ailment, can bring great long-term value to the patient and their outlook on life. For more information and articles on depression visit