Self-management in coexisting long-term conditions often becomes a survival task, not a supported plan
Adults living with both physical and mental health conditions described self-management as an ongoing negotiation with symptoms, services, and identity. In this qualitative study from the UK, eight community-dwelling adults with a physical long-term condition and coexisting anxiety or depression described a reality shaped less by formal support than by improvisation, persistence, and adaptation. The central problem was not a lack of motivation. It was the burden of trying to manage complex illness in a system that often treated each condition in isolation.
The interviews, conducted between May and August 2025 and analysed with Interpretative Phenomenological Analysis, produced a clear picture of cumulative strain. Participants did not describe self-management as a neat set of tasks carried out in a stable environment. They described it as layered work, where symptoms, emotional distress, service fragmentation, and social pressures collided. For many, the process of managing long-term illness was inseparable from trying to preserve a sense of identity and control.
One participant’s framing captured the emotional force of the study title: a wish to take back power. That aspiration sat against the practical reality of being repeatedly pushed into adaptation without adequate support.
Fragmented care left participants carrying the load alone
Three themes organized the findings: moving beyond sink or swim, self-managing as a choice or systemic exclusion, and unseen struggles in learning to live with long-term conditions. Together, they point to a model of care that often assumes capability where there is exhaustion, and resilience where there is depletion. Participants frequently described negative interactions with healthcare professionals, and those encounters shaped how willing they were to ask for help again.
A striking pattern emerged around responsibility. Self-management was often framed by services as an individual task, but participants experienced it as something they were compelled to absorb because coordinated support was limited. When mental health symptoms overlapped with physical illness, even routine tasks became harder to sustain. Medication routines, symptom monitoring, attendance at appointments, and lifestyle adjustments all had to compete with low mood, anxiety, and uncertainty about how each condition influenced the other.
The burden intensified when care plans did not acknowledge the interactions between conditions. Separate conversations for separate diagnoses left little room for the person holding them together. In clinical terms, this is where treatment burden becomes clinically important: the more fragmented the care, the more cognitive and emotional work is required from the patient before any intervention can deliver benefit.
Visibility, age, and identity shaped who received support
Participants also described how condition visibility altered the response they received from others. When illness was not obvious, support could be delayed or minimized. When symptoms were visible, others sometimes recognized need more quickly. Either way, visibility affected how much validation people received and how strongly they felt their struggles were believed.
Age added another layer. Experiences differed across the life course, but age-related assumptions could distort care in both directions. Some people felt overlooked because their distress was treated as ordinary coping difficulty rather than a serious interaction between long-term conditions. Others felt their needs were underestimated because they were expected to “manage” on their own. In both settings, the burden of explanation fell back on the patient.
Identity struggles threaded through the interviews as well. Living with coexisting long-term conditions meant constantly revising a sense of self around limitations, setbacks, and changing capacity. The language of self-management can sound empowering in policy documents, yet the interviews showed how fragile that empowerment becomes when people have little control over the structure of care. A short sentence from the study’s findings carries the clinical weight plainly: self-management was often experienced as exclusion.
Integrated support would need to treat the person, not the diagnosis list
The findings point toward a holistic scaffolded support model that links health and social needs rather than splitting them apart. That approach is especially relevant for people whose anxiety or depression alters energy, concentration, and follow-through on physical disease management. Integrated care is not simply a service preference; it is the mechanism by which treatment becomes realistically usable. When psychological distress and physical symptoms are addressed together, the patient is less likely to be forced into triage between competing demands.
The interviews also suggest that support needs to be flexible over time. Coexisting conditions do not behave like static entities. Symptoms fluctuate, priorities shift, and the practical tasks of self-management change with context. A rigid model that assumes one stable plan will miss much of the lived experience revealed here. Health professionals who respond to variation with adjustment rather than judgment are more likely to preserve engagement.
The study also exposes a common failure in chronic illness care: assuming that education alone solves the problem. Participants already understood they had to manage their conditions. What they lacked was reliable scaffolding, consistent relationships, and care that recognized the overlap between physical and mental health. Education without infrastructure simply relocates responsibility without relieving burden.
Small qualitative samples can still surface large clinical problems
This was a small interview study, with eight adults from the UK, so it cannot define prevalence or generalize numerically across all patients with coexisting long-term conditions. It does, however, expose a clinically familiar pattern with unusual clarity: when care systems fragment, self-management becomes harder, less equitable, and more emotionally costly. The use of in-depth interviews strengthened the ability to capture meaning, but the format cannot estimate how often these barriers occur or how they vary across different communities.
Even so, the implications for practice are difficult to ignore. Adults living with physical and common mental health conditions need support that is person-centred, flexible, and integrated enough to reflect the overlap between diagnoses. Service models that separate anxiety or depression from chronic physical illness risk missing the very interactions that drive poor self-management. In bedside terms, the study argues for a shift away from expecting patients to assemble fragmented care on their own and toward designing systems that do some of that work for them.