ABSTRACT
Particularly in serious chronic medical conditions, where the patient's coping capacity and psychological integrity are severely tested, symptoms of anxiety and depression sometimes become indistinguishable features of the principal medical illness. These psychological distress states, although they do not formally qualify as diagnostic entities, nonetheless, are associated with a substantial degree of discomfort and significantly reduce quality of life. A study lending dramatic support to this observation was recently reported by Johnson, Weissman, and Klerman (1992), who found that levels of service burden and health impairment were as high or higher for individuals with subdiagnostic levels of depressive symptoms than for individuals receiving a diagnosis of major depression or dysthymic disorder. When such states coexist with a medical disorder, they frequently serve to further undermine the patient's sense of well-being and can in some instances subvert adherence to medical treatment regimens.
