In the Netherlands, approximately 20.2% of the adult population experiences a mood disorder at least once in their lifetime and 6.1% have experienced it in the past year. Major depressive disorder (MDD) is one of the most prevalent mental disorders: 5.2% of the Netherlands population have experienced it in the past year (Bijl et al, 1998; de Graaf et al, 2011). A causal relationship between medical illnesses and depression has frequently been assumed, but rarely demonstrated. However, many studies document a positive relationship between medical illness and mental problems: the prevalence of co-morbid MDD is higher in chronic medically ill patients than in the general population (Anderson et al, 2001; Egede et al, 2002). The prevalence of chronic medically ill patients with diabetes and MDD ranges from 7-16% (Egede et al, 2002). This thesis focuses on patients with physical diseases and co-morbid depression. Co-morbidity can be defined as a clinical entity existing or occurring during the clinical course of the index illness (Feinstein, 1970). Patients with a mental index illness and co-morbid depression were excluded from our study. We assessed co-morbid depression in the following chronic medical diseases: diabetes, chronic obstructive pulmonary disorders (COPD) and cardiovascular disorders; more in specific patients with congestive heart failure (CHF), myocardial infarction (MI) and coronary artery disease (CAD). These diseases were chosen as they were the most prevalent co-morbid conditions found in the general hospital (van der Feltz-Cornelis et al, 2010a). Another large scale problem encountered in the general hospital is multimorbidity. Multimorbidity is defined as having a combination of two or more chronic medical illnesses, for example concordant conditions such as hypertension, coronary heart disease and diabetes (Mercer et al, 2012). Patients with multimorbidity were included in the studies in this thesis.

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F.F.H. Rutten (Frans) , C.M. van der Feltz-Cornelis (Christina) , A.T.F. Beekman (Aartjan)
Erasmus University Rotterdam
The Collaborative Care study where this thesis was based on was conducted at the Trimbos-Institute in Utrecht, in cooperation with the Institute of Medical Technology Assessment (iMTA) in Rotterdam. It was part of the Depression Initiative, a national program aimed at supporting depression care in The Netherlands, which was funded by the Foundation for Innovation of Healthcare Insurers. Pro Persona, the Onze Lieve Vrouwe Gasthuis and the Ziekenhuis Groep Twente kindly provided financial support for the production of this thesis.
Erasmus School of Health Policy & Management (ESHPM)

van Steenbergen-Weijenburg, K.M. (2013, September 6). Depression In Chronic Medically Ill Patients: A thesis from the Netherlands Depression Initiative. Erasmus University Rotterdam. Retrieved from