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Chronic Illness and Depression: Their Correlation and How CCM Can Help

Warning: This article includes mentions of suicidal ideation, which may be triggering to some readers. 

If you or someone you know is experiencing thoughts of suicide, please seek immediate medical support. In the U.S., text or call “988” to reach the Suicide and Crisis Lifeline, for 24/7 free and confidential support.

Healthcare increasingly reflects a truth about the human body—physical and mental health are connected. Evidence-based integrated care supports the idea that health conditions must be examined within their broader context.

A collaborative, patient-centered approach is particularly important for patients experiencing chronic illness, defined as a lasting condition requiring ongoing medical attention. 

Where chronic illness exists, depression is often present, too. In fact, research demonstrates a bi-directional relationship between the two wherein chronic illness can lead to depression, and depression can lead to chronic disease. 

Today, about 60 percent of Americans and 85% of older adults have at least one chronic condition. Supporting such significant patient populations with multidimensional health needs can be complex. Tools like Chronic Care Management (CCM) programs, however, can help. 

In the sections that follow, we’ll examine the important relationship between chronic illness and depression and highlight CCM as a powerful tool for caring for the whole patient. 

An overview of chronic depression

Depression is a mental health disorder characterized by persistent low mood or sadness and a loss of interest in activities. Like other chronic conditions, depression is chronic when it affects patients long-term. Symptoms of chronic depression may include: 

• Irritability and anger 
• Abnormal sleep patterns, such as insomnia or excessive sleep 
• Feelings of hopelessness or sadness
• Changes in appetite accompanied by weight loss or weight gain
• Difficulty thinking, concentrating, or making decisions
• Fatigue or lack of energy 
• Frequent or recurring thoughts of death or suicide* 

Often, these symptoms have a broad-sweeping impact in patients’ lives, making it difficult for them to maintain relationships and responsibilities. There are many possible factors that put a patient at increased risk of developing chronic depression, including Social Determinants of Health (SDOH), genetic history, trauma, stress, and other health conditions, including chronic illness. 

Correlation between chronic pain and depression

Research shows that chronic pain and depression are closely linked. While depression only affects about five percent of people, an estimated 30 to 45 percent of people with chronic pain experience depression. Chronic pain and depression are comorbid conditions, meaning they often exist simultaneously and aggravate each other in a vicious cycle. In other words, depression is both a cause and effect of chronic pain and vice-versa, in many patients.

Chronic pain refers to long-term constant or intermittent pain, which often leads to decreased exercise and limited ability to participate in normal activities. It may present as back or joint pain, as part of a diagnosis like fibromyalgia, in headaches, or through nerve pain. Chronic pain can also trigger mood and mental health conditions, like anxiety, insomnia, and extreme fatigue. 

Patients experience chronic pain for many reasons, including injury, autoimmune disorders, obesity, aging, and other factors, including depression. At the same time, chronic pain makes it difficult for people to manage chronic depression risk factors, like stress and anxiety, in healthy ways. So, chronic pain often creates the perfect storm to trigger depression. 

It’s for exactly this reason that disjointed care delivery does patients with chronic pain, depression, or both a huge disservice. Treating each condition and its symptoms separately fails to acknowledge the profound overlap that often exists between the two. 

By contrast, coordinated care management helps patients achieve better outcomes, reducing their risk of acute events and providing the tools and structure to support effective patient self-management. 

How to manage chronic depression with CCM

The Chronic Care Management model improves your ability as a provider to manage serious mental health conditions, including chronic depression. Each of the requirements the Centers for Medicare & Medicaid Services (CMS) outline for CCM are designed to support preventive, patient-centered care. These specific requirements stand out as helpful for patients managing depression.

1. Connection to community resources: CCM connects patients to relevant community-based services to support patient needs related to SDOH, like housing, transportation, or social connection—all of which can improve the underlying causes of depression. 
2. Medication management: For many patients, medication is part of treating chronic depression. On the other hand, some medications put patients at increased risk of experiencing depression. CCM helps support medication adherence and prevent drug interactions, so patients with chronic depression have the opportunity to achieve the best possible outcomes from their prescribed regimen. 
3. Monthly touchpoints: CCM requires care managers to spend at least 20 minutes on remote care for a patient each month. This regular rhythm of communication provides vital social interaction and helps to reduce stigma around mental health issues. 
4. Patient education: Equipping patients with a clear and research-backed understanding of their condition enables them to become active participants in the management of chronic depression. CCM providers like ChartSpan supplement practices’ face-to-face delivery of care with ongoing patient education. 
5. Personalized care plans: Care managers help create personalized health plans, which can include lifestyle recommendations like a healthy diet and regular exercise. Plans are tailored to individual patient needs with provider oversight to ensure goals are both reasonable and evidence-based. 
6. Referral management: If patient needs extend beyond the existing care team, a CCM provider like ChartSpan can notify their provider that the patient might need a referrals, provide necessary documentation, and coordinate timely follow-ups. This is particularly helpful for conditions like chronic depression, which can benefit from the coordinated care expertise of multiple different healthcare specialties, such as primary care and psychiatry. If the provider decides a referral is necessary, the care manager can help coordinate records among all of the providers the patient sees.  
7. Self-management support: Patient self-management is a critical tenet of a CCM program. For example, ChartSpan care managers check in on patients managing chronic conditions to ensure they’re getting adequate sleep, maintaining a healthy diet, and attending appointments. They can also connect patients to support groups and even coordinate transportation to help them take ownership of their health. 

How does CCM benefit patients with chronic depression?

Caring for patients with chronic depression requires a multi-faceted approach. A CCM program helps support patients with chronic depression in these key ways. 

• More responsive care: If care managers notice any signs of depression in monthly touchpoints or other patient communications, they can administer the appropriate Patient Health Questionnaire screenings, PHQ-2 and PHQ-9, and relay concerns back to the providers for referrals if needed. In this way, CCM ensures timely diagnosis and intervention for patients with chronic depression. 
• Increased health ownership: Chronic Care Management empowers patients to confidently manage chronic depression. Patient education, personalized care plans, and self-management give patients the tools they need to become active participants in their healthcare journeys. With CCM, patients gain the confidence to make informed healthcare decisions, ask questions, and voice concerns. 
• Improved mental and physical quality of life: For patients with chronic depression, enrollment in a CCM program can improve health outcomes by reducing the likelihood of acute or emergency health needs and supporting preventive care. Connection to community resources and medication management help address the underlying causes of chronic depression and reduce incidents related to medication gaps or issues. 

To qualify for a Chronic Care Management program offered by Medicare, patients must have two or more chronic conditions that are expected to last at least 12 months and put them at risk of serious decompensation or functional decline. Only certain chronic conditions qualify. Depressive disorders, like chronic depression, are among them. Accordingly, depression may be one of the conditions that qualify a patient for a CCM program. 

How ChartSpan helps patients manage chronic depression

As a nationwide Chronic Care Management provider, ChartSpan serves as a constant source of support for patients managing chronic depression. We provide someone to talk to and administer depression screenings. While providers determine each patient’s course of treatment, we act as a first point of contact ensuring support is always available, even when providers are not. 

From managing appointments and care plans to coordinating medication refills, we help patients stay on track with their chronic depression treatment. We also address SDOH which could be hurdles to receiving care by coordinating transportation. We can help connect patients to resources for housing, healthy food, utility support, weather-appropriate clothing, and more. We’ve witnessed firsthand how our comprehensive approach to CCM can play a vital role in helping patients manage chronic depression. 

From a patient’s perspective

Here’s how CCM benefited one real ChartSpan patient: 

Pearl** struggled with severe chronic pain. During a call with her ChartSpan care team, she made suicidal comments* and reported she was depressed due to her ongoing suffering. After a lengthy conversation, the clinician was able to calm her down and discuss ways they could help. Pearl was very grateful for the conversation and all of the help her care team was willing to provide her. The clinician then spoke on a monthly basis to Pearl throughout the year and expressed that each call was more cheerful and positive.

From a care manager’s perspective

Here’s what one ChartSpan care manager had to say about supporting patients through both physical and mental health challenges. 

Upon entering the patient's chart, I was saddened to see that his wife had recently passed. When he answered, he sounded quite tired and down, as result of his recent loss and his ongoing cancer treatments. I approached the conversation with caution and voiced understanding as he spoke. The patient shared with me that he was grateful for our service and the CCM program as we were a great medical support system for him through this difficult time. He stated that anytime he had called us, we were able to deliver what he needed and more. He truly appreciates our hard work as he has traversed this difficult medical journey.  

This patient story is one of many that demonstrate the important ways CCM can help patients manage chronic depression. 

Care for your patients with ChartSpan's CCM program 

ChartSpan is a leading Chronic Care Management provider. We help providers like you start and sustain a successful CCM program to better care for your patients, including those experiencing chronic depression. Our turnkey solution gives even the busiest practices the capacity to implement CCM. 

Navigating the CMS requirements and staffing a new program can be challenging. With deep expertise in value-based care programs and Chronic Care Management specifically, we can help you determine eligible patients, enroll them in the program, and avoid common pitfalls on the way. 

To learn more about our services and full-service approach to CCM, reach out to start a conversation with an expert on our team.

*If you or someone you know is experiencing thoughts of suicide, please seek immediate medical support. In the U.S., text or call “988” to reach the Suicide and Crisis Lifeline, for 24/7 free and confidential support.

**For privacy purposes, all identifying patient information has been removed from the story and the patient’s name has been replaced by a pseudonym. 

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