Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1042-1051 (doi:10.1542/peds.2006-0249)
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ARTICLE

Asthma Symptom Burden: Relationship to Asthma Severity and Anxiety and Depression Symptoms

Laura P. Richardson, MD, MPHa,b, Paula Lozano, MD, MPHa,c, Joan Russo, PhDd, Elizabeth McCauley, PhDb,d, Terry Bush, PhDc and Wayne Katon, MDd

a Pediatrics
d Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
b Children's Hospital and Regional Medical Center, Seattle, Washington
c Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington

OBJECTIVE. The purpose of this work was to examine the relationship between youth-reported asthma symptoms, presence of anxiety or depressive disorders, and objective measures of asthma severity among a population-based sample of youth with asthma.

METHODS. We conducted a telephone survey of 767 youth with asthma (aged 11–17 years) enrolled in a staff model health maintenance organization. The Diagnostic Interview Schedule for Children was used to diagnose Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, anxiety and depressive disorders; the Child Health Status-Asthma questionnaire (modified) was used to assess asthma symptoms; and automated administrative data were used to measure asthma treatment intensity and severity. Analyses of covariance were performed to determine whether the number of anxiety and depressive symptoms was related to the number of asthma symptoms. Logistic regression analyses were used to evaluate the strength of association between individual symptoms of asthma and the presence of an anxiety or depressive disorder and objective measures of asthma severity.

RESULTS. After adjusting for demographic characteristics, objective measures of asthma severity, medical comorbidity, and asthma treatment intensity, youth with ≥1 anxiety or depressive disorder (N = 125) reported significantly more days of asthma symptoms over the previous 2 weeks than youth with no anxiety or depressive disorders. The overall number of reported asthma symptoms was significantly associated with the number of anxiety and depressive symptoms endorsed by youth. In logistic regression analyses, having an anxiety or depressive disorder was also strongly associated with each of the 6 asthma-specific symptoms, as well as the 5 related nonspecific somatic symptoms contained in the Child Health Status-Asthma questionnaire.

CONCLUSIONS. The presence of an anxiety or depressive disorder is highly associated with increased asthma symptom burden for youth with asthma.

Key Words: anxiety • depression • asthma

Abbreviations: ED—emergency department • GHC—Group Health Cooperative • CHSA-T—Child Health Status-Asthma for Teens • DSM-IV—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • ANCOVA—analysis of covariance • PCDS—Pediatric Chronic Disease Scale • CI—confidence interval • OR—odds ratio • HEDIS—Health Plan Employer Data and Information Set

Accepted Mar 19, 2006.




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