When chronic conditions and behavioral health collide

America’s chronic disease epidemic is getting worse. More than half of adults now have at least 1 chronic condition, such as heart disease, hypertension or diabetes, and 42% of people have 2 or more.¹ At the same time, our nation is facing a behavioral health crisis, with worst-in-the-world death rates from opioid misuse and illicit drug use² and stubbornly elevated rates of mental illness.³

Looking at the trends around chronic conditions or behavioral health can be clear cause for alarm. But what’s not always so apparent is the deep connection between the two, and how problems — or progress — in one arena often amplify impact on the other.

To better understand the complexity of caring for interlinked comorbidities, as well as the benefits that come from more integrated care, consider these statistics.

Though researchers don’t fully understand why, there’s ample evidence that chronic conditions increase one’s risk of developing mental illness. The relationship is often bidirectional as well, meaning chronic physical conditions can lead to mental health issues and mental health issues can lead to chronic physical conditions. 

Those with type 2 diabetes, for instance, face a 2 to 3 times higher risk of depression.⁴ On the flip side, a history of clinical depression increases the risk of subsequent type 2 diabetes by 60%.⁵

Having both a chronic physical condition and a behavioral health issue can make it that much tougher to effectively manage either. For those with rheumatoid arthritis, depression is linked to poorer disease outcomes.⁶ And for cancer patients, research shows a correlation between anxiety and heightened risk of complications.⁷ People with diabetes, too, are up to 2.5 times more likely to experience sustained complications when they also have a mental health disorder.⁸

Chronic diseases are the primary driver of U.S. health care costs.⁹ But when chronic diseases collide with behavioral health issues, the financial burden is even more staggering. Comorbid diabetes and depression is associated with 49% higher healthcare costs.¹⁰ And for individuals with cancer and depression, the total cost of treatment increased 113% in the first year, compared to those without depression.¹¹

Among Medicare beneficiaries with cancer, a new diagnosis of anxiety or depression has been shown to increase health care costs by $1,458 per month on average.¹²

The interplay of chronic conditions and behavioral health needn’t always be negative. In fact, research shows that improving one’s mental health tends to positively affect physical health and vice versa. 

For instance, treating depression in those with multiple sclerosis has been shown to influence the long-term progression of the disease, contributing to a reduction in new brain lesions and markers of inflammation.¹³ And a 2024 study of people with diabetes and depression found that behavioral interventions led to sustained improvement in A1c levels.¹⁴

When it comes to cardiac conditions, anxiety and depression are both incredibly common and significantly influential on health outcomes. That makes the promise of holistic care that spans physical and mental health all the more potent. In a recent study, people hospitalized for heart failure or ischemic heart disease who received talk therapy and appropriate medications were 75% less likely to be hospitalized and 66% less likely to die than those who didn’t receive mental health treatment.¹⁵

Better health outcomes often go hand in hand with more effective cost management. Case in point: In an NCI-supported study of cancer patients with depression, pain and/or fatigue, those who received weekly therapy saw clinically meaningful improvements in their health-related quality of life — and had fewer ER visits, fewer hospital readmissions and shorter hospital stays than those in the standard care group.¹⁶ Researchers estimate that the lower health care utilization driven by such integrated care could save health systems about $16,000 per patient per year.

The collision of increased chronic conditions and ongoing behavioral health challenges cannot be stopped. But that doesn’t mean that healthcare leaders can’t take proactive steps to mitigate its impact and reshape its trajectory. 

An integrated, whole-person approach to care — that is, treating both the physical and behavioral health of a patient — can be a powerful means to do just that.

Optum provides an integrated, whole-person approach to care. Learn about our solutions for complex care management and behavioral health.