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Simões Cunha M, Amaral R, Pereira AM, Almeida R, Alves-Correia M, Loureiro CC, Lopes C, Carvalho J, Ribeiro C, Vidal C, Antolín-Amérigo D, Pinto D, Ferreira-Magalhães M, Vasconcelos MJ, Lozoya C, Santos N, Cardia F, Taborda-Barata L, Ferreira R, Morais Silva P, Ferreira TM, Câmara R, Silva E, Bordalo D, Guimarães C, Calix MJ, da Silva S, Marques ML, Morete A, Nunes C, Vieira C, Páscoa R, Alves A, Marques JV, Reis B, Monteiro L, Monteiro R, Cepa M, Valentim B, Coelho DS, Fernandes S, Meireles P, Aguiar MA, Mourão AR, Fonseca JA, Jácome C. Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies. BMJ Open 2023; 13:e068725. [PMID: 37147092 PMCID: PMC10163458 DOI: 10.1136/bmjopen-2022-068725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms. METHODS This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built. RESULTS According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression. CONCLUSION At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.
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Affiliation(s)
- Mafalda Simões Cunha
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rita Amaral
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
- Department of Women's and Children's Health, Paediatric Research, Uppsala University, Uppsala, Sweden
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Magna Alves-Correia
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Cláudia Chaves Loureiro
- Pulmonology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Lopes
- Basic and Clinic Immunology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Immuno-allergology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Carmelita Ribeiro
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carmen Vidal
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostella, Spain
| | - Dario Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Diana Pinto
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Ferreira-Magalhães
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carlos Lozoya
- Allergy, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Francisca Cardia
- Unidade de Saúde Familiar Terras de Azurara, Agrupamento de Centros de Saúde Dão Lafões, Mangualde, Portugal
| | - Luís Taborda-Barata
- CICS-UBI Centro de Investigação em Ciências da Saúde - Health Sciences Research Centre & UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, Covilha, Portugal
- Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Rosário Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | | | - Tania Monteiro Ferreira
- Unidade de Saúde Familiar Progresso e Saúde, Agrupamento de Centros de Saúde Baixo Mondego, Tocha, Portugal
| | - Raquel Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Eurico Silva
- Unidade de Saúde Familiar João Semana, Agrupamento de Centros de Saúde de Baixo Vouga, Ovar, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Cristina Guimarães
- Unidade de Cuidados de Saúde Personalizados Norte (Arnaldo Sampaio), Agrupamento de Centros de Saúde Pinhal Litoral, Monte Redondo, Portugal
| | - Maria José Calix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Sofia da Silva
- Unidade de Saúde Familiar Cuidarte, Unidade Local de Saúde do Alto Minho, Portuzelo, Portugal
| | - Maria Luís Marques
- Serviço de Imunoalergologia, Hospital da Senhora da Oliveira, Guimarães, Guimaraes, Portugal
| | - Ana Morete
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Serviço de Imunoalergologia, Hospital Infante D Pedro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Carlos Nunes
- Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - Cláudia Vieira
- Unidade de Saúde Familiar Corgo, Agrupamento de Centros de Saúde Douro I - Marão e Douro Norte, Vila Real, Portugal
| | - Rosália Páscoa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Homem do Leme, ACeS Porto Ocidental, Porto, Portugal
| | - Adelaide Alves
- Serviço de Pneumologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Varanda Marques
- Unidade de Saúde Familiar Viseu-Cidade, Agrupamento de Centros de Saúde do Dão Lafões, Viseu, Portugal
| | - Bruno Reis
- Unidade de Cuidados Saúde Personalizados Sicó, Agrupamento de Centros de Saúde Pinhal Litoral, Leiria, Portugal
| | - Luís Monteiro
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- USF Esgueira +, ACES Baixo Vouga, Esgueira, Portugal
| | - Rosário Monteiro
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Homem do Leme, ACeS Porto Ocidental, Porto, Portugal
| | - Margarida Cepa
- Unidade de Saúde Familiar Marquês, ACES Pinhal Litoral, Pombal, Portugal
| | - Bruno Valentim
- Unidade de Saúde Familiar Condeixa, ACES Baixo Mondego, Condeixa-a-Nova, Portugal
| | - Daniela Sousa Coelho
- Unidade de Cuidados de Saúde Personalizados de Amarante, ACES Tâmega I - Baixo Tâmega, Amarante, Portugal
| | - Sara Fernandes
- Unidade de Saúde Familiar Bracara Augusta, ACES Cávado I, Braga, Portugal
| | - Patrícia Meireles
- Unidade de Saúde Familiar Almedina, ACES Douro II - Douro Sul, Lamego, Portugal
| | - Margarida Abreu Aguiar
- Unidade de Saúde Familiar Valongo, ACES Grande Porto III - Maia / Valongo, Valongo, Portugal
| | - Ana Rita Mourão
- Unidade de Saúde Familiar Canelas, ACES Grande Porto VIII - Espinho / Gaia, Vila Nova de Gaia, Portugal
| | - Joao A Fonseca
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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Localio AM, Klusaritz H, Morales KH, Ruggieri DG, Han X, Apter AJ. Primary language and the electronic health record patient portal: Barriers to use among Spanish-speaking adults with asthma. J Asthma 2021; 59:2081-2090. [PMID: 34634975 DOI: 10.1080/02770903.2021.1989462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess electronic health record patient portal use among Spanish-speaking patients with asthma compared to English-speaking patients and identify barriers to use. METHODS Using data collected for a PCORI-funded randomized controlled trial to increase patient portal use in low-income adults with uncontrolled asthma, we estimated the association between portal use, measured using surveys and actual user login data, and primary language. Open-ended survey responses were grouped into common themes. RESULTS Among 301 adults with asthma: age 18-87, 90% female, 17% Spanish speakers; 44% had no portal use during the study. Spanish speakers were less likely to have ever heard of the patient portal than English speakers (p=.001) and reported more difficulty navigating the portal (p<.001). Spanish speakers with low health literacy had less portal use (31%) than their English-speaking counterparts (51%) (p=.02). Compared to high-literacy English speakers, the odds of using the portal for low-literacy Spanish speakers were 0.34 (95% CI 0.14, 0.84) (p=.02). Three-quarters of Spanish speakers cited barriers to portal use compared to one-quarter of English speakers, and many suggested creating a Spanish version to improve user-friendliness. CONCLUSIONS English-only patient portals may not meet the needs of Spanish-speaking patients with uncontrolled asthma. Health systems serving Spanish-speaking communities should implement patient portals in Spanish.
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Affiliation(s)
- Anna M Localio
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Heather Klusaritz
- Master of Public Health Program, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominique G Ruggieri
- Master of Public Health Program, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiaoyan Han
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea J Apter
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bedolla-Barajas M, Morales-Romero J, Fonseca-López JC, Pulido-Guillén NA, Larenas-Linnemann D, Hernández-Colín DD. Anxiety and depression in adult patients with asthma: the role of asthma control, obesity and allergic sensitization. J Asthma 2020; 58:1058-1066. [PMID: 32312136 DOI: 10.1080/02770903.2020.1759087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the frequency of anxiety and depression in adult patients with asthma and to identify factors associated with them. METHODS This cross-sectional study included 164 consecutively recruited patients with asthma aged ≥ 18 years. Participants were clinically assessed and the mental state was analyzed through of the Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI-II); the Asthma Control Test (ACT) was measured, and allergic sensitization and respiratory function were also evaluated. Binary logistic regression models to identify the factors related to anxiety or depression were carried out. Complementary, 95% confidence intervals (CI) were estimated. RESULTS Anxiety was present in 54.3% of patients (95% CI: 46.6%-61.7%) while depression was found in 50.6% (95% CI: 43.0%-58.2%). Depression increased the odds of anxiety in patients with asthma (OR: 26.00, p < 0.0001), whereas an ACT score ≥ 20 points and allergic asthma were associated with a lower odds than the reference group (OR: 0.29; p = 0.007 and OR: 0.29; p = 0.024, respectively). Depression was associated with anxiety and obesity (OR: 25.33, p < 0.0001 and OR: 3.66; p = 0.014, respectively). CONCLUSIONS Overall, more than half of all asthmatic patients suffer from anxiety and depression. Well-controlled asthma and allergic sensitization decreased the likelihood of anxiety, while depression was associated with both obesity and anxiety.
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Affiliation(s)
- Martín Bedolla-Barajas
- Servicio de Alergia e Inmunología Clínica, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, México
| | | | - Juan Carlos Fonseca-López
- Servicio de Urgencias Adultos, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, México
| | - Norma Angélica Pulido-Guillén
- Centro Universitario de Ciencias de la Salud, Maestría en Ciencias de la Salud de la Adolescencia y la Juventud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | - Dante Daniel Hernández-Colín
- Servicio de Alergia e Inmunología Clínica, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, México
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Slatore CG, Falvo MJ, Nugent S, Carlson K. Afghanistan and Iraq War Veterans: Mental Health Diagnoses are Associated with Respiratory Disease Diagnoses. Mil Med 2019; 183:e249-e257. [PMID: 29420832 DOI: 10.1093/milmed/usx108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/10/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Many veterans of the wars in Afghanistan and Iraq have concomitant respiratory conditions and mental health conditions. We wanted to evaluate the association of mental health diagnoses with respiratory disease diagnoses among post-deployment veterans. Methods We conducted a retrospective cohort study of all Afghanistan and Iraq War veterans who were discharged from the military or otherwise became eligible to receive Veterans Health Administration services. The primary exposure was receipt of a mental health diagnosis and the primary outcome was receipt of a respiratory diagnosis as recorded in the electronic health record. We used multivariable adjusted logistic regression to measure the associations of mental health diagnoses with respiratory diagnoses and conducted several analyses exploring the timing of the diagnoses. Results Among 182,338 post-deployment veterans, 14% were diagnosed with a respiratory condition, 77% of whom had a concomitant mental health diagnosis. The incidence rates were 5,363/100,000 person-years (p-y), 587/100,000 p-y, 1,450/100,000 p-y, and 233/100,000 p-y for any respiratory disease diagnosis, bronchitis, asthma, and chronic obstructive lung disease diagnoses, respectively, after the date of first Veterans Health Administration utilization. Any mental health diagnosis was associated with increased odds for any respiratory diagnosis (adjusted odds ratio 1.41, 95% confidence interval 1.37-1.46). The association of mental health diagnoses and subsequent respiratory disease diagnoses was stronger and more consistent than the converse. Conclusion Many Afghanistan and Iraq War veterans are diagnosed with both respiratory and mental illnesses. Comprehensive plans that include care coordination with mental health professionals and treatments for mental illnesses may be important for many veterans with respiratory diseases.
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Affiliation(s)
- Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, (R&D 66) 3710 SW US Veterans Hospital Road, Portland, OR 97239.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, OHSU Division of Pulmonary and Critical Care Medicine, 3181 SW Sam Jackson Park Rd, Mail Code UHN6, Portland, OR 97239-3098
| | - Michael J Falvo
- Department of Veterans Affairs, War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, Mail Stop 129, East Orange, NJ 07018-1095.,Rutgers Biomedical and Health Sciences, New Jersey Medical School, The State University of New Jersey, Stanley S. Bergen Building, 65 Bergen Street, Newark, NJ 07103
| | - Shannon Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, (R&D 66) 3710 SW US Veterans Hospital Road, Portland, OR 97239
| | - Kathleen Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, (R&D 66) 3710 SW US Veterans Hospital Road, Portland, OR 97239.,School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, MC: GH230, Portland, OR 97239
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Woledesenbet MA, Shumet Mekonen S, Sori LM, Abegaz TM. Epidemiology of Depression and Associated Factors among Asthma Patients in Addis Ababa, Ethiopia. PSYCHIATRY JOURNAL 2018; 2018:5934872. [PMID: 30225243 PMCID: PMC6129350 DOI: 10.1155/2018/5934872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/07/2018] [Accepted: 07/16/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Depression in asthma patients can cause worsening of respiratory symptoms. Addressing mental illness in those with asthma improves asthma outcomes. This study aimed to assess the epidemiology of depression and associated factors among asthma patients attending government hospitals in Ethiopia. METHODS Institutional based cross-sectional study was conducted on patients with asthma at three governmental hospitals of Addis Ababa from June to July 2017. Patient health questionnaire (PHQ-9) depression scale was used to assess prevalence of depression among asthmatic patients. The data were entered and analyzed using SPSS version 20 statistical software. Binary logistic regression analysis was conducted to identify associated factors for depression. To indicate the strength of association, odds ratios (OR) and 95% confidence intervals (95% CI) were used. RESULT A total of 405 participants were enrolled in the study giving an overall response rate of 96%. The respondents had mean age of 54.46 and standard deviation (SD) of 10.01 years. About 273 (67.4%) were females. The prevalence of depression among asthma patients was 85 (21%). The odds of developing depression among single asthma patients were increased by 1.63 with 95% CI [1. 8, 3.493]. Depression among asthma patients who had comorbid cardiac illness was 6.2 times higher than those who do not have at CI [1.145, 24.109]. The prevalence of depression among uncontrolled asthma patients was 8 times higher than those with well-controlled asthma at CI [1.114, 19.025]. CONCLUSION One-fifth of asthmatic patients were experiencing depression. Uncontrolled asthma, comorbid cardiac illness, and single patients were important predictors of depression among asthmatic patients. Proper control of asthmatic attack and cardiac illnesses is very important to reduce the burden of depression.
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Affiliation(s)
- Mebrat Abera Woledesenbet
- University of Gondar Hospital, College of Medicine and Health Sciences, Department of Psychiatry, Ethiopia
| | - Shegaye Shumet Mekonen
- University of Gondar, College of Medicine and Health Sciences, Department of Psychiatry, Ethiopia
| | - Lamesa Melese Sori
- University of Gondar Hospital, College of Medicine and Health Sciences, Department of Psychiatry, Ethiopia
| | - Tadesse Melaku Abegaz
- University of Gondar, College of Medicine and Health Sciences, Department of Clinical Pharmacy, Ethiopia
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Depressive symptoms, quality of sleep, and disease control in women with asthma. Sleep Breath 2016; 21:361-367. [PMID: 27796717 DOI: 10.1007/s11325-016-1422-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/19/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE A large number of asthmatic patients, particularly females, present inadequate disease control. Depressive symptoms are reportedly common in asthma and have been related to poor disease control, but the mechanism of this association is still unclear. Poor quality sleep, frequently observed in asthmatics, is also a manifestation of depression and has been related to uncontrolled asthma. This study aimed to investigate the relationship between depressive symptoms, sleep quality, and asthma control. METHODS This was a cross-sectional study of 123 women with previous diagnosis of asthma from a reference center in Fortaleza, Brazil. Depressive symptoms were assessed by the Beck Depression Inventory (BDI); quality of sleep was evaluated by the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness by the Epworth Sleepiness Scale (ESS), and asthma control by the Asthma Control Test (ACT). RESULTS Inadequate asthma control (ACT <20) was found in 94 (76.4 %) subjects, depressive symptoms in 92 (74.8 %), poor quality sleep (PSQI >5) in 99 (80.49 %), and excessive daytime sleepiness (ESS ≥10) in 34 (27.64 %). Depressive symptoms were associated with both poor quality sleep (R = 0.326) and inadequate asthma control (R = -0.299). Regression analysis showed that depressive symptoms and sleep quality were independent predictors of the level of asthma control. CONCLUSION Asthma control in women is independently associated with depressive symptoms and quality of sleep, suggesting that these patients might benefit from simple measures to promote healthy sleep behavior and sleep hygiene and also that routine screening for depression can be relevant, particularly, in poorly controlled cases.
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Ilmarinen P, Tuomisto LE, Kankaanranta H. Phenotypes, Risk Factors, and Mechanisms of Adult-Onset Asthma. Mediators Inflamm 2015; 2015:514868. [PMID: 26538828 PMCID: PMC4619972 DOI: 10.1155/2015/514868] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 12/11/2022] Open
Abstract
Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Genetic factors, atopy, and early respiratory tract infections are well-recognized factors predisposing to childhood-onset asthma. Adult-onset asthma is more often associated with obesity, smoking, depression, or other life-style or environmental factors, even though genetic factors and respiratory tract infections may also play a role in adult-onset disease. Adult-onset asthma is characterized by absence of atopy and is often severe requiring treatment with high dose of inhaled and/or oral steroids. Variety of risk factors and nonatopic nature of adult-onset disease suggest that variety of mechanisms is involved in the disease pathogenesis and that these mechanisms differ from the pathobiology of childhood-onset asthma with prevailing Th2 airway inflammation. Recognition of the mechanisms and mediators that drive the adult-onset disease helps to develop novel strategies for the treatment. The aim of this review was to summarize the current knowledge on the pathogenesis of adult-onset asthma and to concentrate on the mechanisms and mediators involved in establishing adult-onset asthma in response to specific risk factors. We also discuss the involvement of these mechanisms in the currently recognized phenotypes of adult-onset asthma.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Leena E. Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
- Department of Respiratory Medicine, University of Tampere, 33014 Tampere, Finland
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van den Bemt L, Luijks H, Bor H, Termeer E, Lucassen P, Schermer T. Are asthma patients at increased risk of clinical depression? A longitudinal cohort study. J Asthma 2015; 53:43-9. [PMID: 26313241 DOI: 10.3109/02770903.2015.1059852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this study, we assessed whether adult patients with asthma are more likely to be diagnosed with depression than diabetes patients or "healthy" controls during follow-up in primary care. METHODS Data from the Nijmegen Continuous Morbidity Registration were used to assess the risk for a first depression. Patients with asthma were compared with patients with diabetes and with two healthy controls matched on age, gender, socioeconomic status and attending general practice. With Cox proportional hazard analysis, we compared the risk of depression between these groups. These analyses were corrected for relevant covariates including a time-depending variable for multimorbidity. Explorative subgroup analyses were done for age, gender, socioeconomic status and multimorbidity. RESULTS Cumulative incidence of depression in asthma patients was 5.2%, in DM patients 4.1% and in control subjects 3.3%. The hazard ratios for a first episode of depression in the asthma patients (n = 795) compared to DM patients (n = 1033) and control subjects after correction for covariates were 1.11 (95% CI 0.60-2.04) and 1.18 (95% CI 0.78-1.79), respectively. Exploratory analyses showed that asthma patients without multimorbidity were at higher risk for a depression compared to reference groups, while asthma patients with multimorbidity were at lower risk for depression. CONCLUSION Asthma patients were not more likely to be diagnosed with a first depression compared to "healthy" control subjects or diabetes patients. The influence of multimorbidity on depression risk in asthma patients warrants further study.
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Affiliation(s)
- Lisette van den Bemt
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Hilde Luijks
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Hans Bor
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Evelien Termeer
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Peter Lucassen
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tjard Schermer
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
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Brunner WM, Schreiner PJ, Sood A, Jacobs DR. Depression and risk of incident asthma in adults. The CARDIA study. Am J Respir Crit Care Med 2014; 189:1044-51. [PMID: 24456492 PMCID: PMC4098106 DOI: 10.1164/rccm.201307-1349oc] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 01/21/2014] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Asthma is associated with depression, but the temporality of the association has not been established. OBJECTIVES To examine the association between prevalent elevated depressive symptoms and incident asthma, and between prevalent asthma and incident elevated depressive symptoms in a cohort of young and middle-aged adults. METHODS We examined the longitudinal association between asthma and depressive symptoms bidirectionally in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. First, 3,614 participants, free of asthma, were classified by elevated depressive symptoms at the CARDIA Year-5 exam (n = 856 elevated vs. 2,758 not elevated; ages 23-35 yr) and followed for 20 years to incident asthma. Then, 3,016 participants, free of elevated depressive symptoms, were classified by self-reported current asthma status (n = 188 prevalent vs. 2,828 not prevalent) at the CARDIA Year-5 exam and followed for 20 years until onset of elevated depressive symptoms. MEASUREMENTS AND MAIN RESULTS The relative hazard of incident asthma among those with elevated depressive symptoms was 1.26 (95% confidence interval [CI] = 1.02-1.56) after adjustment for covariates. When depressive status was modeled as the total number of reports of elevated depressive symptoms before the onset of asthma, the adjusted hazard ratio was 1.15 (95% CI = 1.02-1.29). The hazard of incident elevated depressive symptoms for those with asthma was no different than the hazard in those without asthma (adjusted hazard ratio = 0.92; 95% CI = 0.70-1.20). CONCLUSIONS This longitudinal observational study points to depression as a marker of risk for incident adult-onset asthma. On the other hand, prevalent asthma is not associated with incident adult-onset depression.
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Affiliation(s)
- Wendy M Brunner
- 1 Asthma Program, Chronic Disease and Environmental Epidemiology Section, Minnesota Department of Health, St. Paul, Minnesota
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Peters JB, Rijssenbeek-Nouwens LH, Bron AO, Fieten KB, Weersink EJM, Bel EH, Vercoulen JH. Health status measurement in patients with severe asthma. Respir Med 2013; 108:278-86. [PMID: 24361162 DOI: 10.1016/j.rmed.2013.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/11/2013] [Accepted: 11/23/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with severe asthma experience problems in different areas of their health status. Identification of these areas will provide insight in the patients needs and perhaps what determines the burden of disease. The Nijmegen Clinical Screening Instrument (NCSI) was recently developed for use in clinical practice in patients with COPD and provides a detailed picture of the patients' physiological functioning, symptoms, functional impairment, and Quality of Life. Main purpose of this study is to evaluate the use of the NCSI as compared to the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ) in patients with severe asthma. METHODS The NCSI, AQLQ, and ACQ were measured in 167 patients with severe asthma. Pearson correlations were calculated between NCSI sub-domains and the AQLQ domains and the ACQ. RESULTS The NCSI measures more aspects of health status as compared to the ACQ and AQLQ in patients with severe asthma. Beside symptoms, subjective impairment, and emotions the NCSI also measures general Quality of Life, health related Quality of Life, satisfaction with relations, fatigue, and behavioural impairment. On all NCSI sub-domains proportions of patients with normal, mild, and severe problems were found. Heterogeneity was found on the number and on the combination of sub-domains on which patients reported severe problems. CONCLUSIONS The NCSI provides a more detailed picture of the individual patient with severe asthma than the ACQ and AQLQ. The use of the NCSI might allow quick identification of the problem areas and possible factors that impair health status.
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Affiliation(s)
- Jeannette B Peters
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, Postbus 66, 6560 AB Groesbeek, The Netherlands; Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, Postbus 66, 6560 AB Groesbeek, The Netherlands.
| | | | - Aad O Bron
- Dutch Asthma Centre Davos, Herman Burchartstrasse 1, 7260 Davos, Switzerland
| | - Karin B Fieten
- Dutch Asthma Centre Davos, Herman Burchartstrasse 1, 7260 Davos, Switzerland
| | - Els J M Weersink
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Elisabeth H Bel
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jan H Vercoulen
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, Postbus 66, 6560 AB Groesbeek, The Netherlands; Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, Postbus 66, 6560 AB Groesbeek, The Netherlands
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Slatore CG, Harber P, Haggerty MC. An Official American Thoracic Society Systematic Review: Influence of Psychosocial Characteristics on Workplace Disability among Workers with Respiratory Impairment. Am J Respir Crit Care Med 2013; 188:1147-60. [DOI: 10.1164/rccm.201309-1656st] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yonas MA, Marsland AL, Emeremni CA, Moore CG, Holguin F, Wenzel S. Depressive symptomatology, quality of life and disease control among individuals with well-characterized severe asthma. J Asthma 2013; 50:884-90. [PMID: 23725317 DOI: 10.3109/02770903.2013.810750] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES A thorough examination of the relationship of asthma severity and control with symptoms of depression is needed to identify groups of asthmatics at high risk for poor disease control outcomes. This study examines the relationship of symptoms of depression with severity and control in a well-characterized cohort of asthmatics and healthy controls. METHODS Depressive symptoms and quality of life were assessed using the Beck Depression Inventory. Disease control was measured by a composite index incorporating symptoms, activity limitation and rescue medication use. RESULTS Individuals with asthma (n = 91) reported more symptoms of depression than controls (n = 36; p < 0.001). Those with severe asthma (n = 49) reported more symptoms of depression (p = 0.002) and poorer asthma control (p < 0.0001) than those with not severe asthma. Worse asthma control was associated with more depressive symptoms in severe (r = 0.46, p = 0.002) but not in not severe (r = 0.13, p = 0.40) asthmatics. The relationship of symptoms of depression among severe asthmatics was attenuated by disease control. Exploratory analyses identified specific disease symptom characteristics, as opposed to exacerbations, as associated with symptoms of depression. CONCLUSIONS Among individuals with severe asthma, increased symptom burden is positively associated with risk for co-morbid depression. These findings point to a need for regular mood disorder screenings and treatment referrals among this group. Further research is warranted to examine whether treatment of comorbid depression improves treatment adherence and asthma-related quality of life.
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Loerbroks A, Herr RM, Subramanian S, Bosch JA. The association of asthma and wheezing with major depressive episodes: an analysis of 245 727 women and men from 57 countries. Int J Epidemiol 2012; 41:1436-44. [PMID: 22879363 DOI: 10.1093/ije/dys123] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Epidemiological studies have shown that asthma is positively associated with depression. Most of this evidence stems from individual studies conducted in Western populations (e.g. Europe, North America and Australia). It is still unclear whether such findings generalize to non-Western countries. To address this question, the present study investigated the association of asthma and wheezing with depression in a large multi-national sample. METHODS We used data from the 2002 World Health Survey. Participants reported physician-diagnosed asthma and attacks of wheezing within the past 12 months. Questions on depressive symptoms, their duration and persistence were used to define presence of a major depressive episode (MDE) within the past 12 months. ORs and 95% CIs were estimated by logistic regression for the entire sample, by continent (Australia, Europe, South America, Asia and Africa) and by country. Complete information was available for 57 countries. RESULTS Both asthma and wheezing were associated with MDE in the entire sample (OR=2.37, 95% CI=2.10-2.66 and OR=3.06, 95% CI=2.75-3.40, respectively). Similar associations were found for all continents with generally stronger ORs in South America, Asia and Africa for both asthma (ORs ≥ 1.8) and wheezing (ORs ≥ 2.8). On the country level, wheezing showed a consistent pattern of association with MDE. Similar patterns were found for asthma. CONCLUSIONS Despite a range of country differences that could affect the association of asthma with depression, such as access to health care, the results of this study indicate that the co-occurrence of asthma and depression is a universal phenomenon.
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Affiliation(s)
- Adrian Loerbroks
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Meldrum SJ, D'Vaz N, Dunstan JA, Mori TA, Hird K, Simmer K, Prescott SL. Allergic disease in the first year of life is associated with differences in subsequent neurodevelopment and behaviour. Early Hum Dev 2012; 88:567-73. [PMID: 22284984 DOI: 10.1016/j.earlhumdev.2011.12.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/14/2011] [Accepted: 12/15/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent trials suggest a link between neuropsychological function, atopy and allergic disease particularly in early childhood; however the nature of this association remains unclear. AIMS To investigate the relationship between early allergic disease and sensitisation at 12 months of age and neurodevelopmental outcomes at 18 months. STUDY DESIGN Linear or binary logistic regression analysis was used to determine whether allergic diseases or sensitization at 12 months of age was a significant predictor of neurodevelopmental test scores at the 18 months. SUBJECTS Infants with a maternal history of allergic disease (n=324). OUTCOME MEASURES Allergic outcomes at 12 months of age included allergen sensitisation, eczema, IgE-mediated and food allergy, and neurodevelopmental outcomes at 18 included the Bayley Scales of Infant Toddler Development III Edition, the Achenbach Child Behaviour Checklist and the Macarthur Scales of Infant Toddler Development. RESULTS Children with any diagnosed allergic disease at 12 months had evidence of reduced motor scores (p=.016), and this was most apparent for a diagnosis of eczema (p=.007). Non-IgE mediated food allergy was significantly positively associated with problem Internalising Behaviours (p=.010), along with a trend for effects on the Social-Emotional composite score for IgE-Mediated food allergies (p=.052). Allergic sensitisation was not independently associated with any effects on neurodevelopmental outcomes. CONCLUSION This study provides evidence that an allergic phenotype in infancy is associated with effects on neurodevelopment. Further research is required to investigate the nature of this relationship.
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Affiliation(s)
- Suzanne J Meldrum
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
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