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Depression worsens teen asthma.

SAN FRANCISCO -- Preteenagers and adolescents with asthma who were also depressed or anxious suffered from asthma symptoms on significantly more days and were more prone to individual symptoms, according to a study presented at the annual meeting of the Pediatric Academic Societies.

Investigators urged physicians to screen for anxiety and depressive disorders when young people have asthma symptoms that do not respond to medication.

"We conclude that youth with asthma and depressive disorders do have a higher symptom burden, and providers should consider screening for depression in youth with high symptom burden if they are not responding to medication or treatment as expected," Dr. Laura Richardson said in a poster presentation.

The researchers surveyed by telephone 767 young people, 11-17 years of age, who had asthma and were enrolled in a staff-model health maintenance organization. They used the Children's Health Survey for Asthma-Teen Version (CHSA-T) questionnaire to assess the number of days of asthma symptoms each participant had experienced in the 2 weeks prior to a call and the incidence of individual symptoms.

Determination of anxiety and depressive disorders was based on the Diagnostic Interview Schedule for Children. In addition, the investigators mined automated medical record data for information on asthma treatment intensity, severity, number of emergency department visits, and hospital admissions.

A total of 125 respondents (16%) were found to have anxiety or depressive disorders, while 642 did not (84%). Nearly two-thirds of the depressed youth but fewer than half of the other respondents were female. Both groups were 14 years old on average, reported Dr. Richardson, a pediatrician specializing in adolescent medicine at the University of Washington in Seattle.

Similar proportions of both groups met Health Plan Employer Data Information Set (HEDIS) asthma severity criteria: 69% of the depressed group and 70% of those who were not depressed. The depressed patients had higher Chronic Disease Scores, however (794.8 VS. 580.5).

"After controlling for asthma severity and other covariates, [we found that] youth with anxiety or depressive disorders had an average of 5.4 symptom days in the prior 2 weeks, compared to 3.5 days in those without anxiety or depressive disorders," Dr. Richardson said.

Respondents with anxiety or depressive disorders also were significantly more likely than the other to report each of six asthma-specific symptoms (wheezing with a cold, cold that would not go away, cough, wheezing without a cold, tightness in chest, and shortness of breath) and five less-specific symptoms (difficulty sleeping, stuffy nose / congestion, itchy eyes, skin rash, and headache).

In addition, the investigators charted a linear relationship between the number of symptoms of anxiety and depression and the number of asthma symptoms that the patients reported. "The more anxiety and depression you have, the more asthma you have," Dr. Richardson said in an interview at the meeting, which was sponsored by the American Pediatric Society, Society for i Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics.


Southwest Bureau
Asthmatic Youths With
Anxiety or Depression Have
More Symptom Days

With anxiety and
  depressive disorders   5.4 days
Without anxiety and
  depressive disorders   3.5 days

Note: Based on survey of 767 asthma
patients in the previous 2-week period.

Source: Dr. Richardson

Note: Table made from bar graph.
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Author:MacNeil, Jane Salodof
Publication:Family Practice News
Geographic Code:1U9CA
Date:Oct 15, 2006
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