Anxiety and depression in adolescents with asthma: a study in clinical practice
Main Article Content
asthma; adolescents; anxiety; depression; asthma control; lung function; treatment.
Background: Anxiety and depression may affect asthma control. Previously, it has been reported that the hospital anxiety depression scale (HADS) questionnaire was fruitful in the management of adolescents with asthma. This study compared the scores of two different questionnaires, namely the Childhood Anxiety Sensitivity Index (CASI) and Children's Depression Inventory (CDI), with asthma control level and lung function in asthmatic adolescents, evaluated in a real-life setting.
Methods: A group of adolescents with asthma was consecutively enrolled. Asthma was diagnosed according to the GINA document, and consistently the symptom control grade was assessed. The adolescents completed the CASI, CDI, and Asthma Control Test (ACT) questionnaires. Visual Analogue Scale (VAS) for asthma symptoms perception and doctor's asthma control evaluation were considered. Lung function and clinical characteristics were also assessed.
Results: Totally, 87 asthmatic adolescents (60 males, 27 females, median age 14.2 years) were evaluated. 16.1% of asthmatic adolescents had anxious symptoms detected by CASI, and 11.5% depressive symptoms revealed by CDI. High scores of both CASI and CDI were significantly associated with uncontrolled asthma (p= 0.013 and 0.043, respectively).
Conclusions: This study showed that anxiety and depression affected asthma control. Thus, in clinical practice, the psychological assessment could be included in asthmatic adolescents' asthma work-up.
2. Brew BK, Lundholm C, Gong T, Larsson H, Almqvist C. The familial aggregation of atopic diseases and depression or anxiety in children. Clin Exp Allergy 2018;48(6):703-711. doi: 10.1111/cea.13127.
3. Easter G, Sharpe L, Hunt CJ. Systematic review and meta-analysis of anxious and depressive symptoms in caregivers of children with asthma. J Ped Psychol 2015;40(7):623-632. doi: 10.1093/jpepsy/jsv012.
4. Holley S, Walker D, Knibb R, et al. Barriers and facilitators to self-management of asthma in adolescents: an interview study to inform development of a novel intervention. Clin Exp Allergy 2018;48(8):944-956. doi: 10.1111/cea.13141.
5. Sundbom F, Malinovschi A, Lindberg E, Alving K, Janson C. Effects of poor asthma control, insomnia, anxiety, and depression on quality of life in young asthmatics. J Asthma. 2016;53 (4):398-403. doi: 10.3109/02770903.2015.1126846.
6. Global Initiative for Asthma. GINA guidelines. Global Strategy for Asthma Management and Prevention. 2019. Available at: htpp://www.ginasthma.org/. Last accessed on September 2020
7. Licari A, Marseglia GL, Tosca MA, Ciprandi G. Asthma control in children and adolescents: a study in clinical practice. J Asthma 2020;57(6):645-647. doi: 10.1080/02770903.2019.1594889.
8. Ciprandi G, Schiavetti I, Riciardolo F. The impact of anxiety and depression on outpatients with asthma. Ann Allergy Asthma Immunol 2015; 115(5):408-414. doi: 10.1016/j.anai.2015.08.007.
9. Licari A, Ciprandi R, Marseglia G, Ciprandi G. Anxiety and depression in adolescents with asthma and their parents: a study in clinical practice. Monaldi Archives for Chest Diseases 2019; 89(3). doi: 10.4081/monaldi.2019.1063.
10. Silverman WK, Fleisig W, Rabian B, Peterson RA. Childhood anxiety sensitivity index. J Clin Child Psychol 1991;20:162-168.
11. Bang YR, Park JH, Kim SH. Cut-off scores of the children’s depression inventory for screening and rating severity in Korean adolescents. Psychiatry Inv 2015;12(1):23-8. doi: 10.4306/pi.2015.12.1.23.
12. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005; 26(2):319-38. doi: 10.1183/09031936.05.00034805.
13. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey form assessing asthma control. J Allergy Clin Immunol 2004; 113(1):59-65. doi: 10.1016/j.jaci.2003.09.008.
14. Tosca MA, Silvestri M, Olcese R, Pistorio A, Rossi GA, Ciprandi G. Breathlessness perception assessed by the visual analog scale and lung function in children with asthma: a real-life study. Ped Allergy Immunol 2012; 23(6):537-542. doi: 10.1111/j.1399-3038.2012.01316.x.
15. Delmas MC, Guignon N, Chee CC, Fuhrman C, Herbet JB, Gonzalez L. Asthma and major depressive episode in adolescents in France. J Asthma. 2011; 48(6):640-646. doi: 10.3109/02770903.2011.585410.
16. Ciprandi G, Cirillo I, Klersy C, Marseglia GL, Caimmi D, Vizzaccaro A. Nasal obstruction is the key symptom in hay fever patients. Otolaryngol Head Neck Surg. 2005; 133(3):429-435. doi: 10.1016/j.otohns.2005.05.049.
17. Ciprandi G, Cirillo I, Klersy C, et al. Role of FEF25-75 as an early marker of bronchial impairment in patients with seasonal allergic rhinitis. Am J Rhinol 2006; 20(6):641-647. doi: 10.2500/ajr.2006.20.2914.
18. Sundbom F, Malinovschi A, Lindberg E, Alving K, Janson C. Effects of poor asthma control, insomnia, anxiety, and depression on quality of life in young asthmatics. J Asthma 2016; 53(4):398-403. doi: 10.3109/02770903.2015.1126846.
19. Howell CR, Lindsay AT, Gross HE, Reeve BB, Huang SW, DeWalt DA, et al. Association of consistently suboptimal quality of life with consistently poor asthma control in children with asthma. Ann Allergy Asthma Immunol 2017; 119(6):562-564.e1. doi: 10.1016/j.anai.2017.09.053.
20. Jones CMJ, DeWalt DA, Huang IC. Impaired patient-reported outcomes predict poor school functioning and daytime sleepiness: the PROMIS Pediatric Asthma Study. Acta Pediatr 2017; 17(8):850-854. doi: 10.1016/j.acap.2017.07.010.
21. Shams MR, Bruce AC, Fitzpatrick AM. Anxiety contributes to poorer asthma outcomes in inner-city Black adolescents. J Allergy Clin Immunol Pract 2018;6(1):227-235. doi: 10.1016/j.jaip.2017.06.034.
22. Bruzzese JM, Reigada LC, Lamm A, et al. The association of youth and caregiver anxiety and asthma care among urban young adolescents. Acad Pediatr 2016;16(8):792-798. doi: 10.1016/j.acap.2016.03.009.
23. Lu Y, Ho R, Li TK, et al. Psychiatric comorbidities in Asian adolescents asthma patients and the contributions of neuroticism and perceived stress. J Adolesc Health 2014;55(2):267-275. doi: 10.1016/j.jadohealth.2014.01.007
24. Letitre SL, de Groot EP, Draaisma E, Brand PLP. Anxiety, depression, and self-esteem in children with well-controlled asthma: case-control study. Arch Dis Child 2014; 99(8):744-8. doi: 10.1136/archdischild-2013-305396.