FCAAIA Notes: The relationship between poor asthma control and psychological morbidity probably works both ways. People with poorly controlled asthma are more likely to have symptoms of depression (NOT the same as clinical depression). Conversely, those with symptoms of depression are more likely to sabotage their own asthma control by exercising less, smoking more and generally not taking as good overall care of themselves. As we enter the holiday season, we tend to eat more, exercise less, and some patients are subject to seasonal affective disorder. Take good care of yourself, follow the asthma plan provided by your allergist, and let us know if you are not as well as you should be.
(Source: https://stamford.mednewsplus.com/html/topicdetails.asp?pid=72§ion_id=100&topic_id=29309&puid=6559&flag=1 October 28, 2011)
Depressive symptoms along with unhealthy behaviors are common among individuals with asthma, a telephone survey conducted in Israel found. Among responders reporting current asthma, 37.4% had symptoms of depression compared with 21.8% of those without asthma (OR 1.84, 95% CI 1.47 to 2.30, P<0.001), according to Aviva Goral, MSc, of the Unit of Mental Health Epidemiology and Psychosocial Aspects of Illness in Tel Hashomer, and colleagues.
Writing online in General Hospital Psychiatry, Goral and colleagues reported that asthmatic individuals with depressive symptoms were at increased risk for unhealthy behaviors, including:
- Physical inactivity, adjusted OR 2.01 (95% CI 1.12 to 3.61, P=0.02)
- Smoking, adjusted OR 1.80 (95% CI 1.04 to 3.12, P=0.04)
- Less than six hours’ sleep at night, adjusted OR 1.81 (95% CI 1.03 to 3.19, P=0.04)
Adults with asthma experience increased rates of psychiatric disorders, such as depression, which in turn can have an adverse impact on their asthma control. And inadequate asthma control in these patients not only can worsen the morbidity and mortality risks associated with their pulmonary disorder, but also can lead to greater psychiatric morbidity, the researchers explained.
Previous studies involving patients with chronic obstructive pulmonary disease demonstrated a link between having symptoms of depression — not even an actual diagnosis — and increased mortality. But these data were from patients with more severe pulmonary illness, and may not reflect the wider experience of individuals with asthma.
“One possible mechanism which may explain the association between asthma and depression is the link with health-related risk factors and behaviors,” the researchers wrote.
To explore the relationships between asthma, symptoms of depression, and health-related risk factors and behaviors, they analyzed data from the Israeli National Health Interview Survey, which was conducted in 2003 and 2004. Psychological distress was scored on a 100-point scale, with a cutoff of 60 indicating significant symptoms of depression.
Among the 9,271 participants, 57.6% were women, and mean age was 47.2. A total of 4.2% reported having current asthma. Among those with asthma, depressive symptoms were associated with these factors:
- Ages 40 to 59, OR 1.70 (95% CI 1.04 to 2.80, P=0.04)
- Female sex, OR 1.78 (95% CI 1.16 to 2.73, P≤0.001)
- Presence of medical comorbidities, OR 2.09 (95% CI 1.36 to 3.22, P<0.001)
Those with higher household income were less likely to report depressive symptoms (OR 0.18, 95% CI 0.11 to 0.30, P<0.001).
Almost one-third of asthmatics who had symptoms of depression smoked, and more than 70% were not physically active. In comparison, only about 20% of those with asthma but without depression were smokers, and only half were physically inactive. “Engagement in routine physical activity is an important component of optimal asthma management as well as in the management of mental disorders,” the researchers observed. In addition, smoking cessation and regular sleep should be addressed using systematic approaches for individuals with asthma and depression, even as these behaviors can be particularly challenging for these patients, they advised.
Limitations of the study included the self-report of symptoms and behaviors, and a lack of data on severity of asthma symptoms and medication use. The study also was restricted to individuals with landline phones, which may limit the generalizability of these findings.
The researchers concluded that clinicians should be aware of the common overlap between asthma and depressive symptoms, even in patients who have not been given a specific diagnosis of depression, and tailor treatment accordingly. “Future longitudinal studies could elucidate causal mechanisms which may explain the association between respiratory conditions and mental disorders,” they wrote.