Original article
The Prevalence of DSM-IV Anxiety and Depressive Disorders in Youth with Asthma Compared with Controls

https://doi.org/10.1016/j.jadohealth.2007.05.023Get rights and content

Abstract

Purpose

To determine the prevalence of anxiety and depressive disorders in youth with asthma compared with a control sample of youth and to determine the sociodemographic and clinical characteristics associated with having one or more anxiety/depressive disorders among youth with asthma.

Methods

A telephone interview was offered to all youth aged 11–17 years with asthma (N = 781) and a random sample of similar aged controls (N = 598) enrolled in a Health Maintenance Organization. The C-DISC-4.0 was used to diagnose anxiety and depressive disorders and reliable and valid questionnaires were used to assess severity of anxiety and depressive symptoms. Automated diagnostic, pharmacy and health use data were used to measure asthma treatment intensity, asthma severity and nonasthmatic medical comorbidity. One parent was interviewed to assess sociodemographic variables, child/adolescent psychiatric symptoms and to confirm the asthma diagnosis.

Results

In all, 16.3% of youth with asthma compared with 8.6% of youth without asthma met DSM-IV criteria for one or more anxiety and depressive disorders (OR = 1.92, 95% CI = 1.13–3.28). Independent factors associated with a significantly higher likelihood of meeting criteria for one or more anxiety or depressive disorders included female gender [OR = 1.96 (95% CI = 1.27, 3.03)], living in a single-parent household, [OR = 1.96 (95% CI = 1.26, 3.07)], more parent-reported externalizing behaviors [OR = 1.03 (95% CI = 1.01, 1.05)], more recent diagnosis of asthma [OR = 0.94 (95% CI = 0.89, 0.98)], and more impairment on the asthma physical health scale [OR = 0.95 (95% CI = 0.94, 0.96)].

Conclusions

Youth with asthma have an almost twofold higher prevalence of comorbid DSM-IV anxiety and depressive disorders compared with control youth. Clinical factors associated with meeting criteria for one or more anxiety and depressive included more recent asthma diagnosis, more impairment on the asthma physical health scale, and increased externalizing behaviors.

Section snippets

Setting

Group Health Cooperative (GHC) is a nonprofit health maintenance organization in Washington State with 25 GHC-owned primary care clinics as well as 75 contracted clinics. GHC has computerized cost and accounting systems that have organized cost and use summaries for every GHC enrollee since 1989. The study protocol was reviewed and approved by the institutional review board of GHC.

Participants and recruitment

Potential participants between 11 and 17 years of age who were enrolled in GHC for ≥6 months were identified from

Results

Of the 1458 youth with asthma and parents in the initial sample, 1288 proved eligible (Figure 1). A total of 833 eligible parents gave consent and permission for us to contact their child/adolescent with asthma. Of these, we completed 781 child/adolescent interviews for a final recruitment rate of 60.6%. Of the 1360 control youth without asthma, 1183 proved eligible (Figure 1). A total of 648 eligible parents gave consent and permission to contact their child/adolescent without asthma. Of

Discussion

Youth with asthma compared with controls were found to be almost twice as likely to meet DSM-IV criteria for one or more anxiety and depressive disorders. Unlike some prior reports, which have emphasized a higher rate of panic disorder in youth with asthma [1], [2], [3], [4], [5], our data suggest that there is an increase in all anxiety and depressive disorders in youth with asthma compared with controls (although only the difference in rates of agoraphobia reached statistical significance).

Conclusions

Physicians should be aware of the increased rate of DSM-IV anxiety and depressive disorders in youth with asthma and that factors that raise the risk of meeting criteria for these mental health disorders include female gender, living in a single-parent household, more recent asthma diagnosis, higher parent rated behavior problems, and greater asthma physical impairment. Given the high rate of comorbid anxiety and depressive disorders in youth with asthma and the adverse effect on asthma symptom

Acknowledgments

This study was supported by grants from the National Institute of Mental Health to Dr. Katon (MH-067587 and MH-069741).

References (40)

  • E.J. Costello et al.

    Scales to assess child and adolescent depression: checklists, screens, and nets

    J Am Acad Child Adolesc Psychiatry

    (1988)
  • D. Shaffer et al.

    The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA StudyMethods for the Epidemiology of Child and Adolescent Mental Disorders Study

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • R. McGee et al.

    DSM-III disorders from age 11 to age 15 years

    J Am Acad Child Adolesc Psychiatry

    (1992)
  • W.J. Katon

    Clinical and health services relationships between major depression, depressive symptoms, and general medical illness

    Biol Psychiatry

    (2003)
  • T. Bush et al.

    Anxiety and depressive disorders are associated with smoking in adolescents with asthma

    J Adolesc Health

    (2007)
  • L.J. Damschroder et al.

    The impact of considering adaptation in health state valuation

    Soc Sci Med

    (2005)
  • J.H. Kashani et al.

    Psychopathology and self-concept in asthmatic children

    J Pediatr Psychol

    (1988)
  • G. Vila et al.

    Prevalence of DSM-IV disorders in children and adolescents with asthma versus diabetes

    Can J Psychiatry

    (1999)
  • A.N. Ortega et al.

    Childhood asthma, chronic illness, and psychiatric disorders

    J Nerv Ment Dis

    (2002)
  • R.D. Goodwin et al.

    Asthma and panic attacks among youth in the community

    J Asthma

    (2003)
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