Section 1 - Lifestyle modifications

1. The effect of a chronic condition diagnosis ^1–4

• It can be confronting and foreign being diagnosed with a chronic condition and needing to adapt to ongoing treatment and management. See Table 1.

• While initial feelings of sadness are expected, ongoing invasive symptoms of Depression or Anxiety disorders can be debilitating, affecting a persons ability to function physically, socially and emotionally
• 36% of people with chronic conditions have comorbid mental health issues
• Certain medicines used to treat chronic conditions can also trigger mood changes
• Children and adolescents with chronic conditions often face physical, cognitive, social and emotional development challenges, putting them at higher risk of developing a mental illness
• Parents and carers of children with chronic conditions often experience high levels of stress and anxiety

Figure 1. Cyclic effect of a chronic condition on a persons wellbeing

2. Vulnerable, victimised, minority and marginalised groups ^5,6

• Those who have been or are still subject to racism, vilification or discrimination based on socioeconomic background, race, skin colour, sexual identity, beliefs, ethnicity, appearance, stereotyping or gender include:
  • migrants and refugees
  • religious groups
  • overweight people
  • living in rural and remote locations
  • old age
  • disability
  • socioeconomic disadvantaged

1. Aboriginal and Torres Strait Islander people ^5–8
   • The source of health disparities for Aboriginal and Torres Strait Islander peoples from introduction of diseases, alcohol, tobacco, highly processed foods and inactivity, has led to the highest rates of chronic conditions in Australia
   • Historical genocide and forced child separation from Aboriginal and Torres Strait Islander families, has led to:
     • erosion of identity and language
     • culture suppression
     • physical and sexual abuse
     • community disorganisation
     • family dysfunction and dynamics
     • domestic violence and abuse
     • low self-esteem
     • parenting difficulties
     • child protection, justice system contact and incarceration
     • social conflict
2. Women ^7–10
   • The health of women is shaped by:
     • inequitable gendered distribution of power
     • characteristics of society’s gender structure including:
       • economic deprivation i.e. wage gap
       • reduced subjective social status e.g. reduced labour force participation, prevalence of conservative religion, gender roles and expectations, marketing, media
       • psychosocial resources e.g. self-esteem, autonomy
       • exposure to harassment, violence and unsafe living or working conditions i.e. feminisation of poverty
       • gender biased health care, especially for black women
     • structural sexism:
       • gender based job segregation
       • under representation in powerful business, professional, media, and governmental positions
       • control of female body autonomy through a patriarchal legal system and sexual violence
   • Subsequently, from childhood, women experience high rates of:
     • sexual exploitation from predators
     • violence and murder
     • mental health issues
     • perpetual vulnerability, from chronic abuse and violence
     • inadequate support services, shelters and mental health resources for at risk women
     • chronic conditions and lower self-rated health and physical functioning
3. Transgender and gender diverse people ^11–16
   • Historically, in an era without anti-discrimination protections, trans and gender diverse people were subject to loss of employment and relationships, harassment, violence and murder
   • As a result, the root of health inequalities today are:
     • cultural and social norms that preference and prioritise heterosexuality
     • minority stress associated with sexual orientation, gender identity and sex characteristics
     • victimisation, discrimination (individual and institutional) and stigma
   • From childhood, these experiences affect the way health care is accessed for disproportionately high levels of chronic conditions
   • Compared to heterosexual men and women, trans and gender diverse people report highest rates of:
     • hypertension, cancer, stroke and obesity
     • mood disorders, suicide and self-harm
     • musculoskeletal and gastrointestinal problems
     • poor lifestyle behaviours
   • The prevalence increases considerably for those with additional minority status
   • See Resource 1. for clinician related information
4. Homeless people ^16–20
   • Affecting people of all ages, including children, homeless people are among Australia’s most socially and economically disadvantaged as a result of:
     • unemployment
     • family and domestic violence
     • mental health conditions
     • disability
     • substance use
     • chronic conditions
     • adverse early life childhood experiences and trauma
   • Disproportionately represented by marginalised and minority groups, homelessness results in high rates of:
     • unemployment
     • psychiatric illness
     • substance use
     • musculoskeletal disorders
     • skin and foot problems
     • poor oral health
     • STIs and blood borne viruses
     • further chronic conditions
     • sexual exploitation
     • death and disability > 10 times general population
     • seeking routine medical care late, leading to acute intervention with poor outcomes
   • Barriers to effective health care include:
     • competing needs and priorities i.e. food, water, shelter
     • poor health, disability
     • physical access i.e. cost, distance, ability
     • medication access, security and affordability
     • stigma e.g. hygiene
     • poor service co-ordination and communication

3. Supporting social-emotional wellbeing ^{1,3,4–10,12,14,–16,18–20}

• The privilege of being a clinical professional carries with it the responsibility to provide uncompromising care of all patients with trust, mutual respect, and understanding
• See Engaging our patients to understand effective patient engagement including unconscious biases, listening, honest reflection, clinical power imbalance and gaining a clear understanding of barriers and goals
• When applying social-emotional wellbeing support to patients (of all ages), health care professionals should:
  • use culturally relevant language (including terms to describe transgender and gender diverse people) that upholds the principles of safety, dignity, and respect
  • ask and use a patients preferred name and pronouns
  • openly discuss and identify if a patient is from a marginalised or minority group
  • receive cultural-awareness training to provide culturally sensitive care
  • be mindful of social attitudes, laws, economic circumstances and lived experiences of people
  • assess for co-existing mental health or other psychosocial concerns, especially for children with a chronic condition
  • refer to a social worker and psychologist to provide tools and skills for self care
  • with consent, work with families, schools, and communities to promote acceptance of gender diverse expressions of behaviour and identities of young people
  • frequently assess patients and carers for Depression or Anxiety disorders by using a self or clinician-rated mood scale. See Resource 2.
  • acknowledge any concerns and reassure the patient that good adherence to appropriate treatment can improve the symptoms of their condition
  • offer parents behavioural or attachment based support as children with chronic conditions often exhibit higher emotional and behavioural disturbances
  • ensure optimal coordination of services and communication with those with limited resources or ability to maintain contact e.g. outreach services
• Provide relevant support Resources 1–4.

4. References

• All Chronic Conditions Manual references are available via the downloadable References PDF

5. Resources

1. TransHUB information for clinicians and The Australian Professional Association for Trans Health
2. The DASS tool, the DASS scoring tool – The GAI-20 validated screening tool for older adults – The Hospital Anxiety and Depression Scale – The KICA-dep validated in Aboriginal and Torres Strait Islander communities available – The DMI-10 and K10 validated in people with chronic illnesses – The Geriatric Depression Scale–Short Form – The Edinburgh Postnatal Depression Scale
3. Beyondblue Coping with a serious health event: How to keep mentally well
4. Beyondblue: Chronic physical illness, anxiety and depression