Untangling cause and effect, though, can be very difficult. “We have shown that patients with sinus disease and depression have significantly worse sleep quality (88%) compared with patients with no depression,” said Dr. Alt. This is consistent with previous investigations, which have established a strong correlation between sleep dysfunction and depression, with depressed patients reporting diminished sleep quality, he added. “This is most likely a two-way street,” he said. “The relationship between disease severity, depression, and poor sleep is most likely bidirectional; disability predicts worse sleep and depression, which may then be a predictor of worse disease severity and quality of life.”
Explore This IssueApril 2014
Stigma Still Stings
Unfortunately, many patients and physicians avoid discussing mental health problems. “There are still a lot of people who believe that depression is kind of a weakness,” Dr. Lydiatt said.
“From a generational perspective, it’s only been relatively recently that it’s OK to talk about depression and mental health,” Dr. Buchmann said. He’s noticed that his older patients, in particular, are hesitant to consider depression. “I’ve had patients tell me, ‘I’m just weak. I can’t deal with this.’”
That kind of mindset may hinder patients’ health. Depression and anxiety are highly treatable conditions, but treatment hinges on appropriate diagnosis and treatment. Dr. Buchmann often experiences resistance when he suggests or refers patients for treatment of possible mental health conditions. “If I tell a patient, ‘You’ve got a heart problem. I need to send you to a cardiologist or start you on some medication,’ they’re all for it. “But if I say, ‘Hey, I don’t think your brain is working right; we need to maybe put you on some medicine,’ patients will say, ‘I don’t want to do that.’ We have to do a better job of demystifying mental health issues. We have to help patients understand that the brain is an organ, just like the heart and kidney.”
But many otolaryngologists don’t feel qualified to address patients’ mental health issues. Time is an ever-present limitation, as is lack of knowledge of mental health conditions. Those concerns, though, shouldn’t stop physicians from providing the care patients need. “You have to treat the whole patient,” Dr. Buchmann said.
Managing Mental Health
No one expects otolaryngologists to become mental health experts, but developing a series of strategies to manage patients’ mental health conditions can optimize their physical health and emotional well-being, while allowing you to efficiently manage your time.