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Alonso J, de Jonge P, Lim CCW, Aguilar-Gaxiola S, Bruffaerts R, Caldas-de-Almeida JM, Liu Z, O'Neill S, Stein DJ, Viana MC, Al-Hamzawi AO, Angermeyer MC, Borges G, Ciutan M, de Girolamo G, Fiestas F, Haro JM, Hu C, Kessler RC, Lépine JP, Levinson D, Nakamura Y, Posada-Villa J, Wojtyniak BJ, Scott KM. Association between mental disorders and subsequent adult onset asthma. J Psychiatr Res 2014; 59:179-88. [PMID: 25263276 PMCID: PMC5120389 DOI: 10.1016/j.jpsychires.2014.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 07/18/2014] [Accepted: 09/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. METHODS During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. RESULTS 1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR = 1.8; 95%CI 1.3-2.5), panic (OR = 1.4; 95%CI 1.0-2.0), generalized anxiety (OR = 1.3; 95%CI 1.1-1.7), specific phobia (OR = 1.3; 95%CI 1.1-1.6); post-traumatic stress (OR = 1.5; 95%CI 1.1-1.9); binge eating (OR = 1.8; 95%CI 1.2-2.9) and alcohol abuse (OR = 1.5; 95%CI 1.1-2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). CONCLUSIONS A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain.
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Carmen C W Lim
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - Sergio Aguilar-Gaxiola
- University of California, Davis, Center for Reducing Health Disparities, School of Medicine, Sacramento, CA, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC - KUL), Leuven, Belgium
| | - Jose Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, PR China
| | - Siobhan O'Neill
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Derry, Northern Ireland, UK
| | - Dan J Stein
- University of Cape Town, Department of Psychiatry & Mental Health, Groote Schuur Hospital, Cape Town, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | | | - Guilherme Borges
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry (Mexico) and Metropolitan Autonomous University, Mexico City, Mexico
| | - Marius Ciutan
- National School of Public Health and Professional Development, Bucharest, Romania
| | | | - Fabian Fiestas
- Evidence Generation for Public Health Research Unit, National Institute of Health, Lima, Peru
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; CIBER de Salud Mental (CIBERSAM), Spain; University of Barcelona, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Jean Pierre Lépine
- Hôpital Saint-Louis Lariboisière Fernand Widal, INSERM U 705, CNRS UMR 8206, Paris, France
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi-ken, Japan
| | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, CALLE 28 No. 5B-02, Bogota, DC, Colombia
| | - Bogdan J Wojtyniak
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Kate M Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
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Blakemore A, Dickens C, Anderson R, Tomenson B, Woodcock A, Guthrie E. Complex interventions reduce use of urgent healthcare in adults with asthma: systematic review with meta-regression. Respir Med 2014; 109:147-56. [PMID: 25433953 DOI: 10.1016/j.rmed.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/15/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Asthma accounts for considerable healthcare expenditure, a large proportion of which is attributable to use of expensive urgent healthcare. This review examines the characteristics of complex interventions that reduce urgent healthcare use in adults with asthma. METHOD Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane library, from inception to January 2013 were conducted. Studies were eligible for inclusion if they: i) included adults with asthma ii) assessed the efficacy of a complex intervention using randomised controlled trial design, and iii) included a measure of urgent healthcare utilisation at follow-up. Data on participants recruited, methods, characteristics of complex interventions and the effects of the intervention on urgent healthcare use were extracted. RESULTS 33 independent studies were identified resulting in 39 comparisons altogether. Pooled effects indicated that interventions were associated with a reduction in urgent healthcare use (OR = 0.79, 95% CI = 0.67, 0.94). When study effects were grouped according to the components of the interventions used, significant effects were seen for interventions that included general education (OR = 0.77, 95% CI = 0.64, 0.91), skills training (OR = 0.64, 95% CI = 0.48, 0.86) and relapse prevention (OR = 0.75, 95% CI = 0.57, 0.98). In multivariate meta-regression analysis, only skills training remained significant. CONCLUSIONS Complex interventions reduced the use of urgent healthcare in adults with asthma by 21%. Those complex interventions including skills training, education and relapse prevention may be particularly effective in reducing the use of urgent healthcare in adults with asthma.
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Affiliation(s)
- Amy Blakemore
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK; National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Chris Dickens
- Institute of Health Research, University of Exeter Medical School and Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Room 007, Salmon Pool Lane, Exeter, EX2 4SG, UK
| | - Rebecca Anderson
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Barbara Tomenson
- Biostatistics Unit: Institute of Population Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Ashley Woodcock
- Institution of Inflammation and Repair, University of Manchester, 2nd Floor Education and Research Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - Else Guthrie
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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53
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Baptist AP, Hamad A, Patel MR. Special challenges in treatment and self-management of older women with asthma. Ann Allergy Asthma Immunol 2014; 113:125-30. [PMID: 25065349 DOI: 10.1016/j.anai.2014.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Center for Managing Chronic Disease, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Ahmad Hamad
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Minal R Patel
- Center for Managing Chronic Disease, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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Leander M, Lampa E, Rask-Andersen A, Franklin K, Gislason T, Oudin A, Svanes C, Torén K, Janson C. Impact of anxiety and depression on respiratory symptoms. Respir Med 2014; 108:1594-600. [PMID: 25282543 DOI: 10.1016/j.rmed.2014.09.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/03/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
Abstract
Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20-44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33-1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.
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Affiliation(s)
- Mai Leander
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
| | - Erik Lampa
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Rask-Andersen
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Karl Franklin
- Surgical and Perioperative Sciences, Department of Surgery, Umeå University,Umeå Sweden
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Anna Oudin
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Sweden
| | - Cecilie Svanes
- Bergen Respiratory Research Group, Institute of Medicine, University of Bergen and Department of Occupational Medicine, Haukeland University Hospital Bergen, Bergen, Norway
| | - Kjell Torén
- Section of Occupational and Environmental Medicine University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
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Liu S, Wu R, Li L, Liu L, Li G, Zhang X, Guo Y, Wang Y, Zhang H, Li G, Li H. The prevalence of anxiety and depression in Chinese asthma patients. PLoS One 2014; 9:e103014. [PMID: 25054657 PMCID: PMC4108371 DOI: 10.1371/journal.pone.0103014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 06/25/2014] [Indexed: 12/30/2022] Open
Abstract
It is well documented that the psychiatric disorders are common in Asthma patients in China while the studies on the relationship between asthma control and psychological disorder are comparatively rare. We therefore performed a cross-sectional study on asthmatic outpatients in one Chinese tertiary center to investigate the correlation among asthma, anxiety and depression. Demographic data, anxiety and depression scores, the level of asthma control were collected in 261 patients. All patients were evaluated with Asthma Control Test (ACT), Self-Rating Anxiety Scale (SAS) and Self-rating depression scale (SDS) questionnaires. A multivariate analysis was performed to investigate the relationship between asthma control and psychological disorder. The result showed that 31 asthma patients had anxiety symptom while thirty-five asthma patients had depression. One hundred and ninety-two asthma patients were well controlled and 69 patients were not. The study found a negative correlation between ACT and SAS(r = -0.231, p<0.001) as well as ACT and SDS(r = -0.23, p<0.001) and depression (OR: 12.295, 95%CI: [5.374-28.128], p<0.001) were both independently associated with poor asthma control. We concluded that Asthma control is greatly affected by psychological disorder in Chinese patients.
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Affiliation(s)
- Shigang Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruohan Wu
- Beijing University of Chinese Medicine, Beijing, China
| | - Lei Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoqin Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xia Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuyan Guo
- Beijing University of Chinese Medicine, Beijing, China
| | - Yinghui Wang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hong Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guangxi Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Hui Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Kapadia SG, Wei C, Bartlett SJ, Lang J, Wise RA, Dixon AE. Obesity and symptoms of depression contribute independently to the poor asthma control of obesity. Respir Med 2014; 108:1100-7. [PMID: 24947900 DOI: 10.1016/j.rmed.2014.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/23/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
Abstract
UNLABELLED Obesity is a major risk factor for poorly controlled asthma, but the reasons for poor asthma control in this patient population are unclear. Symptoms of depression have been associated with poor asthma control, and increase with higher body mass index (BMI). The purpose of this study was to assess whether depressive symptoms underlie poor asthma control in obesity. METHODS We determined the relationship between BMI, psychological morbidity and asthma control at baseline in a well-characterized patient population participating in a clinical trial conducted by the American Lung Association-Asthma Clinical Research Centers. RESULTS Obese asthmatic participants had increased symptoms of depression (Center for Epidemiologic Studies Depression Scale score in lean 10.1 ± 8.1, overweight 10.0 ± 8.1, obese 12.4 ± 9.9; p = 0.03), worse asthma control (Juniper Asthma Control Questionnaire score in lean 1.43 ± 0.68, overweight 1.52 ± 0.71, obese 1.76 ± 0.75; p < 0.0001), and worse asthma quality of life (scores in lean 5.21 ± 1.08, overweight 5.08 ± 1.05, obese 4.64 ± 1.09; p < 0.0001). Asthmatics with obesity and those with symptoms of depression both had a higher risk of having poorly controlled asthma (adjusted odds ratio of 1.83 CI 1.23-3.52 for obesity, and 2.08 CI 1.23-3.52 for depression), but there was no interaction between the two. CONCLUSION Obesity and symptoms of depression are independently associated with poor asthma control. As depression is increased in obese asthmatics it may be an important co-morbidity contributing to poor asthma control in this population, but factors other than depression also contribute to poor asthma control in obesity.
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Affiliation(s)
- S G Kapadia
- University of Vermont College of Medicine, Burlington, VT, USA
| | - C Wei
- Johns Hopkins University, Baltimore, MD, USA
| | | | - J Lang
- Nemours Children's Hospital, Orlando, FL, USA
| | - R A Wise
- Johns Hopkins University, Baltimore, MD, USA
| | - A E Dixon
- University of Vermont College of Medicine, Burlington, VT, USA.
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57
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Asthma and depression: the Cooper Center Longitudinal Study. Ann Allergy Asthma Immunol 2014; 112:432-6. [PMID: 24650441 DOI: 10.1016/j.anai.2014.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Prior research suggests a possible association between asthma and depression. OBJECTIVE To examine the association between asthma and depressive symptoms, controlling for asthma medications, lung function, and overall health. METHODS We conducted a cross-sectional study of 12,944 adults who completed physician-based preventive health examinations at the Cooper Clinic from 2000 to 2012. Information on medical histories, including asthma and depression, and medications were collected. Participants reported overall health status, completed spirometry testing, and underwent depression screening using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Dependent variables of current depressive symptoms (CES-D scores ≥10) and lifetime history of depression were separately modeled using logistic regression with independent variables, including demographics, spirometry, asthma controller medications, and patient-reported health status. RESULTS The sample was predominantly white and well educated. The prevalence of asthma was 9.0%. Asthma was associated with an odds ratio (OR) of 1.41 (95% CI, 1.16-1.70; P < .001) of current depressive symptoms based on CES-D score. Asthma was also associated with lifetime history of depression (OR, 1.66; 95% CI, 1.40-1.95; P < .001). Neither lung function nor asthma controller medications were significantly associated with depression. CONCLUSION Asthma was associated with increased prevalence of current depressive symptoms and lifetime depression in a large sample of relatively healthy adults. These findings suggest that the increased likelihood of depression among patients with asthma does not appear to be exclusively related to severe or poorly controlled asthma. People with asthma, regardless of severity, may benefit from depression screening in clinical settings.
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58
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Coogan PF, Yu J, O'Connor GT, Brown TA, Palmer JR, Rosenberg L. Depressive symptoms and the incidence of adult-onset asthma in African American women. Ann Allergy Asthma Immunol 2014; 112:333-8.e1. [PMID: 24440322 DOI: 10.1016/j.anai.2013.12.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/11/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Some evidence suggests that depression may increase the risk of adult-onset asthma. No data are available for African American women, in whom the prevalence of depression and asthma is high. OBJECTIVE To conduct prospective analyses of the relation of depressive symptoms to asthma incidence in the Black Women's Health Study, a prospective cohort of US black women followed since 1995 with mailed biennial questionnaires. METHODS Of 31,848 participants followed from 1999 to 2011, 771 reported incident asthma. Depressive symptoms were ascertained on 1999 and 2005 follow-up questionnaires with the Center for Epidemiological Studies-Depression Scale (CES-D). Participants rated the frequency of 20 symptoms. A score was calculated by summing the responses to all questions. Cox regression models were used to derive incidence rate ratios and 95% confidence intervals for 4 categories of the CES-D score in relation to incident asthma, adjusted for body mass index, smoking, and other covariates. RESULTS The multivariable incidence rate ratio in the highest category of CES-D score (≥ 33) compared with the lowest (<16) was 2.08 (95% confidence interval 1.58-2.74), with a significant trend (P < .0001). The incidence rate ratio was higher in women who took antidepressants, were current or former smokers, were not obese, and were at least 40 years old, although there were no statistically significant interactions. CONCLUSION A positive association was observed between CES-D score and the incidence of adult-onset asthma. If the hypothesis is confirmed, depression could contribute substantially to the burden of asthma in adults.
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Affiliation(s)
- Patricia F Coogan
- Slone Epidemiology Center at Boston University, Boston, Massachusetts.
| | - Jeffrey Yu
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Timothy A Brown
- Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
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