Improving Wellbeing in Patients with Chronic Conditions: Theory, Evidence, and Opportunities

Overview

The global epidemiological transition is changing the nature of health and disease. Healthcare systems remain focused on dealing with acute conditions, yet chronic disease is associated with greater burden. Doctors often think of health as the absence of disease, yet chronic conditions are seldom curable. Chronic conditions are typically managed, not cured, yet the psychological wellbeing of patients with chronic conditions is seldom addressed by treating physicians. This is unfortunate considering that psychological distress contributes to premature mortality, and that psychiatric conditions can lead to reductions in life expectancy of up to 20 years. Loneliness – an epidemic of our age – is associated with an increase in risk of mortality that is equivalent to smoking 15 cigarettes a day. By contrast, positive psychological attributes including optimism and psychological wellbeing are associated with longevity, and positive relationships may have beneficial effects on health outcomes. It is possible therefore that patients with chronic conditions would benefit the most from interventions to improve psychological wellbeing, yet have fewer opportunities to experience them, leading to a downward spiral of negative emotion, social isolation, loneliness, and further ill-health.

According to salutogenic theory, patients with chronic disease who also have a sense of optimism, control over their life, purpose and meaning, capacity to overcome obstacles, and positive social ties might be considered healthy. These possibilities lead to important questions. Is it possible to flourish when one is also afflicted with chronic disease? Is it possible to flourish despite being physically ill? Might flourishing be more achievable in some conditions than others? Which interventions are the most effective? If mental wellbeing can be improved, are there subsequent beneficial effects on health outcomes?

Articles welcomed are broad in scope, but must be relevant to the research topic area. Conditions and diseases may include, but would not be limited to traumatic or acquired brain injury, common mental disorders, obesity, diabetes, cardiovascular disease, dementia, cancer, frailty, and disability. Articles on wellbeing in family caregivers of patients with chronic conditions would also be within the scope of this Research Topic. Original research on novel treatment approaches, including smartphone applications, would be of interest. Critical review articles on state-of-the-art approaches to improving health and wellbeing would be welcomed, as would be articles on biopsychosocial pathways to mental wellbeing.