Asthma and serious psychological distress: prevalence and risk factors among US adults, 2001-2007

Anxiety and depression in asthma patients: impact on asthma control

OBJECTIVE

There is evidence that asthma is associated with an increase in psychiatric symptoms and mental disorders. This association can make it difficult to achieve asthma control. The purpose of this study was to determine whether the level of asthma control is associated with anxiety and depression.

METHODS

A crosssectional study involving 78 patients with confirmed moderate or severe asthma and under regular treatment at the Asthma Outpatient Clinic of the Federal University of São Paulo Hospital São Paulo, in the city of São Paulo, Brazil. The patients were divided into two groups by asthma control status, as assessed by the asthma control test, and were subsequently compared in terms of demographic, clinical, and spirometric data, as well as scores for asthma quality of life and hospital anxiety/depression.

RESULTS

The sample was predominantly female. Of the 78 patients, 49 (63%) were classified as having uncontrolled asthma. The prevalence of anxiety and of anxiety+depression was significantly higher among patients with uncontrolled asthma than among those with controlled asthma (78% and 100%; p = 0.04 and p = 0.02, respectively), whereas there were no differences between the two groups in terms of the prevalence of depression, spirometry results, or quality of life score.

CONCLUSIONS

In this sample, the prevalence of anxiety symptoms was higher in the patients with uncontrolled asthma than in those with controlled asthma.In the evaluation of asthma patients, the negative impact of mood states ought to be taken into consideration when asthma control strategies are being outlined.

Association of serious psychological distress with health services expenditures and utilization in a national sample of US adults

OBJECTIVE

The Kessler six-item scale has been shown to be a valid and reliable measure of serious psychological distress (SPD) in community samples. We examined the effect of SPD on health service expenditures and utilization for seven categories in a national probability sample of community dwelling adults in the United States.

METHODS

We used the two-step sample selection model to examine the association between SPD and total, office-based, outpatient, emergency department (ED), inpatient, dental, home health and prescription expenditures and utilization in 18,330 US adults who participated in the 2007 Medical Expenditure Panel Survey (MEPS).

RESULTS

SPD was significantly associated with $1735 ( 95% CI: $702-2769) higher total expenditures, $285 higher office expenditures ( 95% CI: $30-539), $183 higher ED expenditures (95% CI: $64-303), $282 (95% CI: $62-503) higher home health expenditures, $614 (95% CI: $403-825) higher prescription expenditures and $41 (95% CI: -$103 to $22) lower dental expenditures. SPD was associated with 3.09 (95% CI: 2.09-4.08) more office visits, 0.27 (95% CI: 0.17-0.36) more ED visits, 0.84 (95% CI: 0.36-1.32) more inpatient visits, 2.93 (95% CI: 0.13-5.70) more home health visits, 8.13 (95% CI: 6.08-10.18) more prescriptions and 0.18 (95% CI: -0.30 to -0.07) less dental visits.

CONCLUSIONS

Among US adults, SPD is associated with significant increases in total expenditures and most other categories of expenditure and utilization. Targeted interventions to mitigate the adverse effects of SPD are needed.

[Asthma control. Possible obstacles along the way]

With current therapeutic regimens, asthma should be well controlled in most patients. However, although asthma-related hospital admissions and mortality have decreased, the potential efficacy of treatments is not translating into optimal asthma control and quality of life. This discrepancy may be due to several factors and is complex to analyze. Poor asthma control can be caused by diverse reasons such as the patient's failure to understand how to take the medication, the presence of an untreated, underlying comorbid condition that aggravates the asthma, and the possibility that the patient has a severe form of glucocorticosteroid-insensitive asthma. The present article reviews the situations in which poor asthma control occurs for human-related reasons. These situations can be due to patients themselves and be independent of the disease or can be due to inadequate intervention by health professionals in specific areas and circumstances linked to asthma. A small but important group of patients with asthma is also analyzed; in this group, the asthma per se is severe and is refractory to routine treatments.

The role of income in reducing racial and ethnic disparities in emergency room and urgent care center visits for asthma-United States, 2001-2009

OBJECTIVE

To examine racial/ethnic disparities and associated factors in asthma-related emergency room (ER) and urgent care center (UCC) visits among US adults and determine whether disparities vary across increasing income strata.

METHODS

We analyzed data from 238,678 adult respondents from the 2001 to 2009 National Health Interview Survey and calculated the weighted annual prevalence of an ER/UCC visit for persons with current asthma. We used logistic regression to calculate adjusted odds ratios (AORs) for asthma-related ER/UCC visits by race/ethnicity and income, adjusting for demographics, socioeconomic, and other health-related factors.

RESULTS

The average annual prevalence of asthma-related ER/UCC visits among adults with current asthma was highest for Puerto Ricans (24.8%, 95% confidence interval [CI]: 20.3-29.9) followed by non-Hispanic American Indian/Alaskan Natives (22.1%, 95% CI: 14.4-32.4), non-Hispanic blacks (20.4%, 95% CI: 18.5-22.4), other Hispanics (17.3%, 95% CI: 15.0-19.9), Asians (11.0%, 95% CI: 7.8-15.4), and non-Hispanic whites (10.1%, 95% CI: 9.4-10.9). Puerto Ricans (AOR: 2.01; 95% CI: 1.54-2.62), non-Hispanic blacks (AOR: 1.72; 95% CI: 1.46-2.03), and other Hispanics (AOR: 1.55; 95% CI: 1.25-1.92) with current asthma had significantly higher odds of an asthma-related ER/UCC visit than non-Hispanic whites. Lower socioeconomic status, obesity, and serious psychological distress were also associated with higher odds of asthma-related ER/UCC visits. Puerto Ricans with the lowest income (AOR: 3.52; 95% CI: 2.27-5.47), non-Hispanic American Indian/Alaskan Natives with the highest income (AOR: 5.71; 95% CI: 1.48-22.13), and non-Hispanic blacks in every income stratum had significantly higher odds of asthma-related ER/UCC visits compared to non-Hispanic whites in the highest income stratum.

CONCLUSIONS

Racial/ethnic disparities in asthma-related ER/UCC visits persist after accounting for income and other socioeconomic factors. Further research is needed to identify modifiable risk factors directly associated to race/ethnicity to decrease the asthma burden on minority populations.

Anxiety and depression in asthma

PURPOSE OF REVIEW

there is growing awareness of the correlation between psychological factors, the course of asthma, and the outcomes of asthma treatment. However, the implications of this correlation are still poorly understood. Here, we review the role of anxiety and depression in asthma with a focus on recent literature.

RECENT FINDINGS

recent studies suggest an interaction between behavioral, neural, endocrine, and immune processes and suggest that psychological factors play an active role in the genesis of asthma. Notably, the role of chronic stress has been investigated, including the parental psychological state during pregnancy. There is evidence that in patients with asthma, such stress may induce hyporesponsiveness of the hypothalamus-pituitary-adrenal axis, resulting in reduced cortisol secretion.

SUMMARY

even though it is generally accepted that anxiety and depression are more common in asthmatic patients and that there is a close correlation between psychological disorders and asthma outcomes, such as poorer control of asthma symptoms, the implications and practical consequences of this link remain weak. New studies are introducing an intriguing model of the links between emotional stress, brain centers, the immune system, and the hypothalamus-pituitary-adrenal axis that is far removed from the original concept of 'asthma nervosa'.

Psychiatric comorbidity in asthma patients. Associated factors

OBJECTIVE

To study the prevalence of anxiety and depression in patients with asthma and to identify associated factors.

MATERIAL AND METHODS

The study was based on individual data of subjects aged ≥18 years drawn from the 2006 Spanish National Health Survey. We identified asthmatic individuals through a specific questionnaire. Presence of depression or anxiety was assessed using the following questions: ( 1 ) "Have you suffered depression or anxiety over the previous 12 months?" ( 2 ) "Has your medical doctor confirmed the diagnosis?" ( 3 ) "Have you consumed antidepressants prescribed by your physician over the last 2 weeks?" ( 4 ) "Have you consumed anxiolytics prescribed by your physician over the last 2 weeks?" Those who answered yes to questions 1, 2, and 3 or to all questions were considered "Depression sufferers," those who answered yes to questions 1, 2, and 4 were considered "Anxiety sufferers." We analyzed sociodemographic characteristics and health-related variables.

RESULTS

Of the 28,966 subjects included in the study, 1650 were classified as asthmatic (5.6%). The prevalence of anxiety was 9.7% among people with asthma and 6.6% among those without the disease (p < .01). After multivariate adjustment the probability of a subject suffering anxiety was 1.27 (95% CI 1.08-1.49) higher among those with asthma than among those without. Independent and significantly associated variables with anxiety among asthmatic patients were older age, concomitant comorbidities, and visits to general practitioner in the last 4 weeks. The prevalence of depression was 9% among asthmatics and 5.5% among those without the disease (p < .05). The multivariate adjustment revealed that suffering depression was associated with suffering asthma (adjusted OR 1.39, 95% CI 1.18-1.64). Variables associated with depression among asthmatic patients were female sex, older age, worse self-related health, concomitant comorbidities, abstemious individuals, and the need for attendance on emergency room in the last year.

CONCLUSIONS

Suffering anxiety or depression is associated with suffering asthma. Associated variables with anxiety or depression among asthmatic patients include older age and concomitant comorbidities.

Parental psychosocial stress and asthma morbidity in Puerto Rican twins

BACKGROUND

Little is known about paternal psychosocial factors and childhood asthma.

OBJECTIVE

We sought to examine the link between maternal and paternal psychosocial stress and asthma outcomes in young children.

METHODS

Parents of 339 pairs of Puerto Rican twins were interviewed individually about their own psychosocial stress and about asthma in their children at age 1 year and again about their child's asthma at age 3 years. Fathers were asked about symptoms of posttraumatic stress disorder (PTSD), depression, and antisocial behavior. Mothers were asked about depressive symptoms. Outcomes assessed in children included recent asthma symptoms, oral steroid use and hospitalizations for asthma in the prior year, and asthma diagnosis. Generalized estimated equation models were used for the multivariate analysis of parental psychosocial stress and asthma morbidity in childhood.

RESULTS

After multivariable adjustment, paternal PTSD symptoms, depression, and antisocial behavior were each associated with increased asthma symptoms at age 1 year (eg, odds ratio, 1.08 for each 1-point increase in PTSD score; 95% CI, 1.03-1.14). Maternal depressive symptoms were associated with an increased risk of asthma hospitalizations at age 1 year. At age 3 years, maternal depressive symptoms were associated with asthma diagnosis and hospitalizations for asthma (odds ratio for each 1-point increase in symptoms, 1.16; 95% CI, 1.00-1.36). In an analysis combining 1- and 3-year outcomes, paternal depression was associated with oral steroid use, maternal depressive symptoms were associated with asthma hospitalizations and asthma diagnosis, and parental depression was associated with hospitalizations for asthma.

CONCLUSIONS

Both paternal and maternal psychosocial factors can influence asthma morbidity in young Puerto Rican children.