Asthma Patients Often Depressed

Adjustment to a chronic disease can be difficult.    This study suggests that patients with asthma should be closely monitored for depressive symptoms.  Every effort should be made to reduce the impact of asthma on daily life.

Asthma Patients Often Depressed

ANAHEIM, Calif. -- Depression and asthma appear to go hand in hand, even in patients whose asthma is relatively mild and who report generally good health, a researcher said here.

Analysis of some 13,000 participants in the Cooper Institute Longitudinal Study indicated that a diagnosis of asthma was a risk factor for reports of significant current depressive symptoms with an odds ratio of 1.41 (95% CI 1.16 to 1.65, P<0.001) after adjusting for asthma severity and self-assessment of overall health status.

Asthma and a previous history of depression also were significantly associated, with an odds ratio of 1.65 (95% CI 1.40 to 1.90,P<0.001), Tim Trojan, MD, of the University of Texas Southwestern Medical Center in Dallas, told attendees at the American College of Allergy, Asthma, and Immunology annual meeting.

Associations between asthma and depression have been reported before, Trojan explained, but those studies could not rule out the possibility that patients were simply sad about feeling sick with asthma.

Consequently, he and his colleagues utilized records from the Cooper Institute Longitudinal Study, begun in 1970 by the institute's founder, Kenneth Cooper, MD, the aerobics advocate. The database has unusually detailed information on patients including spirometry values, scores on the Center for Epidemiologic Studies Depression Scale (CES-D), medical history, body mass index, and lifestyle factors such as smoking and drinking status, as well as standard demographics.

Trojan and colleagues analyzed data on 12,944 study participants, including 1,169 with a diagnosis of asthma. Of these, only 187 were on controller medications, suggesting that the sample mostly included people with relatively mild asthma.

About 81% of the overall sample indicated that their health status was good or excellent, as opposed to fair or poor. Current depressive symptoms (CES-D scores of 10 or higher) were present in 11% and a past history of depression in 14%.

Bivariate analyses indicated that the risk of depressive symptoms was significantly increased, not only by a diagnosis of asthma, but also by female gender, hypertension, and current smoking. It was significantly decreased in nonwhites, those with more than a high school education, age older than 50, and current drinking.

Multivariate analysis produced the odds ratio 0f 1.40 for depressive symptoms with an asthma diagnosis. When expressed as an r² correlation coefficient, the value of 0.119 suggested that the relationship was only modest at best, Trojan said.

But a classification analysis based on the association correctly categorized 89.5% of study participants, he said.

The same held true for the association between asthma and depression history. The r² correlation coefficient was 0.110, but the classification analysis categorized 85.7% of participants correctly, Trojan said.

He noted that the study had a number of limitations including the fact that some of the data such as depression history and smoking and drinking status were self-reported, and the Cooper Institute database consists of people who are "mostly white and mostly healthy." Trojan added that they are probably relatively affluent as well, although income data are not collected.

Nevertheless, he said, the study findings "mean that your mild asthmatic ... who doesn't look or feel all that bad still has a significant risk, or could have a significant risk, of having depressive symptoms and should be evaluated for this."

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