A Fresh Look at Co-morbidity - Pharmaceutical Executive


A Fresh Look at Co-morbidity
You may think you understand a disease. But then it arrives in tandem. A new survey takes a fresh look at co-morbidity.

Pharmaceutical Executive

What is a Marketer to Do?
Based on the 2005 NHWS, nearly one in every five American adults (18 percent, or about 39 million people) has been diagnosed with depression. That is low compared with the percentage of depressed people among arthritis and migraine patients.

The NHWS indicates that 28 percent of all diagnosed arthritics (and 34 percent of those diagnosed with rheumatoid arthritis) are also diagnosed with depression, as are 40 percent of migraine patients. It is interesting that the connection with depression is strong for both diseases, even though they are so dissimilar. Arthritis is a chronic condition with half the patients over 55 years of age, while migraine is an acute (albeit recurring) condition afflicting many younger people—half of migraine suffers are under 44. The common denominator is, of course, pain.

The number of patients afflicted with both high cholesterol and depression, at 23 percent, is much closer to the percentage of the population that suffers from depression (18 percent). People with high cholesterol experience no pain as a result of their condition, and not coincidentally, they don't experience depression with a much greater frequency than the overall US population.

An Age of Depression

Seniors are the patients least likely to be dianosed with depression. Just over 16 percent of the US population is over 65, but seniors represent only eight percent of the diagnosed depressed population. Similarly, one in three arthritics is over age 65, but seniors represent just 15.6 percent of arthritics who have been diagnosed with depression. And the distribution of diagnosed depression among patients with migraines tracks the distribution of depression in the general population—except for seniors. The incidence of migraine among seniors is small, but the incidence of concomitant depression is smaller than what would be expected.

There is no logical reason why depression should occur less frequently among the aged (and many reasons why it might occur more frequently). So undiagnosed cases are a better explanation of these statistical disparities than a lower incidence of depression.

The National Institute of Mental Health suggests that depression often goes undiagnosed or untreated in the elderly because:

  • Older people are often reluctant to discuss their feelings with physicians.
  • Depressive symptoms may be dismissed as a normal part of aging.
  • Some symptoms may be excused as crankiness or grumpiness.
  • Attention problems related to depression may look like Alzheimer's disease.
  • Mood changes may also be caused by medicines for blood pressure or heart disease.

To marketers of antidepressants, the segment of patients over age 65 represents an underserved population—many of whom may be reached when they are visiting a physician because of pain symptoms.

On Remote Control

Clinical depression carries with it feelings of extreme sadness, guilt, helplessness, and hopelessness. It is thus easy to understand why people's fundamental attitudes toward health (and their ability to control it) correlate strongly to their tendency to be depressed when they have a pain-inducing illness.

Both arthritis and migraine sufferers with co-morbid depression are significantly more likely than their counterparts without depression to agree or strongly agree with the statement, "No matter what I do, if I'm going to get sick, I will." Similarly, they are significantly less likely to agree with the claims, "I am in control of my health" and "If I take the right actions, I can stay healthy."

Of course, it is not possible to untangle the cause-and-effect relationship between such a worldview and depression; these views could either contribute to, or be a byproduct of, depression. But people with such a fatalistic view of their health may exacerbate their conditions by being slow to seek treatment and noncompliant in following doctor's orders.

Well Treated


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