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Chen VCH, Wang TN, Kuo CJ, Yang YH, Lee CP, Stewart R, Wu SI. Associations of asthma and psychiatric comorbidities on suicide mortality among community adolescents: A 20-year cohort study. Psychiatry Res 2024; 340:116087. [PMID: 39182318 DOI: 10.1016/j.psychres.2024.116087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND The role of psychiatric comorbidity as a confounder between asthma and subsequent suicide mortality in adolescents remained unclarified. METHODS This study used a 20-year community-based cohort in Taiwan. Adolescents aged 11 to 16 from 123 schools were classified into three subgroups: current asthma (symptoms present in the past year), previous asthma (history of asthma but no symptoms in the past year), and no asthma. The mortality and medical care utilizations until the end of follow-up in 2015 were obtained. Cox proportional hazard and competing risk models were performed. Different adjustment models that included covariates of demographic status, allergy, cigarette smoking, psychiatric diagnoses, alcohol or substance misuse, and attention deficit and hyperactivity disorders were compared. RESULTS During the follow-up, 285 out of 153,526 participants died from suicide. The crude hazard ratio for suicide was 1.95 (95 % CI=1.46∼2.60) in the current asthma subgroup and 2.01 (1.36∼2.97) in the previous asthma subgroup. The adjusted hazard ratios (aHR) attenuated to 1.67 (1.25∼2.24) and 1.72 (1.16∼2.54) respectively after further adjustment for all mental disorders, ADHD, substance, and alcohol use disorders. CONCLUSIONS Our adjustment analyses stratified by different models highlight evidence of asthma as an independent risk factor that predicts suicide among adolescents. Depression and mental disorders were potential confounders and identifications of asthma and psychiatric disorders might help decrease suicide risk.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Center of Excellence for Chang-Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuan-Pin Lee
- Center of Excellence for Chang-Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Shu-I Wu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Section of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan.
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2
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Sheykhi M, Pourvali A, Ghandi Y, Alaghmand A, Zamanian M, Eslambeik T, Tajerian A. Exploring the relationship between asthma, its severity and anxiety symptoms in pediatric patients: a case-control study. J Asthma 2024; 61:491-500. [PMID: 38009701 DOI: 10.1080/02770903.2023.2289158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/25/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Asthma is a global health concern, especially among children, and is associated with various underlying mechanisms. Childhood exposure to early life stress and anxiety can potentially exacerbate asthma symptoms and complicate its management. While some studies have suggested the benefits of psychological therapies as adjuncts to medication in asthma management, evidence remains inconsistent, emphasizing the need for rigorous evaluation. METHOD This case-control study involved 120 children aged 5-15, with 60 children having asthma and 60 healthy controls. Asthma severity was assessed based on EPR3 guidelines, while anxiety symptoms were measured using the Spence Children's Anxiety Scale (SCAS). Demographic data and asthma-related information were collected via questionnaires. Statistical analyses were conducted to explore the relationship between asthma and anxiety. RESULTS Children with asthma exhibited significantly higher anxiety symptoms compared to those without asthma (p < 0.001). Subdomain analysis revealed elevated scores in separation anxiety (SA; p = 0.025), social phobia (SP; p < 0.001), agoraphobia (p = 0.004), and fears of physical injury (p < 0.001) in children with asthma. Furthermore, increased need for SABA, frequency of nocturnal symptoms, and asthma severity were associated with higher anxiety levels in pediatric asthma patients. CONCLUSIONS This study highlights a significant association between asthma and heightened anxiety symptoms in children, particularly in domains, such as SA, SP, agoraphobia, and fears related to physical injury. However, limitations include reliance on self-evaluation questionnaires and the observational nature of the study, emphasizing the need for cautious interpretation.
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Affiliation(s)
- Mahdi Sheykhi
- School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Ali Pourvali
- Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Yazdan Ghandi
- Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Anita Alaghmand
- Department of Psychiatry, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Zamanian
- Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
| | - Tina Eslambeik
- School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Amin Tajerian
- School of Medicine, Arak University of Medical Sciences, Arak, Iran
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3
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Gaffin JM, Castro M, Bacharier LB, Fuhlbrigge AL. The Role of Comorbidities in Difficult-to-Control Asthma in Adults and Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:397-408. [PMID: 34863928 PMCID: PMC8837696 DOI: 10.1016/j.jaip.2021.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023]
Abstract
Assessment of asthma comorbidities, conditions that adversely affect the pathobiology of asthma or impair its response to therapies, is a fundamental step in the evaluation and management of patients with difficult-to-treat asthma. Identifying and effectively treating asthma comorbidities, such as obesity, obstructive sleep apnea, and chronic sinusitis with nasal polyps, may improve asthma control and reduce exacerbations. In addition, identifying comorbid T2 inflammatory conditions may help guide optimal selection of biologic therapies. Here, we describe common comorbid conditions found in adult and pediatric difficult-to-control asthma, discuss evidence for the association with asthma morbidity and treatment benefit, and provide information on how and when to assess comorbidities.
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Affiliation(s)
- Jonathan M. Gaffin
- Division of Pulmonary Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Leonard B. Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
| | - Anne L. Fuhlbrigge
- Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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4
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Morin H, Worsley D, Zhang X, Faerber J, Pettit AR, Kenyon CC, Doupnik SK. Depression and Anxiety Symptoms During and After Pediatric Asthma Hospitalization. Hosp Pediatr 2021; 11:1272-1280. [PMID: 34670757 DOI: 10.1542/hpeds.2020-000950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Depression and anxiety are common in children with asthma, and asthma hospitalization is an underused opportunity to identify mental health concerns. We assessed depression and anxiety symptoms during asthma hospitalization and 1 to 2 months post discharge. METHODS This prospective cohort study included children aged 7 to 17 years who were hospitalized for asthma exacerbation. Participants completed the self-report PROMIS (Patient-Reported Outcomes Measurement Information System) depression and anxiety symptom scales (T score mean = 50, SD = 10) during hospitalization and 1 to 2 months after discharge. Higher scores indicate more symptoms and/or greater severity. We compared patients' scores during hospitalization and at follow-up using paired t tests and examined individual patients' depression and anxiety symptom trajectories using a Sankey diagram. RESULTS Among 96 participants who completed the study, 53% had elevated symptoms of depression, anxiety, or both either during hospitalization or after discharge. During hospitalization, 38% had elevated depression symptoms and 45% had elevated anxiety symptoms. At postdischarge follow-up, 18% had elevated depression symptoms and 20% had elevated anxiety symptoms. We observed all possible symptom trajectories: symptoms during hospitalization that persisted (especially if both depression and anxiety symptoms were present), symptoms that resolved, and symptoms that were present at follow-up only. CONCLUSIONS Just more than half of youth hospitalized for asthma exacerbation experienced depression and/or anxiety symptoms during hospitalization or at follow-up. Patients who had both depression and anxiety symptoms during hospitalization were the most likely to have persistent symptoms at follow-up. Screening at both time points may be useful to identify mental health symptoms.
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Affiliation(s)
- Haley Morin
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Diana Worsley
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Xuemei Zhang
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer Faerber
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Chén C Kenyon
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie K Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania .,Department of Pediatrics and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Le TP, Sutherlin TK, Teverbaugh LA, Gleason MM, Carlson JC. The impact of socioeconomic risk factors and mental health on asthma. Ann Allergy Asthma Immunol 2021; 126:453-457. [PMID: 33610758 DOI: 10.1016/j.anai.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Thao P Le
- Department of Pediatrics, Tulane University, New Orleans, Louisiana
| | | | | | - Mary Margaret Gleason
- Eastern Virginia Medial School, Norfolk, Virginia; Childnren's Hospital of the King's Daughters, Chesapeake, Virginia
| | - John C Carlson
- Department of Pediatrics, Tulane University, New Orleans, Louisiana.
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6
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Gonzalez VJ, Kimbro RT, Cutitta KE, Shabosky JC, Bilal MF, Penny DJ, Lopez KN. Mental Health Disorders in Children With Congenital Heart Disease. Pediatrics 2021; 147:peds.2020-1693. [PMID: 33397689 PMCID: PMC7849200 DOI: 10.1542/peds.2020-1693] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Data on anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) are lacking for youth with congenital heart disease (CHD), particularly those with simple CHD. This study aims to characterize these disorders in youth with CHD compared to those without CHD. METHODS A comparative cross-sectional study was conducted by using the electronic medical records of a large tertiary care hospital between 2011 and 2016. Inclusion criteria were youth aged 4 to 17 years with >1 hospitalization or emergency department visits. Exclusion criteria were patients with arrhythmias or treatment with clonidine and/or benzodiazepines. The primary predictor variable was CHD type: simple, complex nonsingle ventricle, and complex single ventricle. The primary outcome variable was a diagnosis and/or medication for anxiety and/or depression or ADHD. Data were analyzed by using logistic regression (Stata v15; Stata Corp, College Station, TX). RESULTS We identified 118 785 patients, 1164 with CHD. Overall, 18.2% (n = 212) of patients with CHD had a diagnosis or medication for anxiety or depression, compared with 5.2% (n = 6088) of those without CHD. All youth with CHD had significantly higher odds of anxiety and/or depression or ADHD. Children aged 4 to 9 years with simple CHD had ∼5 times higher odds (odds ratio: 5.23; 95% confidence interval: 3.87-7.07) and those with complex single ventricle CHD had ∼7 times higher odds (odds ratio: 7.46; 95% confidence interval: 3.70-15.07) of diagnosis or treatment for anxiety and/or depression. Minority and uninsured youth were significantly less likely to be diagnosed or treated for anxiety and/or depression or ADHD, regardless of disease severity. CONCLUSIONS Youth with CHD of all severities have significantly higher odds of anxiety and/or depression and ADHD compared to those without CHD. Screening for these conditions should be considered in all patients with CHD.
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Affiliation(s)
- Vincent J. Gonzalez
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | | | - Katherine E. Cutitta
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - John C. Shabosky
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Mohammad F. Bilal
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Daniel J. Penny
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Keila N. Lopez
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
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7
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Griffiths D, Giancola LM, Welsh K, MacGlashing K, Thayer C, Gunnlaugsson S, Stamatiadis NP, Sierra GC, Hammond A, Greco KF, Simoneau T, Baxi SN, Gaffin JM. Asthma control and psychological health in pediatric severe asthma. Pediatr Pulmonol 2021; 56:42-48. [PMID: 33058494 PMCID: PMC7736198 DOI: 10.1002/ppul.25120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Psychological comorbidities have been associated with asthma in adults and children, but have not been studied in a population of children with severe asthma. The aim of this study was to test the hypothesis that symptoms of anxiety or depression are highly prevalent in pediatric severe asthma and negatively effects asthma control. METHODS Longitudinal assessments of anxiety or depression symptoms (Patient Health Questionnaire-4 [PHQ-4]), asthma control (Asthma Control Test [ACT]), and lung function were performed in a single-center pediatric severe asthma clinic. Participant data were collected during routine clinical care. Primary outcomes were ACT and forced expiratory volume in 1 s per forced vital capacity (FEV1/FVC). RESULTS Among 43 subjects (with total 93 observations), 58.1% reported at least one anxious or depressive symptom and 18.6% had a PHQ-4 more than 2, the threshold for an abnormal test result. After adjusting for age, sex, race, and asthma medication step, there was a significant reduction in ACT for girls with PHQ-4 more than 2 (adjusted mean [SE] ACT for PHQ-4 > 2: 13.64 [0.59], ACT for PHQ-4 ≤ 2: 20.64 [1.25], p = .02) but not boys. Moreover, there was a significant differential effect of mental health impairment for girls than boys. ACT for girls with PHQ more than 2: 13.64 (0.59) compared with boys with PHQ-4 more than 2: 17.82 (0.95), adjusted mean difference ACT by sex = 4.18 points; 95% confidence interval, 0.63-7.73; p = .033. In adjusted models, there was no association between PHQ-4 more than 2 and FEV1/FVC. CONCLUSIONS Symptoms of anxiety and depression are common. In children with severe asthma, a PHQ-4 score more than 2 is associated with worse asthma symptom control in girls, but not boys.
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Affiliation(s)
- Delaney Griffiths
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lauren M Giancola
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kelly Welsh
- Department of Social Work, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kristen MacGlashing
- Department of Social Work, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christine Thayer
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sigfus Gunnlaugsson
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie P Stamatiadis
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gabriella C Sierra
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam Hammond
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberly F Greco
- Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Sachin N Baxi
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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8
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Screening for Anxiety Disorders Among Schoolchildren with Asthma. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to perform screening for anxiety disorders among children with asthma and to reveal factors associated with general anxiety disorder and its specific forms.
This was a cross-sectional study conducted among out-patients with asthma during routine visits to pediatricians. They were screened for anxiety disorders using SCARED self-reported questionnaire. Additional data were collected using specially designed questionnaire as well as the patient files. Statistical analysis was performed by the SPPS software using descriptive statistics and logistic regression.
Study population consisted mostly of schoolchildren (n=58), 8-12 years old, and adolescents (13-17 years) (n=13). Approximately 33.8% respondents were positive for general anxiety disorder. The most common were separation anxiety and social anxiety, recorded among 49.3% and 32.4% of patients, respectively. Generalized anxiety and panic/somatic disorder were recorded in the same percentage of patients (21.3%), while avoiding school was the least frequent (14.08%). Influence of numerous factors was tested, but only the following showed significant effects: peak expiratory flow test was associated with general anxiety disorder, patient’s age and gender with PD, and living place, asthma control according to GINA and age on GAD. Parent’s smoking was associated with SAD, age and patient’s weight status with SPH, and GINA asthma control with SA.
These findings suggest that anxiety disorders are common among children and adolescents with asthma. Various factors can be associated with general anxiety disorder and its specific forms, but some of them being preventable as avoiding smoking in the family.
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9
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Cobham VE, Hickling A, Kimball H, Thomas HJ, Scott JG, Middeldorp CM. Systematic Review: Anxiety in Children and Adolescents With Chronic Medical Conditions. J Am Acad Child Adolesc Psychiatry 2020; 59:595-618. [PMID: 31676391 DOI: 10.1016/j.jaac.2019.10.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/22/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Youth with chronic medical conditions (CMCs) have been reported to be at increased risk for developing anxiety disorders. Importantly, suffering from anxiety may also have an impact on their disease-related outcomes. This study set out to systematically review the literature on anxiety and seven CMCs (asthma, congenital heart disease, diabetes, epilepsy, inflammatory bowel disease, juvenile idiopathic arthritis, and sickle cell disease) among youth. METHOD A systematic review was performed according to the PRISMA statement. Searches were conducted across PubMed, PsycNET, Embase, and reference lists of the included studies (1990-2018). Three independent reviewers screened titles and abstracts and conducted full-text assessment. Studies were included if they reported the prevalence of anxiety or the association of anxiety on disease-related outcomes in children and/or adolescents with the focal CMCs. RESULTS A total of 53 studies met the predetermined inclusion criteria. Across the CMCs, the prevalence of anxiety disorder was increased in youths with CMCs compared to the general population. Evidence for a relationship between anxiety and adverse disease-related outcomes was limited. For asthma, inflammatory bowel disease, and sickle cell disease, there was some evidence indicating that anxiety was associated with adverse outcomes; supported by two longitudinal studies, one in asthma and one in inflammatory bowel disease. For diabetes, results were inconsistent; with some studies indicating that anxiety was associated with worse and others with better treatment adherence. CONCLUSION The prevalence of anxiety disorders in youth with CMCs is higher than that in the general population. Anxiety may also be associated with adverse disease-related outcomes for youths, but it is not possible to draw definitive conclusions. Longitudinal studies making use of parent/youth composite anxiety measures and a combination of parent/youth reported and objective measures of disease-related outcomes are needed. Given the burden of disease of anxiety disorders, regardless of the impact on the disease outcomes, screening for and treatment of anxiety is recommended in youths with CMCs.
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Affiliation(s)
- Vanessa E Cobham
- Child and Youth Mental Health Service [CYMHS], Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia; School of Psychology, The University of Queensland, Brisbane, Australia.
| | - Anna Hickling
- School of Psychology, The University of Queensland, Brisbane, Australia; Mater Research Institute, Brisbane, Queensland, Australia
| | - Hayley Kimball
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Hannah J Thomas
- Queensland Centre for Mental Health Research, Brisbane, Australia, and the Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - James G Scott
- Queensland Centre for Mental Health Research, Brisbane, Australia, and the Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Metro North Mental Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia, and QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Christel M Middeldorp
- Child and Youth Mental Health Service [CYMHS], Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia, and Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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Tran L, Sharrad K, Kopsaftis Z, Stallman HM, Tai A, Spurrier N, Esterman A, Carson-Chahhoud K. Pharmacological interventions for the treatment of psychological distress in patients with asthma: a systematic review and meta-analysis. J Asthma 2020; 58:759-769. [PMID: 32065543 DOI: 10.1080/02770903.2020.1731826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective: To evaluate the effectiveness and safety of pharmacological interventions for the treatment of psychological distress in people with asthma.Data sources: Electronic searches were performed in Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase, PsycInfo, Health Technology Assessment Database and Web of Science (inception to April 2019).Study selections: Included studies were randomized controlled trials (RCT) or controlled clinical trials investigating the effect of pharmacological interventions for psychological distress in people with asthma. Records were screened and data extracted by two independent authors into standardized pilot-tested extraction templates. Data was analyzed according to standard Cochrane methodology and entered into Review Manager Software version 5.3.Results: From 5,689 studies, six RCTs (n = 215) met inclusion criteria and were included in the systematic review, of which four studies were included in the meta-analysis. A meta-analysis of four studies (n = 158) indicated no evidence of an effect for selective serotonin reuptake inhibitors (Citalopram or Escitalopram) on reduction of psychological distress in adult patients with asthma. Similarly, antiepileptic medication (Levetiracetam) was no better than placebo in the treatment of psychological distress in people with asthma. Adverse events were poorly reported across all studies but were slightly increased among intervention participants compared to control participants.Conclusions: There was great heterogeneity between studies and overall poor methodological quality providing insufficient evidence to make recommendations for or against the use of pharmacotherapy in asthma patients with psychological distress. Further confirmatory trials are warranted to make recommendations for clinical practice.
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Affiliation(s)
- Liem Tran
- School of Medicine, Deakin University, Geelong, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute, Adelaide, Australia.,School of Health Sciences, University of South Australia, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Kelsey Sharrad
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, Adelaide, Australia.,School of Health Sciences, University of South Australia, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Zoe Kopsaftis
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, Adelaide, Australia.,School of Health Sciences, University of South Australia, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia.,Respiratory Medicine Unit, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Helen M Stallman
- School of Social Sciences, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Mind and Neuroscience - Thompson Institute, Queensland, Australia
| | - Andrew Tai
- Respiratory and Sleep Medicine, Women's & Children's Hospital, Adelaide, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Nicola Spurrier
- SA Health, Department for Health and Ageing, Adelaide, South Australia, Australia.,Department of Paediatrics and Child Health, Flinders University, Bedford Park, South Australia, Australia.,School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Adrian Esterman
- School of Nursing and Midwifery, University of South Australia, Adelaide, Australia.,UniSA Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Kristin Carson-Chahhoud
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, Adelaide, Australia.,School of Health Sciences, University of South Australia, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
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11
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Ajdacic-Gross V, Bechtiger L, Rodgers S, Müller M, Kawohl W, von Känel R, Mutsch M, Rössler W, Seifritz E, Castelao E, Strippoli MPF, Vandeleur C, Preisig M, Howell P. Subtypes of stuttering determined by latent class analysis in two Swiss epidemiological surveys. PLoS One 2018; 13:e0198450. [PMID: 30086147 PMCID: PMC6080750 DOI: 10.1371/journal.pone.0198450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/18/2018] [Indexed: 02/03/2023] Open
Abstract
Aims Associations between stuttering in childhood and a broad spectrum of risk factors, associated factors and comorbidities were examined in two large epidemiological studies. Subtypes of stuttering were then identified based on latent class analysis (LCA). Methods Data were from two representative Swiss population samples: PsyCoLaus (N = 4,874, age 35–82 years) and the ZInEP Epidemiology Survey (N = 1,500, age 20–41 years). Associations between stuttering and sociodemographic characteristics, familial aggregation, comorbidity and psychosocial risk / associated factors were investigated in both samples. LCAs were conducted on selected items from people in both samples who reported having stuttered in childhood. Results Initial analyses linked early anxiety disorders, such as separation anxiety disorder and overanxious disorder, to stuttering (PsyCoLaus). ADHD was associated with stuttering in both datasets. In the analyses of risk / associated factors, dysfunctional parental relationships, inter-parental violence and further childhood adversities were mutual predictors of stuttering. Moreover, comorbidities were seen with hay fever, asthma, eczema and psoriasis (PsyCoLaus). Subsequent LCA identified an unspecific group of persons who self-reported that they stuttered and a group defined by associations with psychosocial adversities (ZINEP, PsyCoLaus) and atopic diseases (PsyCoLaus). Conclusions The two subtypes of developmental stuttering have different risk / associated factors and comorbidity patterns. Most of the factors are associated with vulnerability mechanisms that occur early in life and that have also been linked with other neurodevelopmental disorders. Both psychosocial and biological factors appear to be involved in the etiopathogenesis of stuttering.
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- * E-mail: (VA); (PH)
| | - Laura Bechtiger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Margot Mutsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
- Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland
- Institute of Psychiatry, Laboratory of Neuroscience (LIM27), University of Sao Paulo, Sao Paulo, Brazil
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | | | - Caroline Vandeleur
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Peter Howell
- Department of Experimental Psychology, University College, London, United Kingdom
- * E-mail: (VA); (PH)
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Meuret AE, Kroll J, Ritz T. Panic Disorder Comorbidity with Medical Conditions and Treatment Implications. Annu Rev Clin Psychol 2017; 13:209-240. [PMID: 28375724 DOI: 10.1146/annurev-clinpsy-021815-093044] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Panic disorder (PD) is unique among the anxiety disorders in that panic symptoms are primarily of a physical nature. Consequently, comorbidity with medical illness is significant. This review examines the association between PD and medical illness. We identify shared pathophysiological and psychological correlates and illustrate how physiological activation in panic sufferers underlies their symptom experience in the context of the fight-or-flight response and beyond a situation-specific response pattern. We then review evidence for bodily symptom perception accuracy in PD. Prevalence of comorbidity for PD and medical illness is presented, with a focus on respiratory and cardiovascular illness, irritable bowel syndrome, and diabetes, followed by an outline for potential pathways of a bidirectional association. We conclude by illustrating commonalities in mediating mechanistic pathways and moderating risk factors across medical illnesses, and we discuss implications for diagnosis and treatment of both types of conditions.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Juliet Kroll
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
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Walker VG. Exploration of the Influence of Factors Identified in the Literature on School-aged Children's Emotional Responses to Asthma. J Pediatr Nurs 2017; 33:54-62. [PMID: 28065421 PMCID: PMC5376515 DOI: 10.1016/j.pedn.2016.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 01/16/2023]
Abstract
Approximately 6.3 million US children suffer from asthma. The purpose of this study was to explore factors on school-aged children's emotional responses to asthma, N=85, ages 6-12. Correlations included Asthma related child emotional functioning QOL and (a) asthma severity, r=-0.30, p<0.01, (b) child internalizing behaviors, r=-0.26, p<0.05, (c) child externalizing behaviors r=-0.43, p<0.001; Caregiver emotional functioning QOL and (a) asthma severity, r=-0.39, p<0.001, (b) child internalizing behaviors, r=-0.22, p<0.05, (c) child externalizing behaviors, r=-0.25; p<0.05. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the variance in asthma related child emotional functioning QOL, F (4, 79)=7.051, p<0.001 (asthma severity, β=-0.31, p<0.01; child externalizing problem behaviors, β=-0.43, p<0.001). Findings imply that asthma research should consider problem behaviors of school-aged children when addressing asthma related emotional functioning QOL.
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Courtet P, Giner L, Seneque M, Guillaume S, Olie E, Ducasse D. Neuroinflammation in suicide: Toward a comprehensive model. World J Biol Psychiatry 2016. [PMID: 26223957 DOI: 10.3109/15622975.2015.1054879] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Suicidal behaviour (SB) entered the DSM-5, underlying a specific biological vulnerability. Then, recent findings suggested a possible role of the immune system in SB pathogenesis. The objective of this review is to present these main immune factors involved in SB pathogenesis. METHODS We conducted a review using Preferred Reporting Items for Systematic reviews and Meta-Analysis criteria, and combined ("Inflammation") AND ("Suicidal ideation" OR "Suicidal attempt" OR "suicide"). RESULTS Post mortem studies demonstrated associations between suicide and inflammatory cytokines in the orbitofrontal cortex, a brain region involved in suicidal vulnerability. Also, microgliosis and monocyte-macrophage system activation may be a useful marker of suicide neurobiology. Kynurenine may influence inflammatory processes, and related molecular pathways may be involved in SB pathophysiology. Few recent studies associated inflammatory markers with suicidal vulnerability: serotonin dysfunction, impulsivity and childhood trauma. Interestingly, the perception of threat that leads suicidal individuals to contemplate suicide may activate biological stress responses, including inflammatory responses. CONCLUSIONS Translational projects would be crucial to identify a specific marker in SB disorders, to investigate its clinical correlations, and the interaction between inflammatory cytokines and monoamine systems in SB. These researches might lead to new biomarkers and novel directions for therapeutic strategies.
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Affiliation(s)
- Philippe Courtet
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
| | | | - Maude Seneque
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
| | - Sebastien Guillaume
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
| | - Emilie Olie
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
| | - Deborah Ducasse
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
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15
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Chen YT, Chien CY, Tai SY, Huang CM, Lee CTC. Asthma associated with chronic rhinosinusitis: a population-based study. Int Forum Allergy Rhinol 2016; 6:1284-1293. [PMID: 27353023 DOI: 10.1002/alr.21813] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/25/2016] [Accepted: 05/23/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Few studies have investigated the relationship between asthma and chronic rhinosinusitis (CRS). The present study investigated the association between asthma and the risk of CRS in a large national sample. METHODS Patients newly diagnosed with asthma (International Classification of Diseases, Ninth Revision [ICD-9], Clinical Modification code 493) between 2000 and 2008 were identified from the Taiwan National Health Insurance Research Database. The cases were compared with sex-, age-, residence-, and insurance premium-matched controls, and both groups were followed until the end of 2009 for incidences of CRS with or without nasal polyps (CRSwNP or CRSsNP, respectively). Competing risk-adjusted Cox regression analyses were performed after adjustment for sex, age, residence, insurance premium, steroid use, hyperlipidemia, diabetes, hypertension, coronary artery disease, Charlson comorbidity index score, and mortality. We also performed a case-control study to determine the association between asthma and CRS. RESULTS The cohort study analysis examined 81,462 patients with a mean ± standard deviation (SD) follow-up period of 5.8 ± 2.4 years. Asthma was an independent predictor of CRSsNP (hazard ratio = 2.58; 95% confidence interval [CI], 2.20 to 3.03; p < 0.001) in the fully adjusted models. In the case-control analysis, both CRSwNP and CRSsNP were associated with asthma in the fully adjusted models. CONCLUSION Asthma was associated with increased risks of CRSwNP and CRSsNP, independent of several potential confounding factors.
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Affiliation(s)
- Yu-Ting Chen
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Yu Chien
- Department of Otorhinolaryngology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Otorhinolaryngology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Otorhinolaryngology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Shu-Yu Tai
- Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Chiu-Mieh Huang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Charles Tzu-Chi Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
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16
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Zhang L, Zhang X, Zheng J, Wang L, Zhang HP, Wang L, Wang G. Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis. J Thorac Dis 2016; 8:1257-68. [PMID: 27293845 PMCID: PMC4886028 DOI: 10.21037/jtd.2016.04.68] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/06/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The longitudinal associations between psychological dysfunction (PD) and asthma exacerbations (AE) have not been adequately addressed. This study aimed to systematically assess the influence of PD on AE, and to determine whether different PD affects AE differentially. METHODS Electronic databases (PubMed, Cochrane library, Web of Science, Embase, and Ovid) were searched for prospective cohort studies on the influence of PD on AE in individuals with asthma. Relative risk (RR) and adjusted RR (RRadj) were pooled across studies. Subgroup analyses assessed the effects of different types of PD and the time-dependent response to the duration of PD exposure. RESULTS Ten articles that involved 31,432 adults with asthma with follow-up of 6.0-86.4 months were included. PD significantly increased the risk of AE [RRadj =1.06, 95% confidence interval (95%CI): 1.04-1.09, P<0.001], presenting as hospitalizations (RRadj =1.22, 95% CI: 1.12-1.34, P<0.001), unscheduled doctor visits (RR =4.26, 95% CI: 2.52-7.19), and emergency department (ED) visits (RRadj =1.06, 95% CI: 1.01-1.10, P=0.009) because of asthma. Depression significantly increased the risk of AE (RRadj =1.07, 95% CI: 1.04-1.11, P<0.001), presenting as hospitalizations (RRadj =1.26, 95% CI: 1.07-1.49, P=0.007) and ED visits (RRadj =1.06, 95% CI: 1.02-1.11, P=0.007) because of asthma. Anxiety was only associated with an increased risk of AE in pregnant women (RR =1.05, 95% CI: 1.01-1.08), possibly due to the small amount of data available on anxiety. The influence of PD on AE was only significant when the PD exposure time exceeded one year. CONCLUSIONS Co-morbid PD adversely affects AE, and there are differential effects of depression and anxiety. Asthmatic subjects with PD may benefit from more attention when establishing a treatment regimen in clinical practice.
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Yatsenko O, Pizano J, Nikolaidis A. Revisiting maternal–infant bonding’s effects on asthma: A brief history. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1161267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Olga Yatsenko
- Department of Neurodevelopmental Research, Porter Pediatric and Adolescent Associates, Porter, TX, USA
| | - Joseph Pizano
- Department of Neurodevelopmental Research, Porter Pediatric and Adolescent Associates, Porter, TX, USA
| | - Andreas Nikolaidis
- Department of Neurodevelopmental Research, Porter Pediatric and Adolescent Associates, Porter, TX, USA
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18
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Tunde-Ayinmode MF. Children with bronchial asthma assessed for psychosocial problems in a teaching hospital in Nigeria. Afr Health Sci 2015; 15:690-700. [PMID: 26124821 DOI: 10.4314/ahs.v15i2.49] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Paediatric bronchial asthma causes respiratory related mortality and morbidity globally and elevates the risk of psychological and social problems (psychosocial problems); which may result in poorer asthma control. The rate of and associated factors for psychosocial problems among our asthmatic children was assessed in this study. METHODS Seventy five (75) children aged 7 to 14 years with bronchial asthma who were attending clinics at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, were assessed with Child behaviour questionnaire and a semi-structured questionnaire. RESULTS Probable psychological morbidity was present in 25% of the children. The most frequently reported social impairments associated with the disease were: interference with play (60%), domestic work (49%), fear of dying anytime (29%) and feeling of being a burden on the family (25%). Psychological morbidity was significantly associated with lower maternal education (p=0.020) and occupation (p=0.038), polygamy (p=0.012), fathers having more than 5 children (p=0.027) and mothers having inadequate spousal support (p=0.012). Inadequate spousal support and lower maternal occupational level were the significant predictors of morbidity following logistic regression. CONCLUSION Routine psychosocial assessment and care for children with asthma needs to be introduced into our clinics to help protect them and their families from avoidable suffering.
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Preter M, Klein DF. Lifelong opioidergic vulnerability through early life separation: a recent extension of the false suffocation alarm theory of panic disorder. Neurosci Biobehav Rev 2014; 46 Pt 3:345-51. [PMID: 24726574 DOI: 10.1016/j.neubiorev.2014.03.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/03/2014] [Accepted: 03/14/2014] [Indexed: 12/11/2022]
Abstract
The present paper is the edited version of our presentations at the "First World Symposium On Translational Models Of Panic Disorder", in Vitoria, E.S., Brazil, on November 16-18, 2012. We also review relevant work that appeared after the conference. Suffocation-False Alarm Theory (Klein, 1993) postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively occur when the alarm is erroneously triggered. The expanded Suffocation-False Alarm Theory (Preter and Klein, 2008) hypothesizes that endogenous opioidergic dysregulation may underlie the respiratory pathophysiology and suffocation sensitivity in panic disorder. Opioidergic dysregulation increases sensitivity to CO2, separation distress and panic attacks. That sudden loss, bereavement and childhood separation anxiety are also antecedents of "spontaneous" panic requires an integrative explanation. Our work unveiling the lifelong endogenous opioid system impairing effects of childhood parental loss (CPL) and parental separation in non-ill, normal adults opens a new experimental, investigatory area.
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Affiliation(s)
- Maurice Preter
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Donald F Klein
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, 550 1st Ave, New York, NY 10016, USA.
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20
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Goodwin RD, Robinson M, Sly PD, McKeague IW, Susser ES, Zubrick SR, Stanley FJ, Mattes E. Severity and persistence of asthma and mental health: a birth cohort study. Psychol Med 2013; 43:1313-22. [PMID: 23171853 PMCID: PMC3857579 DOI: 10.1017/s0033291712001754] [Citation(s) in RCA: 50] [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] [Indexed: 01/22/2023]
Abstract
BACKGROUND The goal of the current study was to investigate asthma and mental health among youth in the community, and to consider the role of asthma severity and persistence in this link. Method Data were drawn from the Raine Study, a population-based birth cohort study in Western Australia. Logistic regression models and generalized estimating equations were used to examine the relationship between asthma at age 5 years and the range of internalizing and externalizing mental health problems at ages 5-17 years. Analyses were stratified by asthma severity and persistence, and adjusted for a range of potential confounders. RESULTS More severe and persistent asthma at age 5 was associated with significantly increased odds of affective, anxiety, somatic, oppositional defiant and conduct problems at ages 5-17. Mild asthma and remitted asthma were not associated with heightened vulnerability to mental disorders. CONCLUSIONS Our results suggest that youth with symptomatic asthma are more likely to suffer from a wide range of mental health problems, and that the likelihood of mental health problems appears to increase as a function of asthma severity. Youth with poorly controlled and/or more severe and persistent asthma may be considered a vulnerable group who might benefit from mental health screening in clinical, school and community settings.
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Affiliation(s)
- R D Goodwin
- Department of Psychology, Queens College, City University of New York, Flushing, NY 10032, USA.
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21
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Arabiat DH, Jabery MA, Wardam L. Screening for anxiety symptoms and social desirability in children and adolescents living with chronic illnesses in Jordan. J Child Health Care 2013; 17:62-71. [PMID: 23242812 DOI: 10.1177/1367493512450623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research aims to investigate the rate and nature of anxiety symptoms in a group of children and adolescents living with chronic illnesses in Jordan, and their relation to social desirability in a cultural sample not previously researched. Using the Revised Children's Manifest Anxiety Scale (R-CMAS), anxiety and social desirability data were obtained from 114 children diagnosed with chronic illnesses and 162 healthy control participants. Based on children's self-report, participants were categorized according to their adaptive style paradigm as either high anxious, low anxious, or repressor. It was proposed that children who score high on social desirability and low on anxiety are repressors. The prevalence of these categories was compared across the two groups. Anxiety was reported in 9.64 percent of the chronic illnesses and 12.34 percent of the healthy peers. Using the data obtained in the present study, the rate and nature of anxiety in children with chronic illnesses were lower for children in Jordan when compared to previous studies. However, social desirability values were similar to those established in Western societies suggesting a significantly higher percentage of children identified as repressors in children with long-term illnesses. These results supported the hypothesis regarding the relationship between social desirability and expressed anxiety symptoms.
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22
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Lu Y, Mak KK, van Bever HPS, Ng TP, Mak A, Ho RCM. Prevalence of anxiety and depressive symptoms in adolescents with asthma: a meta-analysis and meta-regression. Pediatr Allergy Immunol 2012; 23:707-15. [PMID: 22957535 DOI: 10.1111/pai.12000] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It remains unclear whether anxiety and depressive symptoms are more prevalent in adolescents with asthma when compared with healthy individuals. This meta-analysis aimed to evaluate the difference in the aggregate prevalence of depressive and anxiety symptoms between adolescents with asthma and healthy controls and to explore the underlying moderators that potentially explain the heterogeneity of the effect size. A meta-analysis of published work was performed using the random effects model. The differences in aggregate prevalence of depressive and anxiety symptoms between adolescents with asthma and healthy controls were determined. Meta-regression and subgroup analysis were performed to identify factors that may contribute to heterogeneity. A total of eight studies were eligible for analysis. The aggregate prevalence of depressive and anxiety symptoms was significantly higher among 3546 adolescents with asthma than that of 24,884 controls (depression, 0.27; 95% CI, 0.18.6-0.39 vs. 0.13; 95% CI, 0.09-0.19; anxiety, 0.33; 95% CI, 0.19-0.52 vs. 0.21; 95% CI, 0.12-0.33). The risk of developing depression and anxiety is significantly higher among adolescents with asthma when compared with controls (depression: pooled odds ratio, 2.09; 95% CI, 1.65-2.64; p < 0.001; anxiety: pooled odds ratio, 1.83; 95% CI, 1.63-2.07; p < 0.001). Meta-regression revealed that the proportions of Caucasian (p = 0.008) and smokers (p < 0.001) were significant moderators which explained the significant heterogeneity when comparing the risk of developing depressive symptoms among adolescent asthma patients vs. controls while age, gender, and severity of asthma were not significant. Family doctors, pediatricians, and healthcare providers should formulate strategies to detect depressive and anxiety symptoms in adolescents with asthma and offer psychological interventions to reduce the burden of psychiatric comorbidity.
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Affiliation(s)
- Yanxia Lu
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
OBJECTIVES Adolescence is a time of increasing risk for some anxiety disorders. Scant data exist on adolescent anxiety in emergency department (ED) settings. We sought to characterize select clinical characteristics and health care use associated with anxiety disorders in a pediatric ED. METHODS We screened a convenience sample of 100 adolescent-parent dyads presenting to the ED for the presence of child anxiety disorders using the 5-item Screen for Child Anxiety Related Emotional Disorders, parent (SCARED-P) and child (SCARED-C) versions. Additional demographic and clinical data were also collected. RESULTS The SCARED-P and SCARED-C screens identified probable anxiety disorder(s) in 26% to 33% of adolescent participants, respectively. Correlates of positive SCARED-C screens were female sex, asthma, presenting complaint involving headache or migraine, and school absenteeism due to physical problems. Correlates of positive SCARED-P screens were lower parental educational level, presenting complaint involving headache or migraine, and more medical specialty and total medical visits. Few anxious adolescents had received mental health services in the past 6 months. In multivariate models, female sex was independently associated with SCARED-C total score, and presenting complaint involving headache or migraine was independently associated with SCARED-P total score. CONCLUSIONS The current pilot data suggest that anxiety disorders are more prevalent among adolescent ED patients than among the general population but largely untreated. Several demographic and clinical variables may help to identify occult anxiety disorders. Greater awareness of anxiety disorders in this population may assist in redirecting a pattern of low use of mental health services but higher overall health care use.
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Abstract
A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who have asthma? (b) What are the potential gaps in the literature regarding the emotional responses of school-age children (ages 6-12) who have asthma? (c) Are children with a lower socioeconomic status (SES) and those who are minorities represented in the literature proportionate to their prevalence? Two main focus areas regarding emotional responses were identified: (a) factors related to children who have asthma and (b) factors related to caregivers of children who have asthma. Internalizing disorders were reported consistently for children and caregivers of children who have asthma. Negative consequences of asthma for children included panic and asthma attacks, missed school days, and behavioral problems. Issues for caregivers included higher levels of anxiety and depressive symptoms, asthma management deficits, and lower caregiver warmth and involvement. Gaps in the literature included separated studies for children ages 6-12, a lack of a standardized method to define SES, studies that were of a more experimental nature, and a disparate number of studies of minority children and caregivers relative to their asthma prevalence.
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Acosta-Pérez E, Canino G, Ramírez R, Prelip M, Martin M, Ortega AN. Do Puerto Rican youth with asthma and obesity have higher odds for mental health disorders? PSYCHOSOMATICS 2012; 53:162-71. [PMID: 22284423 DOI: 10.1016/j.psym.2011.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Island Puerto Rican (PR) youth experience disproportionately high asthma and obesity rates compared with other racial/ethnic groups on the U.S. mainland. Previous research has demonstrated associations of chronic disease with psychiatric disorders. OBJECTIVE We examined the relationship among anxiety/depressive disorders, asthma, and obesity in an epidemiologic community sample of youth. METHODS The sample (n = 656) was derived from the second wave of an island-wide probabilistic representative household sample of PR youth stratified and based on whether or not they had a diagnosis of asthma and/or depressive/anxiety disorder. For this study, we used the subpopulation ages 10-19 years. RESULTS Asthma and obesity were significantly related to higher odds of depressive/anxiety disorders in youth. Obesity moderated the relationship between asthma attacks and depressive/anxiety disorders. The relationship between asthma attack and higher odds for depressive/anxiety disorders was only present in the non-obese group. Among the obese, females show a significant increase from 11% to 36% in the prevalence of anxiety/depressive disorders. Asthma and obesity were highly prevalent and a significant association was found between asthma attack and depressive/anxiety disorders. The effects of asthma and obesity were not additive; the prevalence for psychiatric disorder for those having both conditions did not increase above the prevalence associated having only one of the conditions. CONCLUSIONS Future studies should consider including longitudinal designs and examine the extent to which important variables not included in this study, such as body image dissatisfaction (particularly among females), teasing, and discrimination may moderate the relationship among obesity and depressive and anxiety disorders in youth.
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Affiliation(s)
- Edna Acosta-Pérez
- Behavioral Science Research Institute, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico.
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Pandey GN, Rizavi HS, Ren X, Fareed J, Hoppensteadt DA, Roberts RC, Conley RR, Dwivedi Y. Proinflammatory cytokines in the prefrontal cortex of teenage suicide victims. J Psychiatr Res 2012; 46:57-63. [PMID: 21906753 PMCID: PMC3224201 DOI: 10.1016/j.jpsychires.2011.08.006] [Citation(s) in RCA: 251] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 08/15/2011] [Accepted: 08/18/2011] [Indexed: 01/12/2023]
Abstract
Teenage suicide is a major public health concern, but its neurobiology is not well understood. Proinflammatory cytokines play an important role in stress and in the pathophysiology of depression-two major risk factors for suicide. Cytokines are increased in the serum of patients with depression and suicidal behavior; however, it is not clear if similar abnormality in cytokines occurs in brains of suicide victims. We therefore measured the gene and protein expression levels of proinflammatory cytokines interleukin (IL)-1β, IL-6, and tissue necrosis factor (TNF)-α in the prefrontal cortex (PFC) of 24 teenage suicide victims and 24 matched normal control subjects. Our results show that the mRNA and protein expression levels of IL-1β, IL-6, and TNF-α were significantly increased in Brodmann area 10 (BA-10) of suicide victims compared with normal control subjects. These results suggest an important role for IL-1β, IL-6, and TNF-α in the pathophysiology of suicidal behavior and that proinflammatory cytokines may be an appropriate target for developing therapeutic agents.
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Affiliation(s)
- Ghanshyam N. Pandey
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Hooriyah S. Rizavi
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Xinguo Ren
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Jawed Fareed
- Loyola University Medical Center, Maywood, Illinois
| | | | | | | | - Yogesh Dwivedi
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
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Slattery MJ, Essex MJ. Specificity in the association of anxiety, depression, and atopic disorders in a community sample of adolescents. J Psychiatr Res 2011; 45:788-95. [PMID: 21111430 PMCID: PMC3079801 DOI: 10.1016/j.jpsychires.2010.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 11/02/2010] [Indexed: 02/02/2023]
Abstract
The specificity of relationships between anxiety and depressive symptoms, with each of the major atopic disorders of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) was systematically investigated within a single study sample. Participants included 367 adolescents who participated in a community, longitudinal study investigating risk factors for the development of psychiatric and physical health problems. Mental health symptoms were assessed at 7, 9, 11, and 13 years of age. Lifetime history of atopic disorders was assessed by parent report at age 13. Analysis of variance was used to investigate the specificity of the associations between anxiety and depression, and each of the atopic disorders. Results indicated that anxiety was associated with a lifetime history of atopic disorders as a group. The association was significantly strengthened when controlling for depression and externalizing psychiatric symptoms. Among atopic disorders, "pure" anxiety was associated with asthma and AR, and having both asthma and AR strengthened the association compared to having either disorder alone. The association of "pure" anxiety with asthma and AR is consistent with existing data suggesting a relationship between anxiety and respiratory disorders. Having both asthma and AR appeared to confer an additive "dose effect" on the strength of the association. The lack of an association with depression suggests that other factors may contribute to the differential expression of anxiety and depression with atopic disorders. Findings demonstrate the importance of assessing the impact of co-morbid psychiatric symptoms and atopic disorders within individual studies to determine the specificity of underlying relationships between these conditions.
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Affiliation(s)
- Marcia J. Slattery
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA,Corresponding author. . Tel.: +1 608 263 6100; fax +1 608 262 9246
| | - Marilyn J. Essex
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Feldman JM, Acosta Pérez E, Canino G, McQuaid EL, Goodwin RD, Ortega AN. The role of caregiver major depression in the relationship between anxiety disorders and asthma attacks in island Puerto Rican youth and young adults. J Nerv Ment Dis 2011; 199:313-8. [PMID: 21543950 PMCID: PMC3090724 DOI: 10.1097/nmd.0b013e3182174e84] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The goal of this study was to assess whether the association between asthma attacks and anxiety disorders in youth/young adults is reduced after adjusting for the caregivers' psychiatric disorders. An island-wide probability sample of 641 households in Puerto Rico with youth/young adults between ages 10 and 25 years participated along with their caregivers. The Diagnostic Interview Schedule for Children and the Composite International Diagnostic Interview were conducted to assess anxiety and depressive disorders. Youth/young adults with an anxiety disorder were more likely to have a lifetime history of asthma attacks versus youth/young adults without an anxiety disorder. Caregivers of participants with asthma attacks were more likely to have major depression than did the caregivers of participants without asthma attacks. The association between asthma attacks and anxiety disorders in youth was no longer significant after adjustment for caregiver major depression. It is important to consider the role of caregiver depression in asthma-anxiety comorbidity in youth/young adults.
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Affiliation(s)
- Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA.
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Bahreinian S, Ball GDC, Colman I, Becker AB, Kozyrskyj AL. Depression is more common in girls with nonatopic asthma. Chest 2011; 140:1138-1145. [PMID: 21474570 DOI: 10.1378/chest.11-0219] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Asthma may increase the risk of comorbid depressive disorders in children. Children suffering from asthma or depression are more often overweight. We examined whether depression was more likely in children with atopic and nonatopic asthma, independent of abdominal adiposity. METHODS A cross-sectional analysis was performed on data collected in the Study of Asthma, Genes, and Environment in Canada. Children aged 11 to 14 years were assessed by a pediatric allergist to confirm asthma, allergic rhinitis, and atopic dermatitis diagnosis. Atopic asthma was defined based on skin prick testing and allergic asthma based on the presence of allergic rhinitis or atopic dermatitis in addition to asthma. Depressive symptoms were assessed using the Children's Depression Inventory-Short Form. Data were analyzed using logistic regression modeling to determine likelihood of depression in children with asthma, stratified by gender and adjusting for ethnicity, waist circumference (WC), and atopy. RESULTS Four hundred thirty-one children aged 11 to 14 years (136 with asthma and 295 without asthma) were studied. After adjusting for the covariates, girls who had nonatopic or nonallergic asthma were three times more likely to have comorbid depressive symptoms compared with healthy girls (OR, 2.84; 95% CI, 1.00-8.10; OR, 3.47; 95% CI, 1.30-9.25, respectively). For each 10-cm increase in WC of girls, our model showed a 39% to 56% increase in the chance of depression. In boys, neither asthma nor WC showed an association with depression. CONCLUSIONS We recommend all health practitioners who see girls with asthma or girls who are overweight watch for depressive symptoms and treat comorbid depression seriously.
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Affiliation(s)
- Salma Bahreinian
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, AB; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Ian Colman
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB
| | - Allan B Becker
- Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anita L Kozyrskyj
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB; Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB
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Affiliation(s)
- Ghanshyam N Pandey
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612
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Yilmaz A, Cumurcu BE, Tasliyurt T, Sahan AG, Ustun Y, Etikan I. Role of psychiatric disorders and irritable bowel syndrome in asthma patients. Clinics (Sao Paulo) 2011; 66:591-7. [PMID: 21655752 PMCID: PMC3093789 DOI: 10.1590/s1807-59322011000400012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 11/01/2011] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The goals of the study were the following: 1) to determine the frequency of psychiatric disorders and irritable bowel syndrome in patients with asthma and 2) to compare the frequency of these disorders in patients with asthma to their frequency in healthy controls. INTRODUCTION Patients with asthma have a higher frequency of irritable bowel syndrome and psychiatric disorders. METHODS We evaluated 101 patients with bronchial asthma and 67 healthy subjects. All subjects completed the brief version of the Bowel Symptoms Questionnaire and a structured clinical interview for DSM-IV axis disorders (SCID-I/CV). RESULTS There were 37 cases of irritable bowel syndrome in the group of 101 stable asthma patients (36.6%) and 12 cases in the group of 67 healthy subjects (17.9%) (p = 0.009). Irritable bowel syndrome comorbidity was not related to the severity of asthma (p = 0.15). Regardless of the presence of irritable bowel syndrome, psychiatric disorders in asthma patients (52/97; 53.6%) were more common than in the control group (22/63, 34.9%) (p = 0.02). Although psychiatric disorders were more common in asthma patients with irritable bowel syndrome (21/35, 60%) than in those without irritable bowel syndrome (31/62, 50%), the difference was not significant (p = 0.34). In asthma patients with irritable bowel syndrome and psychiatric disorders, the percentage of forced expiratory volume in 1 s (FEV(1)) was lower than it was in those with no comorbidities (p = 0.02). CONCLUSIONS Both irritable bowel syndrome and psychiatric disorders were more common in asthma patients than in healthy controls. Psychiatric disorders were more common in asthma patients with irritable bowel syndrome than in those without irritable bowel syndrome, although the differences failed to reach statistical significance. In asthma patients with IBS and psychiatric disorders, FEV(1)s were significantly lower than in other asthma patients. It is important for clinicians to accurately recognize that these comorbid conditions are associated with additive functional impairment.
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Affiliation(s)
- Ayse Yilmaz
- Department of Chest Diseases, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey.
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Pao M, Bosk A. Anxiety in medically ill children/adolescents. Depress Anxiety 2011; 28:40-9. [PMID: 20721908 PMCID: PMC2990785 DOI: 10.1002/da.20727] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/01/2010] [Accepted: 06/10/2010] [Indexed: 11/08/2022] Open
Abstract
Anxiety disorders are thought to be one of the most common psychiatric diagnoses in children/adolescents. Chronic medical illness is a significant risk factor for the development of an anxiety disorder, and the prevalence rate of anxiety disorders among youths with chronic medical illnesses is higher compared to their healthy counterparts. Anxiety disorders may develop secondary to predisposing biological mechanisms related to a child's specific medical illness, as a response to being ill or in the hospital, a threatening environment, as a result of other genetic and psychological factors, or as a combination of all these factors. Additionally, exposure to physical pain early in one's life and/or frequent painful medical procedures are correlated with fear and anxiety during subsequent procedures and treatments, and may lead to medical nonadherence and other comorbidities. Anxiety disorders can have serious consequences in children/adolescents with chronic and/or life-limiting medical illnesses. Therefore, proper identification and treatment of anxiety disorders is necessary and may improve not only psychiatric symptoms but also physical symptoms. Behavioral and cognitive methods as well as psychotropic medications are used to treat anxiety disorders in pediatric patients. We will review current treatments for anxiety in children/adolescents with medical illnesses and propose future research directions.
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Affiliation(s)
- Maryland Pao
- Office of the Clinical Director, National Institutes of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Abigail Bosk
- Office of the Clinical Director, National Institutes of Mental Health, National Institutes of Health, Bethesda, MD
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Ramsawh HJ, Chavira DA, Stein MB. Burden of anxiety disorders in pediatric medical settings: prevalence, phenomenology, and a research agenda. ACTA ACUST UNITED AC 2010; 164:965-72. [PMID: 20921356 DOI: 10.1001/archpediatrics.2010.170] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The current review describes the phenomenology of several common anxiety disorders in children and adolescents as they present in medical settings. Anxiety disorders and associated features in children are described, along with epidemiology, functional impairment, common somatic complaints, medical comorbidity, health care utilization, and presentation in general and in specialty pediatric medical settings. Recommendations for clinical management in pediatric settings are presented, and evidence-based interventions and emerging treatments for pediatric anxiety disorders are described. The review concludes with a discussion of future research directions that may lead to increased recognition and improved management of anxiety disorders in pediatric medical settings.
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Affiliation(s)
- Holly J Ramsawh
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0855, USA.
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Pandey GN, Dwivedi Y. What can post-mortem studies tell us about the pathoetiology of suicide? FUTURE NEUROLOGY 2010; 5:701-720. [PMID: 21436961 DOI: 10.2217/fnl.10.49] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Suicide is a major public health concern; however, its neurobiology is unclear. Post-mortem brain tissue obtained from suicide victims and normal controls offers a useful method for studying the neurobiology of suicide. Despite several limitations, these studies have offered important leads in the neurobiology of suicide. In this article, we discuss some important findings resulting from these studies, focusing on serotonergic mechanisms, signal transduction systems, neuroendocrine studies and immune function abnormalities in suicide. These studies suggest that abnormalities of certain receptor subtypes, components of signaling systems such as protein kinase C and protein kinase A, transcription factors such as cyclic AMP response element-binding protein and neurotrophins may play an important role in the pathophysiology of suicide. These studies also suggest abnormalities of hypothalamic-pituitary-adrenal axis system components, feedback mechanisms and cytokines, which are chemical mediators of the immune functions. Post-mortem brain tissue offers an opportunity for future studies, such as genetic and epigenetic studies.
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Affiliation(s)
- Ghanshyam N Pandey
- The Psychiatric Institute (MC 912), Department of Psychiatry, University of Illinois at Chicago, 1601 W Taylor St, Chicago, IL 60612, USA
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Lien L, Green K, Thoresen M, Bjertness E. Atopic conditions and mental health problems: a 3-year follow-up study. Eur Child Adolesc Psychiatry 2010; 19:705-13. [PMID: 20358235 DOI: 10.1007/s00787-010-0106-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 03/17/2010] [Indexed: 12/21/2022]
Abstract
The aim of this study was to test the hypothesis that atopic conditions at 15/16 years of age affect both internalized and externalized mental health problems 3 years later. Combined school and postal survey was conducted in urban and rural settings. A total of 3,674 adolescents (70.1% response rate) were followed at two time points and interviewed with similar questionnaires at baseline and follow-up. Hopkins Symptoms Checklist (HSCL-10) was used to assess internalized problems, and two subscales (conduct problems and hyperactivity) from the Strength and Difficulties Questionnaire to measure externalized mental health problems. The atopic conditions investigated were asthma, hay fever and eczema by asking the adolescents whether these conditions were present or not. There was an increase in the prevalence of internalized mental health problems from about 17-25% and a decrease in externalized mental health problems and number of atopic conditions in the follow-up period. Of the atopic conditions, hay fever was most prevalent with about 34% at 15 years of age and 20% at 18. The asthma prevalence was at 10 and 5% and eczema at 25 and 10%, respectively. Internalized mental health problems among girls were significantly associated with atopic conditions 3 years earlier, also after controlling for confounding variables. To live with atopic conditions seem to affect the mood and level of anxiety among adolescent girls. This should be kept in mind by health professionals treating young girls with atopic conditions.
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Affiliation(s)
- Lars Lien
- Institute of Psychiatry, University of Oslo, Blindern, Oslo, Norway.
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Cubo E, Velasco SS, Benito VD, Villaverde VA, Galín JMTG, Santidrián AM, Vicente JM, Guevara JC, Louis ED, Benito-León J, León JB. Psychometric Attributes of the DISC Predictive Scales. Clin Pract Epidemiol Ment Health 2010; 6:86-93. [PMID: 21139991 PMCID: PMC2996515 DOI: 10.2174/1745017901006010086] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 06/15/2010] [Accepted: 06/17/2010] [Indexed: 11/30/2022]
Abstract
Introduction: This study was designed to evaluate the psychometric attributes and screening efficiency of a Spanish version of the Children Predictive Scales (DPS) against the Spanish Diagnostic Interview Schedule for Children (DISC-IV). Method: This pilot cross-sectional study included 61 children aged 9 to 14 years in a mainstream school. The following psychometric attributes were analyzed: acceptability, scale assumptions, internal consistency, and precision, as well the predictive validity (AUC). Results: The scale did not show ceiling or floor effects (6.4%, 1.3%, respectively). The internal consistency was high (α=0.92), and the standard error of measurement was adequate (SEM=1.54). The overall DPS AUC was 0.72 against DISC IV corresponding diagnosis. Conclusion: The Spanish version of the DPS-4.32 seems to be a reliable and precise tool for screening mental health disorders in a school-age population.
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Affiliation(s)
- Esther Cubo
- Neurology Department, General Yagüe Hospital, Burgos, Spain
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The puzzle of problem-solving efficacy: understanding anxiety among urban children coping with asthma-related and life stress. ANXIETY STRESS AND COPING 2010; 23:383-98. [PMID: 19636994 DOI: 10.1080/10615800903118049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Children with asthma living in urban environments are at risk for experiencing anxiety by virtue of both social context and health-related stressors. Although the use of active coping strategies is generally associated with more optimal psychosocial functioning, there is evidence that active coping is less helpful in response to uncontrollable or severe stress. Expectations that one can fix a problem that is uncontrollable or insurmountable may create distress. Problem-solving efficacy was examined as a moderator of the association between stress and anxiety among children residing in inner-city neighborhoods. It was hypothesized that children's perceptions of high problem-solving efficacy would exacerbate their vulnerability to stress. Forty-five parent-child dyads were recruited from urban community health centers. Most participants were members of ethnic minority groups. Hierarchical multiple regression analyses revealed main effects of asthma-related stress and life stress on children's anxiety. However, these effects were moderated by problem-solving efficacy. Asthma-related stress and life stress were positively associated with anxiety only for children who had the highest levels of problem-solving efficacy. In other words, positive expectations about the ability to solve problems functioned as a liability for highly stressed children. Implications for psychosocial interventions with at-risk children are discussed.
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Fiese BH, Winter MA, Wamboldt FS, Anbar RD, Wamboldt MZ. Do family mealtime interactions mediate the association between asthma symptoms and separation anxiety? J Child Psychol Psychiatry 2010; 51:144-51. [PMID: 19754662 PMCID: PMC2804777 DOI: 10.1111/j.1469-7610.2009.02138.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Respiratory problems have been shown to be associated with the development of panic anxiety. Family members play an essential role for children to emotionally manage their symptoms. This study aimed to examine the relation between severity of respiratory symptoms in children with asthma and separation anxiety. Relying on direct observation of family interactions during a mealtime, a model is tested whereby family interactions mediate the relation between asthma severity and separation anxiety symptoms. METHODS Sixty-three children (ages 9-12 years) with persistent asthma were interviewed via the Diagnostic Interview Schedule for Children IV; family interactions were assessed via direct observation of a mealtime; primary caregivers completed the Childhood Asthma Severity Scale; youth pulmonary function was ascertained with pre- and post-bronchodilator spirometry; adherence to asthma medications was objectively tracked for six weeks. RESULTS Poorer pulmonary function and higher functional asthma severity were related to higher numbers of separation anxiety symptoms. Controlling for medication adherence, family interaction patterns mediated the relationship between poorer pulmonary function and child separation anxiety symptoms. CONCLUSIONS Family mealtime interactions may be a mechanism by which respiratory disorders are associated with separation anxiety symptoms in children, potentially through increasing the child's capacity to cognitively frame asthma symptoms as less threatening, or through increasing the child's sense of security within their family relationships.
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MURDOCK KARLAKLEIN, ROBINSON ELIZABETHM, ADAMS SUEK, BERZ JENNIFER, ROLLOCK MICHAELJ. Family–school connections and internalizing problems among children living with asthma in urban, low-income neighborhoods. J Child Health Care 2009; 13:275-94. [PMID: 19713409 PMCID: PMC3480735 DOI: 10.1177/1367493509336682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children with asthma living in urban environments are at risk for experiencing internalizing problems and difficulties at school due to social context and health-related stressors. Parent confidence and participation in the school and children's attitudes about school were explored in association with children's depressed mood and school anxiety. Forty-five parent-child dyads were recruited from urban community health centers. Most participants were members of ethnic minority groups. Hierarchical multiple regression analyses revealed that higher levels of parent confidence in the school were associated with fewer symptoms of school anxiety in children. Children's attitudes toward school moderated the relation between parent participation in the school and children's depressed mood. Specifically, lower levels of parent participation were associated with higher levels of depressed mood only for children with the least positive school attitudes. Although preliminary, these results suggest the importance of attending to family-school connections to optimize the school-related psychological functioning of children living with asthma in urban environments.
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Affiliation(s)
- KARLA KLEIN MURDOCK
- Associate Professor, Department of Psychology, Washington and Lee University, Lexington, VA, USA
| | - ELIZABETH M. ROBINSON
- Postbaccalaureate Fellow, Prevention Research Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, MD, USA
| | - SUE K. ADAMS
- Assistant Professor, Department of Human Development and Family Studies, University of Rhode Island, Kingston, RI, USA
| | - JENNIFER BERZ
- Family and Child Clinician, Brookline Community Mental Health Center, Boston, MA, USA
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Tani H, Matsuda K, Matsumoto T, Hiramoto I, Okamatsu Y, Takehiro S, Kimura K, Higuchi S, Okazaki R, Matsuishi T. Extended-stay hospitalization for childhood asthma in Japan. Pediatr Int 2009; 51:502-6. [PMID: 19400816 DOI: 10.1111/j.1442-200x.2008.02772.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND While recent advances in asthma management have enabled adequate control to be frequently achieved in outpatient settings, children whose asthma remains poorly controlled despite outpatient treatment are often referred to extended-stay hospitals. The aim of the present study was to examine trends concerning extended-stay hospitalization and to evaluate the present status of this approach. METHODS A retrospective study was conducted to assess changes in the number of admissions among 408 children with extended stays at Kamiamakusa General Hospital between 1989 and 2005. Medical and laboratory data of 236 patients admitted since 1994 were obtained from clinical records. RESULTS The number of children with extended-stay hospitalizations since 2000 declined dramatically compared with the early 1990s, while the percentage of patients with complications of childhood asthma, such as severe atopic dermatitis, school absenteeism, and obesity, have increased significantly in the recent past. Practical benefits of extended-stay hospitalization were demonstrated by significant improvement of exercise performance and measurement of pulmonary function parameters and serum IgE concentrations by time of discharge. In addition to improvement in asthmatic symptoms, maintenance drug requirements and frequency of school absenteeism were reduced. CONCLUSIONS The medical mission of extended-stay hospitalizations is currently limited due to the availability of improved pharmacotherapy. Some patients, however, with exceptionally severe asthma or psychological problems that interact with their medical condition still fare poorly under outpatient care and could benefit from group care. Further study is needed to identify the components of long-term programs essential to produce change.
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Affiliation(s)
- Hidekazu Tani
- Department of Pediatrics, Kurume University School of Medicine, Fukuoka, Japan
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Vasquez JC, Fritz GK, Kopel SJ, Seifer R, McQuaid EL, Canino G. Ethnic differences in somatic symptom reporting in children with asthma and their parents. J Am Acad Child Adolesc Psychiatry 2009; 48:855-863. [PMID: 19564802 PMCID: PMC3278967 DOI: 10.1097/chi.0b013e3181a81333] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The purpose of this study is to examine the association between child and parent somatic symptom reporting and pediatric asthma morbidity in Latino and non-Latino white children. METHOD The study consists of 786 children, 7 to 15 years of age, in Rhode Island (RI) and Puerto Rico. Children's and parents' levels of general somatic symptoms were assessed with well-established self-report measures. Clinician-determined asthma severity was based on reported medication use, asthma symptom history, and spirometry results. Asthma-related health care use and functional morbidity was obtained via parent self-report. RESULTS Child and parent reports of general somatic symptoms were significantly related to pediatric asthma functional morbidity when controlling for poverty, parent education, child's age, and asthma severity. In controlling for covariates, Latino children in RI reported higher levels of somatic symptoms than Island Puerto Rican children, and RI Latino parents reported more somatic symptoms than RI non-Latino white parents (p < .05). CONCLUSIONS This study replicates and extends to children in previous research showing higher levels of symptom reporting in Latinos relative to whites. Results also provide new insight into the relation between general somatic symptom reports and pediatric asthma. Ethnic differences in somatic symptom reporting may be an important factor underlying asthma disparities between Latino and non-Latino white children.
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Affiliation(s)
- Juan C Vasquez
- Drs. Fritz, Seifer, and McQuaid and Mr. Vasquez and Ms. Kopel are with the Bradley Hasbro Children's Research Center and the Warren Alpert Medical School of Brown University; and Dr. Canino is with the University of Puerto Rico
| | - Gregory K Fritz
- Drs. Fritz, Seifer, and McQuaid and Mr. Vasquez and Ms. Kopel are with the Bradley Hasbro Children's Research Center and the Warren Alpert Medical School of Brown University; and Dr. Canino is with the University of Puerto Rico.
| | - Sheryl J Kopel
- Drs. Fritz, Seifer, and McQuaid and Mr. Vasquez and Ms. Kopel are with the Bradley Hasbro Children's Research Center and the Warren Alpert Medical School of Brown University; and Dr. Canino is with the University of Puerto Rico
| | - Ronald Seifer
- Drs. Fritz, Seifer, and McQuaid and Mr. Vasquez and Ms. Kopel are with the Bradley Hasbro Children's Research Center and the Warren Alpert Medical School of Brown University; and Dr. Canino is with the University of Puerto Rico
| | - Elizabeth L McQuaid
- Drs. Fritz, Seifer, and McQuaid and Mr. Vasquez and Ms. Kopel are with the Bradley Hasbro Children's Research Center and the Warren Alpert Medical School of Brown University; and Dr. Canino is with the University of Puerto Rico
| | - Glorisa Canino
- Drs. Fritz, Seifer, and McQuaid and Mr. Vasquez and Ms. Kopel are with the Bradley Hasbro Children's Research Center and the Warren Alpert Medical School of Brown University; and Dr. Canino is with the University of Puerto Rico
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Cho SC, Kim BN, Kim JW, Rohde LA, Hwang JW, Chungh DS, Shin MS, Lyoo IK, Go BJ, Lee SE, Kim HW. Full syndrome and subthreshold attention-deficit/hyperactivity disorder in a Korean community sample: comorbidity and temperament findings. Eur Child Adolesc Psychiatry 2009; 18:447-57. [PMID: 19205781 DOI: 10.1007/s00787-009-0755-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 01/15/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The main objective of this study was to investigate the comorbid disorders and temperamental profiles of full syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD). METHOD A sample of 2,493 students was randomly selected from six representative elementary schools in Seoul, Korea. Among 245 children with full syndrome and subthreshold ADHD diagnosed by the diagnostic interview schedule for children-4th version, parents of 185 subjects (mean age 9.0 +/- 1.7 years) and of a random sample of 185 age- and gender-matched non-ADHD children have completed the parent's version of the children behavior checklist (CBCL) and the juvenile temperament and character inventory (JTCI). RESULTS The prevalence rates of full syndrome and subthreshold ADHD were, respectively, 5.90% (95% confidence interval = 4.74-7.06) and 9.00% (95% confidence interval = 7.58-10.41). Subthreshold ADHD cases did not differ from full syndrome ADHD in any JTCI profile, showing high novelty seeking/low persistence/low self-directedness than controls. Subthreshold ADHD also showed increased risk for externalizing disorders and higher scores in eight CBCL scales (somatic complaints, anxious/depressed, social problems, attention problems, delinquent behaviors, aggressive behaviors, externalizing problems and total behavioral problems) compared to the controls. CONCLUSIONS These results support the clinical relevance of subthreshold ADHD in Asian culture. Increased clinical awareness for children with subthreshold ADHD is needed.
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Affiliation(s)
- Soo-Churl Cho
- Division of Child and Adolescent Psychiatry, Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Korea
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Roeder R, Roeder K, Asano E, Chugani HT. Depression and mental health help-seeking behaviors in a predominantly African American population of children and adolescents with epilepsy. Epilepsia 2009; 50:1943-52. [PMID: 19260941 DOI: 10.1111/j.1528-1167.2009.02046.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine whether previously undetected symptoms of depression and psychiatric help-seeking behaviors are associated with demographic or epilepsy-related variables in a predominantly African American sample of pediatric epilepsy patients. METHODS Ninety-six serially recruited parent-child dyads (55% African American, 39% Caucasian) completed the Short Mood and Feelings Questionnaire (SMFQ). Regression analyses determined whether depressive symptoms measured by the SMFQ were associated with demographic (age, gender, and ethnic background) or epilepsy-related variables (age of seizure onset, duration of epilepsy, seizure type, time since last seizure, and number of antiepileptic drugs). Dyads with positive SMFQ screens (score > or = 12) received information about depression and were advised to seek mental health services. Six months later, parents completed follow-up interviews to ascertain mental health service utilization. RESULTS Thirty-five participants (36.5%) screened positive for probable depression. Greater number of antiepileptic drugs was the only predictor variable independently associated with greater (worse) depression scores (p = 0.005). At 6-month follow-up, 12 patients (36.4%) had received mental health care, whereas 21 guardians (63.6%) denied depressive symptoms in their child and never sought mental health services (two dyads lost to follow-up). Logistic regression analyses found no associations between demographic, epilepsy-related, or depressive variables and psychiatric help-seeking. DISCUSSION This study indicates the necessity and feasibility of screening for previously undetected symptoms of depression in pediatric epilepsy clinics serving diverse populations, particularly among patients receiving antiepileptic polytherapy. Additional research on the correlates of depressive symptoms and determinants of psychiatric help-seeking is needed to develop evidence-based interventions for youths with epilepsy and symptoms of depression.
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Affiliation(s)
- Ruth Roeder
- Department of Pediatrics, Division of Pediatric Neurology, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan 48201, USA.
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Goodwin RD, Sourander A, Duarte CS, Niemelä S, Multimäki P, Nikolakaros G, Helenius H, Piha J, Kumpulainen K, Moilanen I, Tamminen T, Almqvist F. Do mental health problems in childhood predict chronic physical conditions among males in early adulthood? Evidence from a community-based prospective study. Psychol Med 2009; 39:301-311. [PMID: 18507873 DOI: 10.1017/s0033291708003504] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Previous studies have documented associations between mental and physical health problems in cross-sectional studies, yet little is known about these relationships over time or the specificity of these associations. The aim of the current study was to examine the relationship between mental health problems in childhood at age 8 years and physical disorders in adulthood at ages 18-23 years. METHOD Multiple logistic regression analyses were used to examine the relationship between childhood mental health problems, reported by child, parent and teacher, and physical disorders diagnosed by a physician in early adulthood. RESULTS Significant linkages emerged between childhood mental health problems and obesity, atopic eczema, epilepsy and asthma in early adulthood. Specifically, conduct problems in childhood were associated with a significantly increased likelihood of obesity and atopic eczema; emotional problems were associated with an increased likelihood of epilepsy and asthma; and depression symptoms at age 8 were associated with an increased risk of asthma in early adulthood. CONCLUSIONS Our findings provide the first evidence of an association between mental health problems during childhood and increased risk of specific physical health problems, mainly asthma and obesity, during early adulthood, in a representative sample of males over time. These data suggest that behavioral and emotional problems in childhood may signal vulnerability to chronic physical health problems during early adulthood.
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Affiliation(s)
- R D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Abstract
RATIONALE Emerging evidence suggests that exposure to environmental tobacco smoke (ETS) may be linked with behavior problems in childhood, but previous research has relied primarily on parent report of exposure, and results are inconclusive. OBJECTIVES To investigate the relationship between exposure to ETS and child behavior problems among children with asthma. METHODS The sample included 220 children who were enrolled in an asthma intervention trial and regularly exposed to ETS at home. Serum cotinine was used to measure exposure to tobacco smoke, and behavior problems were assessed by parent report on the Behavior Assessment System for Children. Covariates in adjusted analyses included: sex, age, race, asthma severity, asthma medication, maternal education, prenatal tobacco exposure, maternal depression, and Home Observation for Measurement of the Environment score. RESULTS Child behavior problems increased with increasing exposure to ETS. A stratified analysis of boys and girls separately indicated higher exposure among girls, but behavior problems were statistically significantly associated with exposure only in boys. Increasing behavior problems included externalizing behavior problems (beta= 2.23, p =.02) such as hyperactivity and aggression, internalizing behavior problems (beta= 2.19, p= .01) such as depression, and behavior symptoms (beta= 2.55, p= .01). CONCLUSIONS Among children with asthma, exposure to ETS is related to increased child behavior problems among boys.
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Riachy M, Bou Khalil P, Khayat G, Kobeissy Y, Yamout R, Mitri R, Saade-Riachy C, Couche N, Taan G, Geahchan N. [Impact of low socioeconomic status on the demography and co-morbidities of asthma]. Rev Mal Respir 2008; 25:275-81. [PMID: 18449093 DOI: 10.1016/s0761-8425(08)71546-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Asthma is a frequent and serious chronic respiratory disease which is sometimes fatal. It involves all ages and all social subclasses. The goal of our study was to determine the demography of asthma in a low socio-economic community in Lebanon and to describe its association with various epidemiologic factors. MATERIALS AND METHODS The computerized data of 44.814 patients of a nongovernmental organization (Hariri Foundation), in Lebanon were reviewed. Asthmatic patients diagnosed by a health professional on the basis of medical criteria during the period from January 2003 to June 2005 were included in the analysis. The socio-economic characteristics of this population were retrieved and their geographical distributions were depicted. The study focused on the association of asthma with cutaneous and ocular allergies, depression, obesity and alcohol consumption. RESULTS The majority of asthmatic patients (75%) belonged to a low socio-economic environment with a salary lower than $200 per month. 31% were illiterate. 583 (1.3%) of patients on the database were asthmatic. The rate in children was higher (2.08%) than in adults (1.09%). The majority of asthma occurred among subjects from Bekaa valley and South Lebanon. Asthma was associated more strongly with being an ex-smoker (OR 4.37; 95% CI 2.38, 8.02) than being a current smoker (OR 1.44; 95% CI 1.11, 1.87). A significant and strong association was found with depression (OR 25.6; 95% CI 3.32, 197.6), obesity (OR 4.09, 95% CI 1.31, 12.73) and with regular alcohol consumption (OR 11.78; 95% CI 1.55, 89.44). CONCLUSION This study describes the association of asthma in this population with low socio-economic status. By defining the demographic characteristics of the asthma population the Ministry of Health and the medical organizations concerned should be better able to manage the condition. This study confirms, in a Lebanese population, the epidemiological associations described in other populations around the world.
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Affiliation(s)
- M Riachy
- Département de Santé Publique, Faculté de Médecine, Université Saint Joseph, Beyrouth, Liban.
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Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 2008; 30:208-25. [PMID: 18433653 DOI: 10.1016/j.genhosppsych.2007.12.006] [Citation(s) in RCA: 379] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 12/11/2007] [Accepted: 12/11/2007] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide an overview of the role of anxiety disorders in medical illness. METHOD The Anxiety Disorders Association of America held a multidisciplinary conference from which conference leaders and speakers reviewed presentations and discussions, considered literature on prevalence, comorbidity, etiology and treatment, and made recommendations for research. Irritable bowel syndrome (IBS), asthma, cardiovascular disease (CVD), cancer and chronic pain were reviewed. RESULTS A substantial literature supports clinically important associations between psychiatric illness and chronic medical conditions. Most research focuses on depression, finding that depression can adversely affect self-care and increase the risk of incident medical illness, complications and mortality. Anxiety disorders are less well studied, but robust epidemiological and clinical evidence shows that anxiety disorders play an equally important role. Biological theories of the interactions between anxiety and IBS, CVD and chronic pain are presented. Available data suggest that anxiety disorders in medically ill patients should not be ignored and could be considered conjointly with depression when developing strategies for screening and intervention, particularly in primary care. CONCLUSIONS Emerging data offer a strong argument for the role of anxiety in medical illness and suggest that anxiety disorders rival depression in terms of risk, comorbidity and outcome. Research programs designed to advance our understanding of the impact of anxiety disorders on medical illness are needed to develop evidence-based approaches to improving patient care.
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Preter M, Klein DF. Panic, suffocation false alarms, separation anxiety and endogenous opioids. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:603-12. [PMID: 17765379 PMCID: PMC2325919 DOI: 10.1016/j.pnpbp.2007.07.029] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 07/24/2007] [Accepted: 07/24/2007] [Indexed: 01/21/2023]
Abstract
This review paper presents an amplification of the suffocation false alarm theory (SFA) of spontaneous panic [Klein DF (1993). False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry; 50:306-17.]. SFA postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively occur when the alarm is erroneously triggered. That panic is distinct from Cannon's emergency fear response and Selye's General Alarm Syndrome is shown by the prominence of intense air hunger during these attacks. Further, panic sufferers have chronic sighing abnormalities outside of the acute attack. Another basic physiologic distinction between fear and panic is the counter-intuitive lack of hypothalamic-pituitary-adrenal (HPA) activation in panic. Understanding panic as provoked by indicators of potential suffocation, such as fluctuations in pCO(2) and brain lactate, as well as environmental circumstances fits the observed respiratory abnormalities. However, that sudden loss, bereavement and childhood separation anxiety are also antecedents of "spontaneous" panic requires an integrative explanation. Because of the opioid system's central regulatory role in both disordered breathing and separation distress, we detail the role of opioidergic dysfunction in decreasing the suffocation alarm threshold. We present results from our laboratory where the naloxone-lactate challenge in normals produces supportive evidence for the endorphinergic defect hypothesis in the form of a distress episode of specific tidal volume hyperventilation paralleling challenge-produced and clinical panic.
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Affiliation(s)
- Maurice Preter
- New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons
- * Corresponding author. Mailing Address: 1160 Fifth Avenue, Suite 112, New York, NY 10029. Phone 1-212-713-5336, Fax 1-212-713-5336, e-mail
| | - Donald F. Klein
- New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1051 Riverside Drive, New York, NY 10032, Phone 1-212-543-6249, e-mail
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Richardson LP, Russo JE, Lozano P, McCauley E, Katon W. The effect of comorbid anxiety and depressive disorders on health care utilization and costs among adolescents with asthma. Gen Hosp Psychiatry 2008; 30:398-406. [PMID: 18774422 PMCID: PMC2614401 DOI: 10.1016/j.genhosppsych.2008.06.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 06/09/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess whether youth with asthma and comorbid anxiety and depressive disorders have higher health care utilization and costs than youth with asthma alone. METHODS A telephone survey was conducted among 767 adolescents (aged 11 to 17 years) with asthma. Diagnostic and Statistical Manual-4th Version (DSM-IV) anxiety and depressive disorders were assessed via the Diagnostic Interview Schedule for Children. Health care utilization and costs in the 12 months pre- and 6 months post-interview were obtained from computerized health plan records. Multivariate analyses were used to determine the impact of comorbid depression and anxiety on medical utilization and costs. RESULTS Unadjusted analyses showed that compared to youth with asthma alone, youth with comorbid anxiety/depressive disorders had more primary care visits, emergency department visits, outpatient mental health specialty visits, other outpatient visits and pharmacy fills. After controlling for asthma severity and covariates, total health care costs were approximately 51% higher for youth with depression with or without an anxiety disorder but not for youth with an anxiety disorder alone. Most of the increase in health care costs was attributable to nonasthma and non-mental health-related increases in primary care and laboratory/radiology expenditures. CONCLUSIONS Youth with asthma and comorbid depressive disorders have significantly higher health care utilization and costs. Most of these costs are due to increases in non-mental health and nonasthma expenses. Further study is warranted to evaluate whether improved mental health treatment and resulting increases in mental health costs would be balanced by savings in medical costs.
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Affiliation(s)
- Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,Children’s Hospital and Regional Medical Center, Seattle, WA
| | - Joan E. Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Paula Lozano
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA
| | - Elizabeth McCauley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA,Children’s Hospital and Regional Medical Center, Seattle, WA
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Tao R, Moore JK, Mayes TL, Emslie GJ. Depression in children and adolescents: optimizing treatment. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17455111.1.2.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Depression is a severe and prevalent illness among children and adolescents. Recent controversies regarding antidepressant use among pediatric patients have left healthcare providers, particularly primary-care providers, feeling uncertain of how to approach the care of depressed pediatric patients. Several large-scale studies of the treatment of pediatric depression have been completed. In addition, substantial progress has been made in our understanding of benefit versus risk in the treatment of pediatric depression. This paper presents the most updated scientific evidence in pediatric depression treatment. The review covers a wide range of treatment modalities including psychotherapy, antidepressant and alternative remedies. Recommendations based on both the scientific evidence and the most current guidelines and treatment algorithms are outlined.
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Affiliation(s)
- Rongrong Tao
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Jarrette K Moore
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Taryn L Mayes
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Graham J Emslie
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
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