Katon Wayne J
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195, USA.
Biol Psychiatry. 2003 Aug 1;54(3):216-26. doi: 10.1016/s0006-3223(03)00273-7.
Patients with chronic medical illness have a high prevalence of major depressive illness. Major depression may decrease the ability to habituate to the aversive symptoms of chronic medical illness, such as pain. The progressive decrements in function associated with many chronic medical illnesses may cause depression, and depression is associated with additive functional impairment. Depression is also associated with an approximately 50% increase in medical costs of chronic medical illness, even after controlling for severity of physical illness. Increasing evidence suggests that both depressive symptoms and major depression may be associated with increased morbidity and mortality from such illnesses as diabetes and heart disease. The adverse effect of major depression on health habits, such as smoking, diet, over-eating, and sedentary lifestyle, its maladaptive effect on adherence to medical regimens, as well as direct adverse physiologic effects (i.e., decreased heart rate variability, increased adhesiveness of platelets) may explain this association with increased morbidity and mortality.
患有慢性疾病的患者中，重度抑郁症的患病率很高。重度抑郁症可能会降低对慢性疾病（如疼痛）的厌恶性症状产生适应的能力。与许多慢性疾病相关的功能逐渐减退可能会导致抑郁，而抑郁又与额外的功能损害相关。即使在控制了身体疾病的严重程度之后，抑郁也与慢性疾病的医疗费用增加约50%有关。越来越多的证据表明，抑郁症状和重度抑郁症都可能与糖尿病和心脏病等疾病的发病率和死亡率增加有关。重度抑郁症对健康习惯（如吸烟、饮食、暴饮暴食和久坐不动的生活方式）的不利影响，其对坚持医疗方案的适应不良影响，以及直接的不良生理影响（即心率变异性降低、血小板黏附性增加）可能解释了这种与发病率和死亡率增加的关联。
