Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence

David M Clarke and Kay C Currie
Med J Aust 2009; 190 (7): S54-S60. || doi: 10.5694/j.1326-5377.2009.tb02471.x
Published online: 6 April 2009


Objective: To review the evidence for an association between depression and anxiety and the National Health Priority Area conditions — heart disease, stroke, diabetes mellitus, asthma, cancer, arthritis and osteoporosis — and for the effectiveness of treatments for depression and anxiety in these settings.

Data sources: Systematic literature search of systematic reviews, meta-analyses and evidence-based clinical practice guidelines published between 1995 and 2007, inclusive.

Data extraction: Each review was examined and summarised by two people before compilation.

Data synthesis: Depression is more common in all disease groups than in the general population; anxiety is more common in people with heart disease, stroke and cancer than in the general population. Heterogeneity of studies makes determination of risk and the direction of causal relationships difficult to determine, but there is consistent evidence that depression is a risk factor for heart disease, stroke and diabetes mellitus. Antidepressants appear to be effective for treating depression and/or anxiety in patients with heart disease, stroke, cancer and arthritis, although the number of studies in this area is small. A range of psychological and behavioural treatments are also effective in improving mood in patients with cancer and arthritis but, again, the number of studies is small.

Conclusion: The evidence for the association of physical illness and depression and anxiety, and their effects on outcome, is very strong. Further research to establish the effectiveness of interventions is required. Despite the limits of current research, policy and practice still lags significantly behind best evidence-based practice. Models of integrated care need to be developed and trialled.

The co-occurrence of depression and physical illnesses is an important issue. The burden of disease for depression itself is similar to that for heart disease.1 In any year, nearly 18% of Australians have one of the common mental disorders (depression, anxiety or substance misuse), and 43% of these people have a physical illness.2 Having a physical illness is one of the strongest risk factors for depression.3 Moreover, evidence now shows that depression is also a risk factor for physical illness and for early death.4 Thus, both the depression and the physical illness need to be considered if we are to understand the complexities of this association and the best ways to treat each.

Our aim was to review and outline the evidence in relation to depression and anxiety and the common chronic diseases — those that are the subject of the National Health Priority Areas. These include cardiovascular disease (heart disease and stroke), diabetes mellitus, asthma, cancer, arthritis and osteoporosis. We included anxiety with depression because the two are often coexistent, and not always easily differentiated. We were interested in finding data on the prevalence of depression and anxiety in patients with these diseases, risk factors for depression and anxiety occurring in patients with these diseases, depression and anxiety as possible risk factors for physical illness, and evidence for effective management of comorbid depression and anxiety and physical illness. Because of the broad scope of the study, we limited the review to secondary sources. This review employs the same methods as, and thus extends, an earlier scoping study conducted on behalf of the Australian Government, commissioned by the National Health Priority Action Council in 2004.5


Each of the six major disease groups was considered in three sections: epidemiology/prevalence; risk factors; and management. Computer searches of literature databases were conducted in each of these areas. The searches were limited to the best evidence in the form of systematic reviews, meta-analyses and evidence-based clinical practice guidelines (National Health and Medical Research Council [NHMRC] Level 1 evidence).6

The same strategy was used to search each health area for thesaurus and freetext search terms for: depression, anxiety and panic; health area (heart disease, stroke, diabetes mellitus, asthma, cancer, arthritis and osteoporosis); and best evidence (randomised controlled,, etc). We will provide full search details on request. The following databases were first searched during April and May 2003: Evidence-Based Medicine Reviews, MEDLINE, Pre-MEDLINE, CINAHL, PsycINFO, Australasian Medical Index, PubMed, The Cochrane Library, National Guidelines Clearinghouse, and the Scottish Intercollegiate Guidelines Network. Results were limited to studies in humans and published in English from 1995 onwards. We repeated the search in May 2007 for items published between 2003 and 2007, inclusive. Each review was examined and summarised by two people before compilation.

Systematic reviews were included if they provided documented inclusion/exclusion criteria and a search strategy, and assessed the methods of included primary studies. Reviews that did not report on direct, specific measures of depression or anxiety (including panic) were excluded. To avoid redundancy, where there were recent (2003–2007) reviews we have reported just those; where not, we refer to earlier reviews. Where there was a lack of Level 1 evidence, but there was other significant literature, we have identified it, although it was beyond scope to appraise this evidence.


A total of 159 reviews were identified (32 on heart disease, 23 on stroke, 19 on diabetes mellitus, 12 on asthma, 36 on cancer, 24 on arthritis and osteoporosis, and 13 general reviews). We will provide a full list on request.


The prevalence of depression was markedly and consistently higher in people with heart disease,7-12 stroke,13-15 diabetes mellitus,16,17 cancer,18-20 rheumatoid arthritis,21,22 and osteoporosis23 than in the general population.2 A summary of the prevalence of comorbid depression, anxiety and panic disorder and other epidemiological factors is shown in Box 1.

The association between heart disease and depression is complex. Rates were similar for myocardial infarction (MI), coronary artery disease, and heart failure,10,12 although about 33%–50% of people with heart disease have pre-existing depression.11 Where depression was diagnosed in hospitalised patients with MI, 60%–70% of patients were still depressed at 1–4 months.7

Post-stroke depression rates are significantly high (up to 40%), and also persist beyond 6 months.13-15

No review was identified for asthma, but data from an Australian survey indicate that, among patients with asthma, the prevalence of depression is more than twice that of populations without asthma.28

In patients with cancer, the prevalence of depression has been estimated to be up to four times that in the general population.18,36 It varies by time from receiving a diagnosis19 and through stages of disease progression.30 Prevalence appears to be higher in cancers with poorer prognoses, such as pancreatic, oropharyngeal and breast cancer,18,19 and colorectal cancer.29

Study estimates of the prevalence of major depression in patients with rheumatoid arthritis vary widely, from 13%–17%21,22 up to 80%,31 although some of these studies use more general terms, such as “psychiatric comorbidity”. Young people with chronic arthritis also have an increased risk of depression, anxiety and social withdrawal.32 One systematic review found a strong and consistent association between osteoporosis and depression.23

Few systematic reviews were found that examined the prevalence of anxiety disorders. A high prevalence of panic disorder is found in patients with cardiac disorders (10%–50%).24 Evidence-based clinical practice guidelines report anxiety to be high in patients with cancer,19,29 with estimates ranging up to 69% as disease progressed.30 A systematic review of post-traumatic stress disorder in survivors of childhood cancer reported a point prevalence of 4.7%–21% and a lifetime prevalence of 20.5%–35%.20

Women with heart disease tend to report more symptoms of depression and anxiety than men,25 although some authors have suggested that this may be due to reporting bias. Among patients with diabetes, the prevalence of both depression and anxiety in women is significantly higher than in men.26,27

Patients with rheumatoid arthritis who experience depression tend to be younger than those who do not.35

The wide variation in overall prevalence rates of depression and anxiety has been attributed to methodological issues, and differences in rating tools and diagnostic criteria.


Risk factors for depression in National Health Priority Area diseases include at least some or all of the following: worsening condition,37 unrelieved pain,37-40 dysphasia,41 functional impairment,41 social isolation,41,42 past history of psychological disturbance,41 and diagnostic and treatment regimens.18,36

Comorbid depression is a risk factor for increased disease severity10 because of non-compliance with treatment and greater complications,18,43 and is associated with longer hospital stays, increased morbidity44 and increased mortality.13

Depression may be a risk factor for developing heart disease,7,9,24,25 stroke,45 diabetes mellitus18,46 and osteoporosis.47 However, some reviewers noted significant heterogeneity between, and lack of power within, the reviewed studies, and therefore concluded that depression is not yet firmly established as an independent risk factor, at least for heart disease.8,48 A summary of risk factors among depression and anxiety and National Health Priority Area diseases is shown in Box 2.


Treatment modalities are considered under pharmacological interventions and psychological, behavioural and educational interventions (see Box 3).

No systematic reviews of pharmacological therapies for treatment of depression were identified for asthma or arthritis and osteoporosis.

There is a consistent body of evidence for the effectiveness of selective serotonin reuptake inhibitors (SSRIs) for treating depression in patients with cancer.18,86,87

In heart disease, SSRIs were safe and had modest efficacy in patients with MI or unstable angina with recurrent or severe depression,67 but did not significantly reduce cardiac adverse events.50

In stroke, there was evidence of effectiveness of antidepressants for treating depression;69,70 however, for prevention of depression, there was inconsistent evidence for the efficacy of antidepressants.72,73

In diabetes mellitus, antidepressants (nortriptyline) ameliorated depression but decreased glycaemic control,75 whereas monoamine oxidase inhibitors increased hypoglycaemia and increased food cravings.76

Cognitive behaviour therapy (CBT) was a modestly effective treatment for depression and anxiety in patients with heart disease,50 adult patients with diabetes,77 children with asthma,82 and people with a range of cancers.37,88 CBT has also been shown to be effective in reducing depression in patients with rheumatoid arthritis and osteoarthritis.98 There was some evidence of effectiveness for other interventions, such as relaxation therapies in patients with mild to moderate heart failure45,68 and cancer,19 and possibly for patients with rheumatoid arthritis when combined with education and biofeedback.99,101 Exercise and exercise-based rehabilitation was effective in people with ischaemic heart disease,45,68 and patients with rheumatoid arthritis and depression and anxiety.100 A summary of the range of interventions is shown in Box 3.


This review of Level 1 evidence of the association between depression and anxiety and physical illness provides an overview of the current research and knowledge in the area. We have not examined the details of individual studies, but have reported the conclusions of the original reviewers. Our review shows that there is a strong association between physical illness and depression and anxiety in all the National Health Priority Area disease groups — that is, that having a physical illness is a risk factor for depression and/or anxiety. Depression, in particular, is also associated with worse functional outcomes for people with physical diseases. Furthermore, the evidence is growing, and supports considering depression as an important risk factor for disease and disease-specific outcomes in heart disease, stroke and diabetes. The actual nature of the association is more uncertain. There are developed biological theories linking depression and heart disease, stroke and diabetes, although research in the area is hampered by the heterogeneity of the clinical conditions. This would be a worthwhile field for future research. Large prospective studies will be required to establish the links with greater certainty.

There is preliminary evidence for modest effectiveness of antidepressant medications in treating depression, and this has been shown for, in particular, heart disease, stroke, cancer and arthritis. Psychological therapies also appear to be effective in reducing depression and anxiety in patients with heart disease, cancer and asthma. Behavioural treatments (eg, psycho-education, relaxation) have been shown to be effective in reducing depression and anxiety in patients with cancer and arthritis. Although these and other treatments may be expected to lead to improvements in mood, functioning and wellbeing, in general, the number of studies that have been completed in each disease group is small, and much more research is needed to provide certainty.

In light of the weight of evidence for increased morbidity and mortality associated with depression and anxiety in these physical illnesses, it becomes apparent that the research task of finding effective solutions is lagging a long way behind. The problem of depression in patients who are physically ill needs to be tackled for these reasons, as well as simply to relieve the suffering that depression brings. Potentially useful targets for research include examining the effectiveness and safety of antidepressant medications, and the effectiveness of psychological and behavioural interventions in the physically ill. The “management” of depression and anxiety is complicated, as is the “management” of chronic illness. Because of the interaction of these two components, solutions will need to be integrated. It is therefore timely to develop and test the clinical and cost-effectiveness of integrated disease management systems for depression in physically ill patients.

There are models to guide this, although systems of chronic disease management have been slow to be taken up by the health system, and evidence for their usefulness is still limited.103 Furthermore, although effective models for incorporating care for depression in chronic disease management do exist,104 they are very few in number. At present, health care is linear — we treat the physical disease first, and then refer the patient for mental health care, or vice versa.105 This is not effective, efficient or cost-effective. Models of integrated care need to be implemented and evaluated. Based on the principles of chronic disease management and the findings of this review, an integrated disease management system could include screening and monitoring, good disease information and self-management advice, as well as a range of cognitive and behavioural strategies applied in a stepped or tiered model.

Our review has drawn together the evidence around the question of depression and anxiety occurring with the common chronic diseases that are the subject of the National Health Priority Areas. The results highlight a substantial body of evidence supporting the interactive effect of depression and anxiety and these physical illnesses. Policy and practice is lagging behind the known evidence. Our review of research shows that there are promising interventions and systems which ought to be developed and tested. Attention needs to be given to matters of research, policy and practice to achieve the necessary improvements in patient outcomes.

1 Epidemiology of depression and anxiety associated with diseases that are National Health Priority Areas





Effect of time

Age and sex

Heart disease

After myocardial infarction or coronary artery disease: 20%;7 1.6%–50%;8 15%–20%;9 20%–28%.10

Before myocardial infarction: 33%–50%.11

Heart failure: 25%–30%;10 14%–26%.12

Panic disorder in patients with coronary artery disease and cardiology outpatients: 10%–50%.24

Depression at time of follow-up after myocardial infarction: 60%–70%.7

Women with heart disease report more symptoms of anxiety and depression than men.25


Post-stroke: 5%–44%;13 6%–34%;14 30%–36%.15

Increased incidence of generalised anxiety disorder.14

Rates of post-stroke depression persist > 6 months.13,14

No age or sex associations for post-stroke depression.15

Diabetes mellitus

Type 2: 8%–52%.16

Type 1: 12%.17

Generalised anxiety disorder in 14% of patients with diabetes; higher in those with type 2.26

No systematic reviews found.

Prevalence rates of both depression and anxiety consistently higher in women than men.26,27


No systematic reviews found.

Survey data show major depression in 14.4% (compared with 5.7% in patients without asthma).28

No systematic reviews found.

No systematic reviews found.

No systematic reviews found.


At diagnosis: 50%19 (this is a global measure of distress).

Ongoing: 20%–35%.19

Cancers with poorer prognosis: 20%–50%;18,19 7%–50%.20

Generally: 15%–23%.18,19

Colorectal cancer: 15%–23%.29

With disease progression: up to 69%.30

Post-traumatic stress disorder in survivors of childhood cancers: point prevalence, 4.7%–21%;20 lifetime prevalence, 20.5%–35%.20

No systematic reviews found.

Arthritis and osteoporosis

Rheumatoid arthritis: 13%–17%;21,22 up to 80%.31

High levels of psychological adjustment problems noted in children and adolescents.32

Osteoporosis: strong and consistent association with depression.23

No systematic reviews found.

Some single studies found a relationship between arthritis and anxiety.33,34

No systematic reviews found.

No systematic reviews found.

Younger patients with arthritis more likely to have depression, anxiety and social withdrawal.35

2 Risk factors among depression and anxiety and diseases that are National Health Priority Areas




Heart disease

Most reviews conclude depression is a risk factor for heart disease.9,11,49-52 However, because of heterogeneity, some suggest methodological problems leave the matter unresolved.8,48

Inconsistent findings.9,10,52,53


Depression is a risk factor for stroke.54

Risk factors for post-stroke depression: past history of depression, other psychiatric disturbance, dysphasia;41 functional impairment, living alone, social isolation;41 physical disability, stroke severity, cognitive impairment, lack of social support or isolation;42 inconsistent evidence about lesion location.55,56

No systematic reviews found.

Diabetes mellitus

Depression is a risk factor for type 2 diabetes.18,46

Risk factors for depression in diabetes mellitus: type 2 diabetes mellitus, particularly for women and socioeconomically disadvantaged people.18

Clinical outcomes: depression is associated with poor adherence to treatment recommendations and poorer outcomes.10,18,43,57

Clinical outcomes: anxiety is a risk factor for poor glycaemic control, although effect sizes are small.58


Risk factors for depression in asthma: significant association between depression or depressive symptoms and severity of asthma.10
Clinical outcomes: psychological dysfunction is a risk factor for frequent exacerbation.59 Insufficient evidence of association with depression and risk of fatal or near-fatal asthma.60

No systematic reviews found.


No evidence for depression or psychosocial factors as a cause of cancer.61  Inconsistent evidence about depression and anxiety and risk of relapse.62

Risk factors for depression in cancer: younger age, increasing illness, advanced stage of illness, disease recurrence, unrelieved symptoms, pain, medications with depressive side effects, body image changes, previous mental health or substance misuse problems;37 chemotherapy, adjuvant therapy or radiation therapy; progressive disease in palliative care;36 secondary lymphoedema.63

In melanoma: interferon treatment can cause depression and anxiety.18

In lung cancer: being female, living alone, helpless/hopeless coping style, fatigue, physical symptom burden and physician-rated performance status are risk factors for depression.29

Clinical outcomes: untreated depression can lead to decreased compliance with medical care, prolonged hospital stays, increased morbidity and possibly increased mortality.44

Risk factors for anxiety in cancer diagnosis and treatment: uncontrolled pain, some drug treatments, some investigative procedures such as computed tomography and magnetic resonance imaging, and exacerbation of pre-existing anxiety;19 secondary lymphoedema.63

Anxiety in prostate cancer is higher with “watchful waiting” than after prostatectomy.64

Arthritis and osteoporosis

Some evidence for depression as a risk factor for osteoporosis.18,47,65

Risk factors for depression in arthritis: lower education levels and workplace support;38 lower social support or social networks;66 greater limitation of workplace activity.38

Risk factors for depression in rheumatoid arthritis: pain.38-40

No systematic reviews found.

3 Management of depression and anxiety: pharmacological and psychological, behavioural and educational interventions



Psychological, behavioural and educational interventions

Heart disease

Sertraline: 20% fewer adverse cardiac events compared with placebo (randomised controlled trial, non-significant finding);50 modest efficacy in patients with myocardial infarction with depression or unstable angina with recurrent or severe depression.67

Fluoxetine: effective for patients with mild depression.67

Insufficient research to demonstrate cardioprotective benefits of selective serotonin reuptake inhibitors.50,67

Randomised controlled trial found modest effect of cognitive behaviour therapy (CBT) on depression and social isolation.50

Some evidence of effectiveness for relaxation therapies and exercise-based rehabilitation in patients with ischaemic heart disease or mild to moderate heart failure.45,68

No significant effect on progression of heart disease.50


Small but significant benefit of pharmacotherapy (selective serotonin reuptake inhibitors, tricyclic antidepressants and psychostimulants) in treating post-stroke depression and reducing depressive symptoms.69,70

Duration of treatment correlated with improvement in depressive symptoms.71

Prophylactic effect inconsistent: some evidence for post-stroke depression rates being lower in patients treated with antidepressants;72 no clear benefit of pharmacotherapy in more recent review.73

Small but significant effect of psychotherapy on improving mood and preventing depression.72

Psychological therapy not effective in treating established post-stroke depression.74

Diabetes mellitus

Antidepressants: ameliorated depression but decreased glycaemic control;75 increased hypoglycaemia and food cravings.76

Self-management training and CBT reduce depression, anxiety and distress.77

CBT effective in adults in reducing blood glucose levels,77  although not all studies show this.78

In children and adolescents, psychological interventions, including CBT, improve: emotional and behavioural problems;79  disease management;80 individual and family functioning;81  and glycaemic control.78


No systematic reviews found.

Psychological interventions have positive effect on emotional and behavioural problems, and disease management in children,79,82 but not adults.83

Education and relaxation improve function and wellbeing in adults.84

Progressive relaxation, CBT, biofeedback82,84 and family therapy85 are effective in children.


Consistent evidence of effectiveness for pharmacological treatment of depression in cancer patients.18,86,87

No systematic reviews were identified that evaluated the effectiveness of pharmacological agents for anxiety.

CBT, behaviour therapy, counselling, psychotherapy, education/information, relaxation and social support alleviate depression and anxiety.19,36,88

Psychosocial and psychoeducational interventions are effective for depression.86,88

School reintegration, health education, home visitation, social work intervention and skills development have no effect on depression; they produce a small reduction in anxiety in children and adolescents.89

Limited consistent evidence of effectiveness for alternative and complementary therapies. Some low-level evidence for: St John’s wort for mild depression;90 hypnotherapy for reducing anxiety and patient-reported pain in children;91,92 guided imagery;93  massage and/or aromatherapy for reducing anxiety.94

Provision of information88,95 or summaries or recordings of consultations89,96 are not effective by themselves in reducing anxiety or depression.

Arthritis and osteoporosis

No systematic reviews found.

A single study found that antidepressants were effective in reducing depression in patients with rheumatoid arthritis.97

Effective in reducing depression in patients with rheumatoid arthritis and osteoarthritis: CBT;98 biofeedback, education and relaxation;99 exercise.100

Effective in reducing anxiety: biofeedback, education and relaxation;101 exercise.100 
Not effective: educational interventions.102

  • David M Clarke1
  • Kay C Currie2

  • 1 Psychological Medicine, Monash University, Melbourne, VIC.
  • 2 National Institute of Clinical Studies, National Health and Medical Research Council, Melbourne, VIC.


The original review was funded by a grant from the Australian Government Department of Health and Ageing. As well as the authors, the co-investigators included Don Campbell, David Kissane, Graham Meadows, Graeme Smith, Leon Piterman, Mark Oakley-Browne and David Barton. The updated review was funded by beyondblue: the national depression initiative. Staff from the Centre for Clinical Effectiveness (Monash Medical Centre) and the National Institute of Clinical Studies (NHMRC) assisted with the searches and data extraction.

Competing interests:

None identified.

  • 1. Moussavi S, Chatterji S, Verdes E, et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370: 851-858.
  • 2. McLennan W. Mental health and wellbeing: profile of adults, Australia, 1997. Canberra: Australian Bureau of Statistics, 1998. 00233CAF/$File/43260_1997.pdf (accessed Dec 2008).
  • 3. Wilhelm K, Mitchell P, Slade T, et al. Prevalence and correlates of DSM-IV major depression in an Australian survey. J Affect Dis 2003; 75: 155-162.
  • 4. Wulsin LR, Vaillant GE, Wells VE. A systematic review of the mortality of depression. Psychosom Med 1999; 61: 6-17.
  • 5. Australian Government Department of Health and Ageing. A scoping study relating to the National Health Priority Area conditions coexisting with depression (and related disorders) Canberra: DoHA, 2003.
  • 6. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1999.
  • 7. Bush DE, Ziegelstein RC, Patel UV, et al. Post-myocardial infarction depression. Evidence report/technology assessment No. 123. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) Rockville, Md: Agency for Healthcare Research and Quality, May 2005. (AHRQ Publication No. 05-E018-2.) (accessed Dec 2008).
  • 8. Sorensen C, Friis-Hasche E, Haghfelt T, Bech P. Postmyocardial infarction mortality in relation to depression: a systematic critical review. Psychother Psychosom 2005; 74: 69-80.
  • 9. Frasure-Smith N, Lesperance F. Recent evidence linking coronary heart disease and depression. Can J Psychiatry 2006; 51: 730-737.
  • 10. Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 2007; 29: 147-155.
  • 11. Agency for Health Care Policy and Research. Cardiac rehabilitation. Clinical Guideline No. 17. Rockville, Md: AHCPR, 1995. (AHCPR Publication No. 96-0672.)
  • 12. Lane DA, Chong AY, Lip GYH. Psychological interventions for depression in heart failure. Cochrane Database Syst Rev 2005; (1): CD003329.
  • 13. Turner-Stokes L, Hassan N. Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 1. Diagnosis, frequency and impact. Clin Rehabil 2002; 16: 231-247.
  • 14. Whyte AM, Mulsant BH. Post stroke depression: epidemiology, pathophysiology and biological treatment. Biol Psychiatry 2002; 52: 253-264.
  • 15. Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke 2005; 36: 1330-1340.
  • 16. Ali S, Stone MA, Peters JL, et al. The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006; 23: 1165-1173.
  • 17. Barnard KD, Skinner TC, Peveler R. The prevalence of co-morbid depression in adults with type 1 diabetes: systematic literature review. Diabet Med 2006; 23: 445-448.
  • 18. Evans DL, Charney DS, Lewis L, et al. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 2005; 58: 175-189.
  • 19. National Breast Cancer Centre and National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults with cancer. Sydney: National Breast Cancer Centre, 2003. (accessed Dec 2008).
  • 20. Bruce M. A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents. Clin Psychol Rev 2006; 26: 233-256.
  • 21. Alpay M, Cassem EH. Mood disorders in rheumatic disease: evaluation and management: many patients respond well to drug therapy and counselling. J Musculoskel Med 1999; 16: 643-646.
  • 22. Dickens C, McGowan L, Clark-Carter D, Creed F. Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med 2002; 64: 52-60.
  • 23. Cizza G, Ravn P, Chrousos GP, Gold PW. Depression: a major, unrecognized risk factor for osteoporosis? Trends Endocrinol Metab 2001; 12: 198-203.
  • 24. Fleet R, Lavoie K, Beitman BD. Is panic disorder associated with coronary artery disease? A critical review of the literature. J Psychosom Res 2000; 48: 347-356.
  • 25. Arthur HM. Depression, isolation, social support, and cardiovascular disease in older adults. J Cardiovasc Nurs 2006; 21 (5 Suppl 1): S2-S7.
  • 26. Grigsby AB, Anderson RJ, Freedland KE, et al. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res 2002; 53: 1053-1060.
  • 27. Anderson R, Freedland K, Clouse R, Lustman P. The prevalence of co-morbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001; 24: 1069-1078.
  • 28. Goldney RD, Ruffin R, Fisher LJ, et al. Asthma symptoms associated with depression and lower quality of life: a population survey. Med J Aust 2003; 178: 437-441. <MJA full text>
  • 29. Australian Cancer Network Colorectal Cancer Guidelines Revision Committee. Guidelines for the prevention, early detection and management of colorectal cancer. Sydney: The Cancer Council Australia and Australian Cancer Network, 2005. (accessed Dec 2008).
  • 30. Australian Cancer Network. Clinical practice guidelines for the prevention, diagnosis and management of lung cancer. Sydney: Australian Cancer Network, Cancer Council of Australia, 2004. (accessed Dec 2008).
  • 31. el-Miedany YM, el-Rasheed AH. Is anxiety a more common disorder than depression in rheumatoid arthritis? Joint Bone Spine 2002; 69: 300-306.
  • 32. LeBovidge JS, Lavigne JV, Donenberg GR, Miller ML. Psychological adjustment of children and adolescents with chronic arthritis: a meta-analytic review. J Pediatr Psychol 2003; 28: 29-39.
  • 33. Kessler RC, Ormel J, Demler O, Stang PE. Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: results from the National Comorbidity Survey. J Occup Environ Med 2003; 45: 1257-1266.
  • 34. McWilliams LA, Goodwin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain 2004; 111: 77-83.
  • 35. Keefe FJ, Smith SJ, Buffington ALH, et al. Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis. J Consult Clin Psychol 2002; 70: 640-655.
  • 36. Rodin G, Lloyd N, Katz M, et al. The treatment of depression in cancer patients: a systematic review. Support Care Cancer 2007; 15: 123-136.
  • 37. Barsevick AM, Sweeney C, Haney E, Chung E. A systematic qualitative analysis of psychoeducational interventions for depression in patients with cancer. Oncol Nurs Forum 2002; 29: 73-84.
  • 38. Li X, Gignac MAM, Anis AH. Workplace, psychosocial factors, and depressive symptoms among working people with arthritis: a longitudinal study. J Rheumatol 2006; 33: 1849-1855.
  • 39. Jakobsson U, Hallberg IR. Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review. J Clin Nurs 2002; 11: 430-443.
  • 40. Covic T, Tyson G, Spencer D, Howe G. Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors. J Psychosom Res 2006; 60: 469-476.
  • 41. Yu LLC, Chen J, Wang S, et al. Relationship between post-stroke depression and lesion location: a meta-analysis. Kaohsiung J Med Sci 2004; 20: 372-379.
  • 42. Bhogal SK, Teasell R, Foley N, Speechley M. Lesion location and poststroke depression: systematic review of the methodological limitations in the literature. Stroke 2004; 35: 794-802.
  • 43. Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complicat 2005; 19: 113-122.
  • 44. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160: 2101-2107.
  • 45. van Dixhoorn J, White A. Relaxation therapy for rehabilitation and prevention in ischaemic heart disease: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2005; 12: 193-202.
  • 46. Knol MJ, Twisk JWR, Beekman ATF, et al. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia 2006; 49: 837-845.
  • 47. Gold DT, Solimeo S. Osteoporosis and depression: a historical perspective. Curr Osteoporos Rep 2006; 4: 134-139.
  • 48. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J 2006; 27: 2763-2774.
  • 49. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med 2004; 66: 802-813.
  • 50. Wulsin LR. Is depression a major risk factor for coronary disease? A systematic review of the epidemiologic evidence. Harv Rev Psychiatry 2004; 12: 79-93.
  • 51. Van der Kooy K, van Hout H, Marwijk H, et al. Depression and the risk for cardiovascular diseases: systematic review and meta-analysis. Int J Geriatr Psychiatry 2007; 22: 613-626.
  • 52. Bunker SJ, Colquhoun DM, Esler MD, et al. “Stress” and coronary heart disease: psychosocial risk factors. Med J Aust 2003; 178: 272-276. <MJA full text>
  • 53. Kubzansky LD, Kawachi I, Weiss ST, Sparrow D. Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence. Ann Behav Med 1998; 20: 47-58.
  • 54. Thomas AJ, Kalaria RN, O’Brien JT. Depression and vascular disease: what is the relationship? J Affect Disord 2004; 79: 81-95.
  • 55. Ouimet MA, Primeau F, Cole MG. Psychosocial risk factors in post-stroke depression: a systematic review. Can J Psychiatry 2001; 46: 819-828.
  • 56. Hackett ML, Anderson CS. Predictors of depression after stroke: a systematic review of observational studies. Stroke 2005; 36: 2296-2301.
  • 57. de Groot M, Anderson R, Freedland KE, et al. Association of depression and diabetes complications: a meta-analysis. Psychosom Med 2001; 63: 619-630.
  • 58. Anderson RJ, Grigsby AB, Freedland KE, et al. Anxiety and poor glycemic control: a meta-analytic review of the literature. Int J Psychiatry Med 2002; 32: 235-247.
  • 59. Ten Brinke A, Sterk PJ, Masclee AAM, et al. Risk factors of exacerbations in difficult to-treat asthma. Eur Respir J 2005; 26: 812-818.
  • 60. Alvarez GG, Fitzgerald JM. A systematic review of the psychological risk factors associated with near fatal asthma or fatal asthma. Respiration 2007; 74: 228-236.
  • 61. McKenna MC, Zevon MA, Corn B, Rounds J. Psychosocial factors and the development of breast cancer: a meta-analysis. Health Psychol 1999; 18: 520-531.
  • 62. de Boer M, Ryckman R, Pruyn J, Van den Borne H. Psychosocial correlates of cancer relapse and survival: a literature review. Patient Educ Couns 1999; 37: 215-230.
  • 63. McWayne J, Heiney SP. Psychologic and social sequelae of secondary lymphedema: a review. Cancer 2005; 104: 457-466.
  • 64. Dale W, Bilir P, Han M, Meltzer D. The role of anxiety in prostate carcinoma: a structured review of the literature. Cancer 2005; 104: 467-478.
  • 65. Wong SY, Lau EM, Lynn H, et al. Depression and bone mineral density: is there a relationship in elderly Asian men? Results from Mr. Os (Hong Kong). Osteoporos Int 2005; 16: 610-615.
  • 66. Demange V, Guillemin F, Baumann M, et al. Are there more than cross-sectional relationships of social support and support networks with functional limitations and psychological distress in early rheumatoid arthritis? The European Research on Incapacitating Diseases and Social Support Longitudinal Study. Arthritis Rheum 2004; 51: 782-791.
  • 67. van Melle JP, de Jonge P, van den Berg MP, et al. Treatment of depression in acute coronary syndromes with selective serotonin reuptake inhibitors. Drugs 2006; 66: 2095-2107.
  • 68. Rees K, Taylor R, Singh S, et al. Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev 2004; (3): CD003331.
  • 69. Cole MG, Elie LM, McCusker J, et al. Feasibility and effectiveness of treatments for post-stroke depression in elderly inpatients: systematic review. J Geriatr Psychiatry Neurol 2001; 14: 37-41.
  • 70. Hackett ML, Anderson CS, House AO. Management of depression after stroke: a systematic review of pharmacological therapies. Stroke 2005; 36: 1098-1103.
  • 71. Chen Y, Guo JJ, Zhan S, Patel NC. Treatment effects of antidepressants in patients with post-stroke depression: a meta-analysis. Ann Pharmacother 2006; 40: 2115-2122.
  • 72. Chen Y, Patel NC, Guo JJ, Zhan S. Antidepressant prophylaxis for poststroke depression: a meta-analysis. Int Clin Psychopharmacol 2007; 22: 159-166.
  • 73. Anderson CS, Hackett ML, House AO. Interventions for preventing depression after stroke. Cochrane Database Syst Rev 2004; (2): CD003689 (updated 2008).
  • 74. Hackett ML, Anderson CS, House AO. Interventions for treating depression after stroke. Cochrane Database Syst Rev 2004; (3): CD003437 (updated 2008).
  • 75. Gill D, Hatcher S. Antidepressants for depression in medical illness. Cochrane Database Syst Rev 2000; (4): CD001312 (updated 2007).
  • 76. Goodnick PJ, Henry JH, Buki VMV. Treatment of depression in patients with diabetes mellitus. J Clin Psychiatry 1995; 56: 128-136.
  • 77. Steed L, Cooke D, Newman S. A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Educ Couns 2003; 51: 5-15.
  • 78. Winkley K, Ismail K, Landau S, Eisler I. Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ 2006; 333: 65-68.
  • 79. Kibby MY, Tyc VL, Mulhern RK. Effectiveness of psychological intervention for children and adolescents with chronic medical illness: a meta-analysis. Clin Psychol Rev 1998; 18: 103-117.
  • 80. McQuaid EL, Nassau JH. Empirically supported treatments of disease-related symptoms in paediatric psychology: asthma, diabetes, and cancer. J Paediatr Psychol 1999; 24: 305-328.
  • 81. Hampson SE, Skinner TC, Hart J, et al. Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review. Health Technol Assess 2001; 5: 1-79.
  • 82. Yorke J, Fleming SL, Shuldham C. A systematic review of psychological interventions for children with asthma. Pediatr Pulmonol 2007; 42: 114-124.
  • 83. Yorke J, Fleming SL, Shuldham C. Psychological interventions for adults with asthma: a systematic review. Respir Med 2007; 101: 1-14.
  • 84. Devine EC. Meta-analysis of the effects of psychoeducational care in adults with asthma. Res Nurs Health 1996; 19: 367-376.
  • 85. Yorke J, Shuldham C. Family therapy for chronic asthma in children. Cochrane Database Syst Rev 2005; (2): CD000089.
  • 86. Agency for Healthcare Research and Quality. Management of cancer symptoms: pain, depression and fatigue. Evidence Report/Technology Assessment: Number 61. Rockville, Md: AHRQ, 2002. (AHRQ Publication No. 02-E031.) (accessed Dec 2008).
  • 87. Williams S, Dale J. The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer 2006; 94: 372-390.
  • 88. Osborn RL, Demoncada AC, Feuerstein M. Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 2006; 36: 13-34.
  • 89. Scott JT, Entwistle VA, Sowden AJ, Watt I. Communicating with children and adolescents about their cancer. Cochrane Database Syst Rev 2003; (3): CD002969.
  • 90. National Institute for Health and Clinical Excellence. Depression: management of depression in primary and secondary care. Clinical Guideline 23 (amended). London: NICE, 2004 (amended 2007).
  • 91. Rajasekaran M, Edmonds PM, Higginson IL. Systematic review of hypnotherapy for treating symptoms in terminally ill adult cancer patients. Palliat Med 2005; 19: 418-426.
  • 92. Richardson J, Smith JE, McCall G, Pilkington K. Hypnosis for procedure-related pain and distress in pediatric cancer patients: a systematic review of effectiveness and methodology related to hypnosis interventions. J Pain Symptom Manage 2006; 31: 70-84.
  • 93. Roffe L, Schmidt K, Ernst E. A systematic review of guided imagery as an adjuvant cancer therapy. Psychooncology 2005; 14: 607-617.
  • 94. Fellowes D, Barnes K, Wilkinson S. Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database Syst Rev 2004; (2): CD002287.
  • 95. McPherson CJ, Higginson IJ, Hearn J. Effective methods of giving information in cancer: a systematic literature review of randomized controlled trials. J Public Health Med 2001; 23: 227-234.
  • 96. Scott JT, Harmsen M, Prictor MJ, et al. Recordings or summaries of consultations for people with cancer. Cochrane Database Syst Rev 2003; (2): CD001539.
  • 97. Frantom CG, Parker JC, Smarr KL, et al. Relationship of psychiatric history to pain reports in rheumatoid arthritis. Int J Psychiatry Med 2006; 36: 53-67.
  • 98. Hawley DJ. Psycho-educational interventions in the treatment of arthritis. Baillieres Clin Rheumatol 1995; 9: 803-823.
  • 99. Astin JA, Beckner W, Soeken K, et al. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheum 2002; 47: 291-302.
  • 100. Westby MD. A health professional’s guide to exercise prescription for people with arthritis: a review of aerobic fitness activities. Arthritis Rheum 2001; 45: 501-511.
  • 101. Glazier R. Managing early prevention of rheumatoid arthritis: systematic review. Can Fam Physician 1996; 42: 913-922.
  • 102. Riemsma RP, Kirwan JR, Taal E, Rasker JJ. Patient education for adults with rheumatoid arthritis. Cochrane Database Syst Rev 2003; (2): CD003688.
  • 103. Smith SM, Allwright S, O’Dowd T. Effectiveness of shared care across the interface between primary and specialty care in chronic disease management. Cochrane Database Syst Rev 2007; (3): CD004910.
  • 104. Simon GE, Katon WJ, Lin EH, et al. Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry 2007; 64: 65-72.
  • 105. Kathol RG, Clarke DM. Rethinking the place of the psyche in health: toward the integration of health care systems. Aust N Z J Psychiatry 2005; 39: 816-825.


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