There is no business in long-term illness. Patients with chronic diseases are much more likely to suffer from depression compared to healthy individuals. They are sensitive to even minor stress. The pain of the patient quickly infects the family living together. Patients with chronic diseases desperately need help from their surroundings. However, as the duration of illness increases, conflicts often arise with family members who are exhausted from caregiving. Minor arguments can escalate into neglect and violence. Both the patient and the family fall into a vicious cycle of depression.
Professor Park Eun-cheol of the Department of Preventive Medicine at Yonsei University said, "As the number of patients with chronic diseases increases, conflicts with families exhausted from caregiving lead to serious depression in our society, but the government's role is hardly visible."
Chronic diseases were once referred to as diseases of developed countries. There was a dominant perception that these diseases, caused by excessive nutrition, a Western diet, and lack of exercise, were only likely to occur in wealthy nations. It has been nearly 50 years since chronic diseases began to be a problem domestically. Professor Park stated, "Since the mid-1970s, the number of deaths from chronic diseases started to exceed those from acute diseases in Korean society."
During difficult times, healthcare focused on patients who were immediately at risk of dying. Thanks to this, Korean medicine has earned a reputation for effectively treating illnesses despite its short history. There are several fields, such as stroke treatment and stomach cancer treatment, where Korea competes for the top ranks globally.
However, being ill is not just about physical pain. The patient's mind also becomes ill. Ailing bodies consume the soul and can ruin an individual's social relationships in an instant. Professor Park noted, "While it is true that Korean medicine has quickly addressed life-and-death situations, it has long neglected areas requiring mental health and emotional care."
The stigma and attitudes toward mental illness illustrate this. Many patients still end their lives in extreme ways due to social neglect and loneliness. The burden of caregiving for chronic diseases is no different. Caregivers, exhausted from long-term caregiving, often report 'caregiver murder' incidents where they end the patient's life and take extreme actions themselves, driven by the compounded burdens of caregiving and financial stress. Professor Park said, "Our society's attention to the social isolation of patients and their families is not sufficient."
Professor Park argues that chronic diseases are not just a problem for specific individuals. As one ages and loses vascular elasticity, the incidence of hypertension, which was 15% in their 30s, rises above 50% in their 60s. The same goes for diabetes. He stated that the increase in the elderly population is concerning, especially in a situation where the caregiving system is already lacking. Most elderly individuals suffer from at least 2 to 3 different diseases.
Professor Park mentioned that he is also a chronic disease patient suffering from hypertension. However, unlike himself, who has accepted it as part of daily life, most patients have a significantly higher probability of suffering from depression. Many fall into deeper depression without resolving conflicts with their families while physically ill and mentally exhausted. Family members caring for patients also experience emotional pain after living in a state of high stress and tension for long periods, similar to the patients. While they sometimes understand and care for each other, they may also become desensitized, and minor misunderstandings can escalate into violence.
Recently, warnings about the burdens felt by families caring for patients with chronic diseases have continued. The Ministry of Health and Welfare disclosed in March that nearly half (45.8%) of families of dementia patients, a representative chronic disease, feel caregiving burdens. Professor Park introduced findings from a study conducted on March 16 with residents of military conscription, including researcher Kim Joon-young (army captain), published in the journal PLOS ONE, which explored how resolving conflicts between chronic disease patients and their families impacts depression.
The research team investigated how the 10,969 patients suffering from 32 of the most common chronic diseases among Koreans, including hypertension, arthritis, acute diseases, and diabetes, resolved conflicts with their families between 2012 and 2022.
Among the patients, nearly half (47%) reported maintaining the same level of conflict as a year ago, or that their family relationships had worsened. Conflicts with families appear in various forms, such as frequent disagreements, throwing objects, arguments, accusations, and violence. Patients who experience negative methods of resolving family conflicts or continue having conflicts are at high risk of falling into depression.
Professor Park stated, "Patients who have led ordinary lives are more vulnerable to conflicts with their families." Men, compared to women, those living in urban areas, and individuals with higher educational levels tend to feel more depressed if they fail to resolve family conflicts. Individuals with average incomes, office workers who commute daily, and patients who consider their health generally good are more likely to fall into deep depression if they cannot properly resolve conflicts.
Careless words and physical violence leave wounds that are difficult to heal. Patients who experience ongoing arguments and domestic violence are at high risk of developing depression. Professor Park commented, "Patients who have experienced even a single instance of negative conflict resolution show much higher levels of depression compared to patients who have maintained harmonious relationships with their families."
Communication, cooperation, and support among family members can be vital in overcoming depression. Such positive conflict resolution methods have clear effects in reducing depression. A calm and respectful attitude is important.
However, there are limitations to placing all responsibility on patients and their families. As of 2019, the number of chronic disease patients in Korea is estimated to have reached 18.8 million. The total for the three major chronic diseases—hypertension, diabetes, and hyperlipidemia—was 14 million in 2023. Professor Park warned against placing the entire responsibility for patient care on families, especially with the increasing elderly population and chronic disease patients.
He also stated, "Some local governments are piloting programs through health centers to reduce the burden on patient families, and it is time to discuss expanding these programs and giving clearer roles to doctors, similar to the primary care physician system."
- Is conflict between patients and their families inevitable?
"Compared to hypertension or diabetes, patients with strokes or dementia have a severely reduced ability to move, making it frustrating for them and exceedingly difficult for caregivers. Let's assume a situation where a person with diabetes has a piece of cake. How concerned would they be? Diabetes can lead to severe consequences such as blindness, amputations, and kidney dialysis, which can be burdensome. Since they live together, conflicts can often arise. If conflicts are not resolved well, there’s a high likelihood of leading to depression or other psychiatric issues."
- Is management of chronic disease patients a problem in other countries as well?
"In other countries, once someone has a chronic disease, family relationships are unlikely to improve. Chronic diseases pose a crisis in family dynamics. There is a strong recognition that one cannot entirely rely on families. For this to not occur, society must take some responsibility, and the government must provide the insufficient resources. Religious organizations also play a part."
- Can you give examples of model countries for managing chronic disease patients?
"Even if they are not perfect, countries like the UK and Nordic countries, which have family and personal primary care physician systems, are worth examining. Some other European countries also follow similar approaches to the UK. In Korea, there are patients who discreetly have a regular doctor. However, the essential duties that primary care physicians should fulfill are still not clearly defined."
- What is Korea's management system like?
"Several health centers have been piloting programs to provide short-term care for families of stroke patients who are struggling. In Korea, most caregiving is shouldered by families, which can cause significant stress. Therefore, programs are being operated to reduce stress, including organizing trips for caregivers. Management should be centered around local clinics."
- It seems that Korean society has a culture where family conflicts are not easily resolved.
"There seems to be a gradual change, as generational cultural differences are evident."
- The relationship between chronic diseases and depression is well-known. What did this research focus on?
"Suffering from chronic diseases leads to conflicts with caregiving families, ultimately exacerbating depression. We investigated how much worse the condition of a patient deteriorates with damaged family relationships, as well as whether the depression significantly improves with relationship improvements."
- Maintaining good relationships with families seems important for patients' mindsets.
"In the past, many patients diagnosed with hypertension often neglected to take medications. They tried to postpone the start of medication, which must be taken for their lifetime. The daily intake itself was burdensome. However, if one thinks of it as taking a vitamin every day, there would be no reason to feel depressed. I myself have had hypertension since my early to mid-40s, and I have rarely felt depressed after changing my outlook."
- The reason ordinary people feel more depressed when they cannot resolve family conflicts.
"Who doesn’t have conflicts? However, just as throwing a stone in calm water creates higher ripples, those leading ordinary, stable lives may find it harder to cope. Those with difficult circumstances may experience numerous conflicts and perceive family conflicts as just another addition. On the other hand, individuals living ordinary lives may have a harder time accepting such conflicts. However, more thorough research is needed."
- What medical systems can alleviate the caregiving burden on families?
"In Africa, it is said that a village raises a child. A system where society supports families caring for patients needs to be established. It would be beneficial to consider a primary care physician system centered around local clinics. It is essential to give roles to doctors and manage this effectively. There’s no need for only family medicine to handle it; even inviting doctors who want to participate and providing them with 8 hours of education a few times would suffice."
- How should this be pursued?
"It should be done by piloting several programs and spreading successful models. There is a successful case from the Obama administration in the U.S. that created a Medical Innovation Center in 2010. If the idea is valid, funding can be secured afterward. The issue arises when we try to implement pilot programs from a top-down approach by the government."
- What aspects should the government or local governments focus on?
"When problems arise, we either immerse ourselves in solving them or neglect them. If you punch a painful spot, you forget the pain. Similar support is needed for patients, helping them find enjoyable ways to live, such as exercising together or finding ways for family members to temporarily forget their caregiving burdens. Until now, chronic diseases have mostly been viewed from the patient's perspective, but now efforts to care for the families who provide care are also needed."
- Where urgently needed support should be directed.
"Hypertension and diabetes require relatively less assistance from families. In contrast, family members of patients with severe mobility issues, like dementia or strokes, face more physical and mental challenges. We should prioritize helping these families."
- Isn't it difficult to support all patient families?
"Some chronic diseases can see considerable reductions in burden with good preemptive management. For instance, arthritis patients can benefit greatly from effective treatment, and even if mobility is compromised, having handrails on stairs can allow them to move independently without needing much support. This can significantly reduce the burden on families."
- How should we manage chronic disease patients in the era of one-person households?
"Patients who cannot be cared for by families should indeed be cared for by society. It is not easy for the state to look after every individual. However, while the central government manages defense, foreign policies, and the economy, local governments should feel responsible for managing sick individuals as much as they do for local economic issues. The government should lay down the infrastructure and support local governments in taking on this responsibility."
- Are there any aspects that require more attention in the future?
"Anxiety. Depression and anxiety seem similar at a glance, but they are different. Panic disorder is at the end of anxiety disorders. Research on family caregiving for mental illness patients is also necessary, as it is almost a blind spot."
References
PLOS ONE (2025), DOI: https://doi.org/10.1371/journal.pone.0318378