Chest
Volume 130, Issue 4, October 2006, Pages 1039-1047
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Original Research
What Is Worse for Asthma Control and Quality of Life: Depressive Disorders, Anxiety Disorders, or Both?

https://doi.org/10.1378/chest.130.4.1039Get rights and content

Background

The high burden of asthma appears to be related to poor asthma control. Although previous studies have reported associations between depressive disorders (DDs) and anxiety disorders (ADs) and worse asthma control and quality of life, the relative impact of these disorders on asthma control and quality of life has not been explored. This study evaluated the relative impact of having a DD and/or AD on asthma control and quality of life.

Method

Five hundred four consecutive adults with confirmed, physician-diagnosed asthma underwent a brief, structured psychiatric interview using the Primary Care Evaluation of Mental Disorders. Asthma control and asthma-related quality of life were assessed using the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ). All patients underwent standard spirometry.

Results

Thirty-one percent of patients (n = 157) met the diagnostic criteria for one or more psychiatric disorders (8% had DD only, 12% had AD only, and 11% had both). Analyses revealed independent effects for DDs on total ACQ scores (p < 0.01), and for DDs and ADs on total AQLQ scores and all four AQLQ subscales (p < 0.05). There were no interaction effects.

Conclusions

Results suggest that DDs and ADs are associated with worse asthma-related quality of life, but only DDs are associated with worse asthma control. Interestingly, having both a DD and an AD did not confer additional risk for worse asthma control or quality of life. Physicians may want to consider the differential impact of negative mood states when assessing levels of asthma control and quality of life.

Section snippets

Study Subjects

A total of 504 consecutive adult patients with physician-diagnosed asthma were recruited from the asthma clinic of Hôpital du Sacré-Coeur de Montréal from June 2003 to March 2005. Patients were eligible if they had a primary diagnosis of asthma, were between the ages of 18 and 75 years, and were fluent in either English or French. A total of 1,243 patients presented to the asthma clinic, of whom 1,094 subjects (88%) were screened for inclusion in the study (the remaining 149 subjects had

Sample Characteristics

A total of 504 adult asthma participated in the present study. Participants were 61% female and had a mean ± SD age of 50 ± 14.4 years.

Prevalence of Psychiatric Disorders

A total of 31% of patients (n = 157) met the diagnostic criteria for one or more psychiatric disorders (Table 1). A total of 23% of patients (n = 117) met the diagnostic criteria for one or more ADs, the most common of which was panic disorder (11%; n = 53). A total of 20% of patients (n = 97) met the diagnostic criteria for one or more DDs, the most common of

Discussion

The results of the present study indicate a high rate of both DDs and ADs among adult asthmatics. Compared to point prevalence rates in the general population, rates of both DDs and ADs were at least double those observed in the general population (20% and 23% vs 2 to 9% and 1 to 13%, respectively26, 40). More importantly, results suggest DDs and ADs may exert distinct effects on important measures of asthma morbidity. Our findings revealed that both DDs and ADs were independently associated

Acknowledgment

The authors thank Drs. Catherine Lemière, Dr. Jean-Luc Malo, and Mr. Guillaume Lacoste for their invaluable assistance with data collection.

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    This study was supported by a fellowship grant from the Canadian Institutes of Health Research (Dr. Lavoie) and a Young Investigators grant from the Auger Foundation of Hôpital du Sacré-Coeur de Montréal.

    Dr. Lavoie has been paid professional honorariums from GlaxoSmithkline and Pfizer Canada.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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