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Tattersall MC, Jarjour NN, Busse PJ. Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:849-862. [PMID: 38355013 DOI: 10.1016/j.jaip.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Airway inflammation in asthma has been well recognized for several decades, with general agreement on its role in asthma pathogenesis, symptoms, propensity toward exacerbation, and decline in lung function. This has led to universal recommendation in asthma management guidelines to incorporate the use of inhaled corticosteroid as an anti-inflammatory therapy for all patients with persistent asthma symptoms. However, there has been limited attention paid to the presence and potential impact of systemic inflammation in asthma. Accumulating evidence from epidemiological observations and cohort studies points to a host of downstream organ dysfunction in asthma especially among patients with longstanding or more severe disease, frequent exacerbations, and underlying risk factors for organ dysfunction. Most studies to date have focused on cognitive impairment, depression/anxiety, metabolic syndrome, and cardiovascular abnormalities. In this review, we summarize some of the evidence demonstrating these abnormalities and highlight the proposed mechanisms and potential benefits of treatment in limiting these extrapulmonary abnormalities in patients with asthma. The goal of this commentary is to raise awareness of the importance of recognizing potential extrapulmonary conditions associated with systemic inflammation of asthma. This area of treatment of patients with asthma is a large unmet need.
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Affiliation(s)
- Matthew C Tattersall
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Paula J Busse
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY
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Feldman JM, Becker J, Arora A, DeLeon J, Torres-Hernandez T, Greenfield N, Wiviott A, Jariwala S, Shim C, Federman AD, Wisnivesky JP. Depressive Symptoms and Overperception of Airflow Obstruction in Older Adults With Asthma. Psychosom Med 2021; 83:787-794. [PMID: 33938504 PMCID: PMC8419010 DOI: 10.1097/psy.0000000000000951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Older adults are at increased risk for depression and poor asthma outcomes. We examined whether depressive symptoms are associated with overperception of airflow obstruction and a pattern of worse asthma control, but not pulmonary function. METHODS We recruited a cohort of adults with asthma 60 years and older in East Harlem and the Bronx, New York. Baseline measures included the Geriatric Depression Scale, Asthma Control Questionnaire, and Mini Asthma Quality of Life Questionnaire. Spirometry was conducted at baseline to assess pulmonary function. Perception of airflow obstruction was assessed for 6 weeks following baseline by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter followed by PEF blows. Participants were blinded to actual PEF values. The percentage of time that participants were in the overperception zone was calculated as an average. RESULTS Among the 334 participants (51% Hispanic, 25% Black), depressive symptoms were associated with overperception of airflow obstruction (β = 0.14, p = .029), worse self-reported asthma control (β = 0.17, p = .003), and lower asthma-related quality of life (β = -0.33, p < .001), but not with lung function (β = -0.01, p = .82). Overperception was also associated with worse self-reported asthma control (β = 0.14, p = .021), but not lung function (β = -0.05, p = .41). CONCLUSIONS Depressive symptoms were associated with greater perceived impairment from asthma, but not pulmonary function. Overperception of asthma symptoms may play a key role in the relationship between depression and asthma outcomes in older adults.
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Affiliation(s)
- Jonathan M Feldman
- From the Ferkauf Graduate School of Psychology (Feldman, Greenfield, Wiviott), Yeshiva University; Division of Academic General Pediatrics, Department of Pediatrics (Feldman, DeLeon, Torres-Hernandez), Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx; Division of General Internal Medicine (Becker, Arora, Federman, Wisnivesky), Icahn School of Medicine at Mount Sinai, New York; Division of Allergy/Immunology, Department of Medicine (Jariwala), Albert Einstein College of Medicine/Montefiore Medical Center; Division of Pulmonary Medicine, Department of Medicine (Shim), Jacobi Medical Center/Albert Einstein College of Medicine, Bronx; and Division of Pulmonary, Critical Care and Sleep Medicine (Wisnivesky), Icahn School of Medicine at Mount Sinai, New York, New York
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Shankar M, Fagnano M, Blaakman SW, Rhee H, Halterman JS. Depressive Symptoms Among Urban Adolescents with Asthma: A Focus for Providers. Acad Pediatr 2019; 19:608-614. [PMID: 30578922 PMCID: PMC6586550 DOI: 10.1016/j.acap.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/09/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Asthma is the most common chronic disease of childhood in the United States, disproportionately affecting urban, poor, and minority children. Adolescents are at high risk for poor asthma outcomes and for depressive symptoms. The purpose of this study is to investigate associations between depressive symptoms and asthma-related clinical and functional outcomes among urban teens. METHODS We used baseline data from a 3-arm randomized trial, School-Based Asthma Care for Teens, in Rochester, NY. We used the Center for Epidemiological Studies Depression Scale with a standard cutoff score of 16 to identify subjects at risk for clinical depression. We used structured in-home surveys and validated scales to assess clinical and functional outcomes and conducted bivariate and multivariate analyses to evaluate differences between groups. RESULTS We identified 277 eligible teens (ages 12 to 16, 80% participation, 54% black, 34% Hispanic, 45% female, 84% on Medicaid). Overall, 28% reported depressive symptoms. Teens with depressive symptoms experienced greater asthma symptom severity and more acute health care utilization for asthma (all P < .001); however, there was no difference in preventive care use between groups. Teens with depressive symptoms also reported lower asthma-related quality of life (P < .001), less sleep (P < .001), and more limitation in mild (adjusted odds ratio [aOR], 2.60; 95% confidence interval [CI], 1.34-5.02) and moderate (aOR, 2.56; 95% CI, 1.41-4.61) activity and in gym (aOR, 2.33; 95% CI, 1.30-4.17). CONCLUSIONS Depressive symptoms are prevalent among urban teens with asthma and are associated with worse asthma-related clinical outcomes, functional limitation, and quality of life. Providers should consider depression as a significant comorbidity that may impact multiple aspects of daily life for this population.
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Affiliation(s)
- Michelle Shankar
- Department of Pediatrics, Division of General Pediatrics (M Shankar, M Fagnano, SW Blaakman, and JS Halterman).
| | - Maria Fagnano
- University of Rochester Department of Pediatrics, Division of General Pediatrics, 601 Elmwood Avenue Box 777, Rochester, NY 14642, USA
| | - Susan W. Blaakman
- University of Rochester Department of Pediatrics, Division of General Pediatrics, 601 Elmwood Avenue Box 777, Rochester, NY 14642, USA,University of Rochester School of Nursing, 255 Crittenden Blvd, Rochester, NY 14620, USA
| | - Hyekyun Rhee
- University of Rochester School of Nursing, 255 Crittenden Blvd, Rochester, NY 14620, USA
| | - Jill S. Halterman
- University of Rochester Department of Pediatrics, Division of General Pediatrics, 601 Elmwood Avenue Box 777, Rochester, NY 14642, USA
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Sastre J, Crespo A, Fernandez-Sanchez A, Rial M, Plaza V, González FC, López JJ, Riaza MM, Orenes MM, Montaño PP, Toro MT, Balaguer CA, Girones MA, Martinez CB, Martín IF, Delgado PG, Calahorro MM, Carrasco GM, Pacheco RR, Tomás VV, Godoy MM, Yébenes JZ, Balza De Vallejo OV, Fernandez JA, Gonzalez TB, De Las Pozas GC, Donado CD, Angulo SD, Ortiz GG, Mañana BR, Gonzalez RB, Nieves EG, Torrado JM, Culla MD, Pla JJ, Bellfill RL, Velasco JM, Nogues EP, Ortun MR, Aguñin PR, Farre NS, Combas JV, Zubeldia IA, Hortigüela GB, Ayuso JC, Álvarez GG, Peña MH, Castro AL, Llorente PL, Martinez PM, Malanda NM, Gonzalez FG, Miguel TP, Hernandez M, Timon SJ, Carreño SP, Olbah MA, Muñoz AA, Mohedad JC, Fernandez DG, Camacho AL, Lopez CM, Gonzalez MM, Bernal SN, Pellon LF, Miguel EM, Portal FO, Rodríguez AS, Alapont MM, Raducan I, Segarra MS, Bonilla PG, Calderon PM, Rodriguez MM, Martinez RL, Pérez MM, Villarejo MM, Aparicio MB, Muíño Joga MD, Garcia-Boente LF, Paz VG, Barcala FG, Orjales RN, Castedo CR, Diaz MR, Fernandez AM, Español SA, San Francisco AR, Navarrete BA, Gomez De Cadiz LC, Rodriguez ME, Lopez JF, Jiménez ML, Caballero JL, Ceres MM, Costoya RM, García CM, Vilchez MR, Ortiz AR, Mazuecos JB, Castro AV, Arenaza BL, Mendizabal SL, Sampedro IP, Vazquez LV, De Sus JC, Villa JC, Pargada DF, Jarque JH, Patiño MC, Gomila AF, Pastrie FN, Lopez JA, Martinez PB, Ruiz De Lobera AV, Gonzalez FC, Carral CP, Racamonde AV, Del Pino MC, Sacanell JR, García IA, Mejias YA, Bausela BA, Cozar MA, Sanz PB, Bobolea I, Fernandez AB, De Santiago Delgado E, Campos RD, Uña JD, Vila AF, Cano MG, De Pedro JG, Galicia MG, De Olano DG, Barbudo BH, Viña AL, Peña AL, Martin GM, De Francisco AM, Borque RM, Moro M, Prieto MR, Frutos MR, Jimenez BR, Rodríguez M, Ribate DR, Perez FR, Hornillos JR, López PS, Martinez FS, Garrido-Lestache JS, Gambasica ZV, Albelda CV, Ramirez JA, De Luiz Martínez G, Núñez IG, De Luna FL, Sáenz De Tejada EO, Galo AP, Martinez RR, Esojo MS, Espinosa RA, Inglés MA, Mora RB, Campos MF, Arellano MP, Puebla MA, Figueroa BG, Fernández SG, Rivera JO, Purroy AT, Garazo BP, Losada SV, Villamuza YG, Bonny JC, Sintes RA, Landin JC, Paz AC, Abelaira MC, Rio FI, Sanmartín AP, Picans I, Moreira AR, Romera RT, Aznar JI, Bellido FM, Hernandez MR, Perez RG, Flores HI, Gutierrez FA, Cimbollek S, De Luque Piñana V, Gallardo JM, Garcia VM, Cuevas JO, Crespo YP, Enriquez JQ, Dominguez PS, Elias ÒS, Pamplona MM, Lara MJ, De Gregorio AM, Martin MA, Canelles MB, Baixauli EB, Serra PC, Gregori MC, Rodriguez PC, De Las Marinas Alvarez M, Palacios MD, El-Qutob López D, Giner JG, Lara SH, Martínez GJ, Santafé JL, Bayo AL, Moragon EM, Sancho IM, Lacomba JM, Sendra EN, Seisdedos LN, Bertol BO, Iniesta AR, Cubillan JR, Sánchez-Toril López F, Vinuesa AS, Gomez AA, De Frutos Arribas J, Fernandez EM, Alonso AS, Sanz CC, Fuentes MD, Sotillos MG, Arazuri NS. Anxiety, Depression, and Asthma Control: Changes After Standardized Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1953-1959. [DOI: 10.1016/j.jaip.2018.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/28/2018] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
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Mangold R, Salzman GA, Williams KB, Hanania NA. Factors associated with depressive symptoms in uncontrolled asthmatics. J Asthma 2017; 55:555-560. [PMID: 28759275 DOI: 10.1080/02770903.2017.1350968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
RATIONALE Recent epidemiological data indicate that approximately 6.7% of US adults suffer from depression in any given year. The purpose of the study is to identify factors associated with depressive symptoms in a large diverse group of patients with poorly controlled asthma. The factors include quality of life (QOL), lung function, asthma knowledge, attitudes, self-efficacy, symptoms and control of disease. METHODS Baseline characteristics of a cohort of 599 subjects with asthma recruited from twenty Asthma Clinical Research Centers across the United States were examined. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to stratify subjects into those with depressive symptoms (CES-D score ≥ 16) and those without depressive symptoms (CES-D < 16). Bivariate statistics were used to compare the two groups; additionally, logistic regression was used to determine factors that have the greatest association with depressive symptoms. RESULTS Subjects with depressive symptoms had significantly lower QOL scores and less knowledge about their disease than subjects with no depression; however, lung function (FEV1%) and asthma control were not significantly associated with depressive symptoms in the logistic regression analysis. Subjects who were non-white had lower household income, high school diploma or less, and those who were unemployed or disabled had significantly higher scores for depressive symptoms. CONCLUSION Subjects with depressive symptoms have significantly less knowledge of their disease and poorer QOL compared to those without depressive symptoms. Evaluating depressive symptoms in subjects with asthma will provide a more complete picture of their overall condition. The role of asthma education on depressive symptoms in this population needs to be further investigated. The effect of QOL on treating depression in asthma patients also needs to be studied.
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Affiliation(s)
- Rita Mangold
- a Saint Luke's Hospital , Kansas City , MO , USA
| | - Gary A Salzman
- b Section of Pulmonary and Critical Care Medicine , University of Missouri-Kansas City , Kansas City , MO , USA
| | - Karen B Williams
- b Section of Pulmonary and Critical Care Medicine , University of Missouri-Kansas City , Kansas City , MO , USA
| | - Nicola A Hanania
- c Section of Pulmonary and Critical Care Medicine , Baylor College of Medicine , Houston , TX , USA
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Abstract
BACKGROUND Prior studies have suggested a relationship between atopy and mental health, although methodological barriers have limited the generalizability of these findings. The objective of this study was to investigate the relationship between early-life atopy and vulnerability to mental health problems among youth in the community. METHOD Data were drawn from the Raine Study (N = 2868), a population-based birth cohort study in Western Australia. Logistic regression and generalized estimating equations were used to examine the relationship between atopy at ages 1-5 years [using parent report and objective biological confirmation (sera IgE)], and the range of internalizing and externalizing mental health problems at ages 5-17 years. RESULTS Atopy appears to be associated with increased vulnerability to affective and anxiety problems, compared to youth without atopy. These associations remained significant after adjusting for a range of potential confounders. No relationship was evident between atopy and attention deficit hyperactivity disorder or externalizing problems. CONCLUSIONS Findings are the first linking atopy (measured by both parent report and objective verification) with increased vulnerability to affective and anxiety problems. Therefore, replication is required. If replicated, future research aimed at understanding the possible biological and/or social and environmental pathways underlying these links is needed. Such information could shed light on shared pathways that could lead to more effective treatments for both atopy and internalizing mental health problems.
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Affiliation(s)
- R D Goodwin
- Department of Psychology,Queens College and The Graduate Center,City University of New York (CUNY),Queens,NY,USA
| | - M Robinson
- Telethon Kids Institute,The University of Western Australia,West Perth,WA,Australia
| | - P D Sly
- Telethon Kids Institute,The University of Western Australia,West Perth,WA,Australia
| | - P G Holt
- Telethon Kids Institute,The University of Western Australia,West Perth,WA,Australia
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Do Panic Symptoms Affect the Quality of Life and Add to the Disability in Patients with Bronchial Asthma? PSYCHIATRY JOURNAL 2015; 2015:608351. [PMID: 26425540 PMCID: PMC4573991 DOI: 10.1155/2015/608351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/17/2015] [Accepted: 08/23/2015] [Indexed: 12/03/2022]
Abstract
Background. Anxiety and panic are known to be associated with bronchial asthma with variety of impact on clinical presentation, treatment outcome, comorbidities, quality of life, and functional disability in patients with asthma. This study aims to explore the pattern of panic symptoms, prevalence and severity of panic disorder (PD), quality of life, and disability in them. Methods. Sixty consecutive patients of bronchial asthma were interviewed using semistructured proforma, Panic and Agoraphobia scale, WHO Quality of life (QOL) BREF scale, and WHO disability schedule II (WHODAS II). Results. Though 60% of the participants had panic symptoms, only 46.7% had diagnosable panic attacks according to DSM IV TR diagnostic criteria and 33.3% had PD. Most common symptoms were “sensations of shortness of breath or smothering,” “feeling of choking,” and “fear of dying” found in 83.3% of the participants. 73.3% of the participants had poor quality of life which was most impaired in physical and environmental domains. 55% of the participants had disability score more than a mean (18.1). Conclusion. One-third of the participants had panic disorder with significant effect on physical and environmental domains of quality of life. Patients with more severe PD and bronchial asthma had more disability.
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Abstract
We assessed the association between asthma and suicidality in a nationally representative sample of US high school students. Data came from the 2007, 2009, and 2011 Youth Risk Behavioral Surveys. Weighted prevalence estimates and adjusted odds ratios were calculated. Subjects with asthma are more likely to report 2-week sadness (35.2%) compared to those without asthma (26.7%). Teens with asthma are also more likely to report suicide ideation (20.1% vs. 15%), planning (15.7% vs. 12.1%), attempt (10.1% vs. 6.9%), and treatment for attempt (3.5% vs. 2%). Although the unadjusted association between lifetime asthma and suicide attempts is statistically significant (crude odds ratio 1.5 (95% CI 1.3-1.8)), after controlling for confounders, that association is no longer statistically significant (AOR 1.2 (1-1.6)). Thus, this increase in suicidality seems to be due to the increased prevalence of sadness among teens with asthma. Similar patterns were seen in the 2007 and 2009 surveys.
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Goodwin RD, Galea S, Perzanowski M, Jacobi F. Impact of allergy treatment on the association between allergies and mood and anxiety in a population sample. Clin Exp Allergy 2013. [PMID: 23181792 DOI: 10.1111/j.1365-2222.2012.04042.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have suggested an association between allergy and mood and anxiety disorders. Yet, extant work suffers from methodological limitations. OBJECTIVE To investigate the association between physician-diagnosed allergy and DSM-IV mood and anxiety disorders in the general population, and to examine the role of allergy treatment in this relationship. METHODS Data were drawn from the German National Health Interview and Examination Survey, a population-based, representative sample of 4,181 adults aged 18-65 in Germany. Allergy was diagnosed by physicians during medical examination and mental disorders were diagnosed using the CIDI. RESULTS Allergy was associated with an increased prevalence of any anxiety disorder [OR = 1.3 (1.1, 1.6)], panic attacks [OR = 1.6 (1.1, 2.1)], panic disorder [OR = 1.6 (1.01, 2.3)], GAD [OR = 1.8 (1.1, 3.0)], any mood disorder [OR = 1.4 (1.1, 1.7)], depression [OR = 1.4 (1.1, 1.7)] and bipolar disorder [OR = 2.0, (1.0, 3.8)]. After adjusting for desensitization treatment status, these relationships were no longer significant. Those treated for allergy were significantly less likely to have any mood or anxiety disorder [OR = 0.65 (0.4, 0.96)], compared to those untreated. All relationships were adjusted for age, gender and socioeconomic status (SES). CONCLUSIONS & CLINICAL RELEVANCE These findings provide the first evidence of a link between physician-diagnosed allergy and DSM-IV mood and anxiety disorders in a representative sample. Treatment for allergy may mitigate much of this relationship.
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Affiliation(s)
- R D Goodwin
- Department of Psychology, Queens College, City University of New York (CUNY), Flushing, NY, USA.
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Baumeister H, Hutter N, Bengel J, Härter M. Quality of life in medically ill persons with comorbid mental disorders: a systematic review and meta-analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2011; 80:275-86. [PMID: 21646822 DOI: 10.1159/000323404] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 12/02/2010] [Indexed: 01/20/2023]
Abstract
BACKGROUND This systematic review aims to investigate the association between comorbid mental disorders and quality of life (QoL) in patients with chronic medical diseases. METHODS Studies investigating adults with diabetes mellitus, coronary artery disease, asthma, chronic back pain and colorectal cancer were included. Two reviewers independently extracted data and assessed methodological criteria. Effect sizes for QoL scores were analyzed in random-effects meta-analyses. Subgroup and sensitivity analyses were conducted. RESULTS The database search identified 7,291 references and 65 primary studies were included. Medically ill persons with comorbid mental disorders showed a significantly decreased overall (d = -1.10; 95% CI = -1.34 to -0.86), physical (d = -0.64; 95% CI = -0.74 to -0.53) and psychosocial (d = -1.18; 95% CI = -1.42 to -0.95) QoL compared to persons without mental disorders. Subgroup analyses did not reveal significant differences between the examined medical diseases or mental disorders. CONCLUSION The review provides evidence of a substantially reduced psychosocial and physical QoL in medically ill patients with comorbid mental disorders. This patient-reported outcome highlights the importance of recognizing and treating comorbid mental disorders in the medically ill.
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Affiliation(s)
- Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
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Butz AM, Halterman JS, Bellin M, Tsoukleris M, Donithan M, Kub J, Thompson RE, Land CL, Walker J, Bollinger ME. Factors associated with second-hand smoke exposure in young inner-city children with asthma. J Asthma 2011; 48:449-57. [PMID: 21545248 DOI: 10.3109/02770903.2011.576742] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the association of social and environmental factors with levels of second-hand smoke (SHS) exposure, as measured by salivary cotinine, in young inner-city children with asthma. METHODS We used data drawn from a home-based behavioral intervention for young high-risk children with persistent asthma post-emergency department (ED) treatment (N = 198). SHS exposure was measured by salivary cotinine and caregiver reports. Caregiver demographic and psychological functioning, household smoking behavior, and asthma morbidity were compared with child cotinine concentrations. Chi-square and ANOVA tests and multivariate regression models were used to determine the association of cotinine concentrations with household smoking behavior and asthma morbidity. RESULTS Over half (53%) of the children had cotinine levels compatible with SHS exposure and mean cotinine concentrations were high at 2.42 ng/ml (SD 3.2). The caregiver was the predominant smoker in the home (57%) and 63% reported a total home smoking ban. Preschool aged children and those with caregivers reporting depressive symptoms and high stress had higher cotinine concentrations than their counterparts. Among children living in a home with a total home smoking ban, younger children had significantly higher mean cotinine concentrations than older children (cotinine: 3-5 year olds, 2.24 ng/ml (SD 3.5); 6-10 year olds, 0.63 ng/ml (SD 1.0); p < .05). In multivariate models, the factors most strongly associated with high child cotinine concentrations were increased number of household smokers (β = 0.24) and younger child age (3-5 years) (β = 0.23; p < .001, R(2) = 0.35). CONCLUSION Over half of the young inner-city children with asthma were exposed to SHS, and caregivers are the predominant household smokers. Younger children and children with depressed and stressed caregivers are at significant risk of smoke exposures, even when a household smoking ban is reported. Further advocacy for these high-risk children is needed to help caregivers quit and to mitigate smoke exposure.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Abstract
OBJECTIVES To assess the adherence to antiasthmatic therapy by the use of questionnaire and objective methods in elderly people, as well as to evaluate the association between cognition, depressive symptoms, functional status, and compliance. METHODS Patients aged 65 to 102 with chronic asthma under therapy were analyzed retrospectively to evaluate adherence using the Modified Morisky (MM) scale and a visual analog scale (VAS). In the second part of the study, a 1-year monitoring of asthma based on electronic diary and assessment of drug usage was performed. The MM scale and VAS as well as the estimation of cognition, depression symptoms, and functional status were carried out at the beginning and at the end of the observations. RESULTS Among 117 participants at the beginning of the study, only 9% and 21% had high adherence to therapy according to the MM scale and VAS, respectively. After 1 year of monitoring, the compliance assessed by the MM scale increased from 3.08 +/- 0.97 to 3.85 +/- 1.01 and by the VAS from 44% +/- 7.8% to 90% +/- 5.9%. Adherence by electronic diary and drug packages was lower than in both MM scale and VAS. Cognition status correlated with the results of MM and VAS tests but did not influence other methods of assessment. There was a statistical correlation between depression symptoms, cognition, and adherence (p >.01) in contrast to functional status. Compliance correlated with asthma control tests and PEFR. CONCLUSION Low adherence to antiasthmatic treatment is common in elderly people. Proper monitoring of asthma by the use of diary or assessment of drugs packages with estimation of depression symptoms and cognition status could increase the compliance and asthma control in this group of patients.
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Affiliation(s)
- Andrzej Bozek
- Clinical Department of Internal Medicine, Dermatology and Allergology, Silesian University School of Medicine, Zabrze 41-800, Poland.
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Adams RJ, Appleton SL, Wilson DH, Taylor AW, Ruffin RE. Associations of physical and mental health problems with chronic cough in a representative population cohort. Cough 2009; 5:10. [PMID: 20003540 PMCID: PMC2804566 DOI: 10.1186/1745-9974-5-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 12/16/2009] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although chronic cough is a common problem in clinical practice, data on the prevalence and characteristics of cough in the general population are scarce. Our aim was to determine the prevalence of chronic cough that is not associated with diagnosed respiratory conditions and examine the impact on health status and psychological health, in a representative adult population cohort METHODS North West Adelaide Health Study (n stage 1 = 4060, stage 2 = 3160) is a representative population adult cohort. Clinical assessment included spirometry, anthropometry and skin tests. Questionnaires assessed demographics, lifestyle risk factors, quality of life, mental health and respiratory symptoms, doctor diagnosed conditions and medication use. RESULTS Of the 3355 people without identified lung disease at baseline, 18.2% reported chronic cough. In multiple logistic regression models, at follow-up, dry chronic cough without sputum production was significantly more common in males (OR 1.5, 95% CI 1.1, 1.9), current smokers (OR 4.9, 95% CI 3.4, 7.2), obesity (OR 1.9, 95% CI 1.3, 2.9), use of ACE inhibitors (OR 1.8, 95% CI 1.1, 2.9), severe mental health disturbance (OR 2.1, 95% CI 1.4, 3.1) and older age (40-59 years OR 1.7 95% CI 1.2, 2.4; > or = 60 years OR 2.1 95% CI 1.3, 3.5). Among non-smokers only, all cough was significantly more common in men, those with severe mental health disturbance and obesity. CONCLUSIONS Chronic cough is a major cause of morbidity. Attention to cough is indicated in patients with obesity, psychological symptoms or smokers. Inquiring about cough in those with mental health problems may identify reversible morbidity.
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Affiliation(s)
- Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, 5011, Australia
| | - Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, 5011, Australia
| | - David H Wilson
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, 5011, Australia
| | - Anne W Taylor
- Population Research and Outcome Studies Unit, South Australian Department of Health, Adelaide, South Australia, 5000, Australia
| | - Richard E Ruffin
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, 5011, Australia
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Effects of Depression on Quality of Life Improvement After Endoscopic Sinus Surgery. Laryngoscope 2008; 118:528-34. [DOI: 10.1097/mlg.0b013e31815d74bb] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mancuso CA, Wenderoth S, Westermann H, Choi TN, Briggs WM, Charlson ME. Patient-reported and physician-reported depressive conditions in relation to asthma severity and control. Chest 2008; 133:1142-8. [PMID: 18263683 DOI: 10.1378/chest.07-2243] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Depressive conditions in asthma patients have been described mostly from patient reports and less often from physician reports. While patient reports can encompass multiple symptoms, physician assessments can attribute symptoms to a mental health etiology. Our objectives were to identify associations between patient- and physician-reported depressive conditions and asthma severity and control. METHODS Patient-reported depressive symptoms were obtained using the Geriatric Depression Scale (GDS) [possible score 0 to 30; higher score indicates more depressive symptoms]. Patients were categorized as having a physician-reported depressive disorder if they had the following: a diagnosis of depression, depressive symptoms described in medical charts, or were prescribed antidepressants at doses used to treat depression. Patients also completed the Severity of Asthma Scale (SOA) [possible score 0 to 28; higher score indicates more severe] and the Asthma Control Questionnaire (ACQ) [possible score 0 to 6; higher score indicates worse control]. RESULTS Two hundred fifty-seven patients were included in this analysis (mean age, 42 years; 75% women). Mean SOA and ACQ (+/- SD) scores were 5.9 +/- 4.2 and 1.4 +/- 1.2, respectively; and mean GDS score was 6.3 +/- 6.4. After adjusting for age, sex, race, Latino ethnicity, education, medication adherence, body mass index, and smoking status, patient-reported depressive symptoms were associated with asthma severity (p = 0.007) and with asthma control (p = 0.0007). In contrast, physician-reported depressive disorders were associated with asthma severity (p = 0.04) but not with asthma control (p = 0.22) after adjusting for covariates. CONCLUSIONS Physician- and patient-reported depressive conditions were associated with asthma severity. In contrast, patient-reported depressive symptoms were more closely associated with asthma control than were physician-reported depressive disorders. Identifying associations between depressive conditions and asthma severity and control is necessary to concurrently treat these conditions in this population. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00195117.
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Affiliation(s)
- Carol A Mancuso
- Hospital for Special Surgery, 535 East Seventieth St, New York, NY 10021, USA.
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The Prevalence of Anxiety Disorders Among Adults with Asthma: A Meta-Analytic Review. J Clin Psychol Med Settings 2007. [DOI: 10.1007/s10880-007-9087-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ng TP, Chiam PC, Kua EH. Mental disorders and asthma in the elderly: a population-based study. Int J Geriatr Psychiatry 2007; 22:668-74. [PMID: 17154223 DOI: 10.1002/gps.1728] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinical studies have mostly linked anxiety disorders with asthma in young patients, but the data are inconsistent for depression. Few population-based studies have investigated the co-morbid diagnoses of mental disorders with asthma in older adults. METHOD Cross-sectional study of a population sample of older adults aged 60 and above (n = 1092). The diagnoses of recent depression and anxiety were made using the Geriatric Mental State (GMS) Schedule. The presence of asthma was ascertained by self-reports of physician-diagnosed asthma. RESULTS Asthma was associated with a higher prevalence of depressive disorders, with odds ratio of 2.45 (95% CI, 1.06-5.69) when compared against non-asthmatic controls; and 2.42 (95% CI, 1.04-5.64) when compared against controls with other chronic illnesses, after adjusting for psychosocial factors, physical co-morbidity and use of depression-causing drugs. Odds ratios were elevated but statistically insignificant for anxiety disorders and dementia. CONCLUSION We observed that asthma in the elderly was more evidently associated co-morbidly with depression, rather than anxiety disorder. However, possible associations with anxiety and dementia are not excluded, and should be further investigated.
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Affiliation(s)
- Tze-Pin Ng
- Gerontological Research Programme, Faculty of Medicine, National University of Singapore, Singapore.
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Schmitz N, Wang J, Malla A, Lesage A. Joint effect of depression and chronic conditions on disability: results from a population-based study. Psychosom Med 2007; 69:332-8. [PMID: 17470668 DOI: 10.1097/psy.0b013e31804259e0] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To estimate and compare the prevalence of functional disability in individuals with both chronic medical conditions and comorbid major depression and individuals with either chronic medical conditions or major depression alone and to determine the joint effect of depression and chronic conditions on functional disability. Evidence exists that major depression interacts with physical illness to amplify the functional disability associated with many medical conditions. METHODS We used data from the Canadian Community and Health Survey Cycle 2.1 (n = 46,262), a nationally representative survey conducted in 2003 by Statistics Canada. Depression, chronic conditions, and functional disability were assessed by personal/telephone interview. RESULTS Prevalence of functional disability was higher in subjects with chronic conditions and comorbid major depression (46.3%) than in individuals with either chronic conditions (20.9%) or major depression (27.8%) alone. With no chronic conditions and no major depression as reference and after adjusting for relevant covariates, the odds ratio of functional disability was 2.49 (95% confidence interval (CI), 1.91-3.26) for major depression, 2.12 (95% CI, 1.93-2.32) for chronic conditions, and 6.34 (95% CI, 5.35-7.51) for chronic conditions and comorbid major depression. CONCLUSIONS The results suggest that there is a joint effect of depression and chronic conditions on functional disability. Research and social policies should focus on the treatment of depression in chronic conditions.
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Affiliation(s)
- Norbert Schmitz
- Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Montreal Canada.
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19
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Dicpinigaitis PV, Tso R, Banauch G. Prevalence of Depressive Symptoms Among Patients With Chronic Cough. Chest 2006; 130:1839-43. [PMID: 17167006 DOI: 10.1378/chest.130.6.1839] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Cough is the most common complaint for which patients in the United States seek medical attention. Although the significant effect of cough on quality of life has been reported, the association of chronic cough with depressive symptomatology has not previously been investigated. DESIGN Prospective, nonrandomized evaluation. SETTING Outpatient department of academic medical center. PATIENTS Representative sample of patients presenting to a specialty center seeking evaluation and treatment of chronic cough. INTERVENTIONS Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), a 20-item self-report questionnaire designed to measure depressive symptomatology and risk for clinical depression, on initial evaluation and again after 3 months. Patients also provided subjective cough scores reflecting the severity of their cough. MEASUREMENTS AND RESULTS Of 100 patients undergoing initial evaluation, 53% scored positive (>/= 16) on the CES-D. Mean CES-D score was 18.3 +/- 13.2 (+/- SD). Among 81 subjects followed up at 3 months, mean CES-D score fell to 7.4 +/- 10.4, and subjective cough score decreased from 10 to 4.9 +/- 3.1. There was a statistically significant improvement in both cough and depression scores after 3 months (p < 0.001). Improvement in cough score correlated significantly with improvement in depression score (p = 0.003; Spearman rho = 0.323). CONCLUSION Depressive symptomatology is very common in patients with chronic cough. Physicians and other caregivers must be aware of the significant risk of clinical depression in this patient population.
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Affiliation(s)
- Peter V Dicpinigaitis
- Einstein Division/Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA.
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Smith A, Krishnan JA, Bilderback A, Riekert KA, Rand CS, Bartlett SJ. Depressive symptoms and adherence to asthma therapy after hospital discharge. Chest 2006; 130:1034-8. [PMID: 17035435 DOI: 10.1378/chest.130.4.1034] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the effect of depressive symptoms on adherence to therapy after discharge in patients hospitalized for asthma exacerbations. DESIGN Prospective cohort study in which depressive symptoms were assessed during hospitalization and use of asthma medications was electronically monitored for 2 weeks after discharge. SETTING Inner-city academic hospital in Baltimore, MD. PATIENTS Patients were 59 adults with a mean age of 43.2 +/- 10.9 years (+/- SD), who were mostly female (64%), African American (80%), and were hospitalized for an asthma exacerbation. MEASUREMENT AND RESULTS Depressive symptoms were assessed with the Center for Epidemiological Studies-Depression scale. Electronic monitors were used to evaluate inhaled corticosteroid and oral corticosteroid use for up to 2 weeks after discharge. Forty-one percent of patients had high levels of depressive symptoms. Mean adherence to therapy was significantly lower in patients with (vs without) high levels of depressive symptoms (60 +/- 26% vs 74 +/- 21%, p + 0.02). Even after controlling for age, gender, and education, depressive symptoms were a significant and independent predictor of poorer adherence. High levels of depressive symptoms were associated with a 11.4-fold increase (95% confidence interval, 2.2 to 58.2) in the odds of poor adherence to therapy after adjustment for potential confounders. CONCLUSIONS Depressive symptoms are common in inner-city adults hospitalized for asthma exacerbations and identify a subset of patients at high risk for poor adherence to asthma therapy after discharge. Further research is needed to determine if screening for and treating depression improves adherence and asthma outcomes in this population.
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Affiliation(s)
- Amena Smith
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21224, USA
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Volicer BJ, Quattrocchi N, Candelieri R, Nicolosi R, Ladebauche P. Depression and alcohol abuse in asthmatic college students. Nurse Pract 2006; 31:49-54. [PMID: 16452902 DOI: 10.1097/00006205-200602000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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López Viña A. [Attitude changes needed to foster treatment adherence in patients with asthma]. Arch Bronconeumol 2005; 41:334-40. [PMID: 15989891 DOI: 10.1016/s1579-2129(06)60233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A López Viña
- Hospital Universitario Puerta de Hierro, Madrid, Spain.
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King JT, Kassam AB, Yonas H, Horowitz MB, Roberts MS. Mental health, anxiety, and depression in patients with cerebral aneurysms. J Neurosurg 2005; 103:636-41. [PMID: 16266045 DOI: 10.3171/jns.2005.103.4.0636] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Aneurysm disease and its treatment can have an adverse impact on mental health, yet the affects of cerebral aneurysms on general mental health, anxiety, and depression are poorly understood.
Methods. Patients with cerebral aneurysms who were seen at a neurosurgery clinic underwent a structured interview, completed the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 12-item Short Form Health Survey (providing a mental component summary [MCS] score for general mental health), and were assigned functional status scores based on the Glasgow Outcome Scale (GOS), Rankin Scale, and Barthel Index. Rank-order methods were used to assess the relationship between mental health, aneurysm characteristics and history, and functional status. Data were collected in 166 patients (71% women) with a mean age of 53.7 years. Depression was present in 8% of the study population and an anxiety disorder in 17%. Patients with both an unsecured aneurysm and a history of subarachnoid hemorrhage (SAH) tended toward higher anxiety scores (p = 0.086). Higher depression scores were associated with a decreased functional status on the GOS (p = 0.015) and Rankin Scale (p = 0.010). The mean 6 standard deviation adjusted MCS score (37.9 ± 7.1) was significantly less than that of the US population (p < 0.001). Lower MCS scores were associated with a decreased functional status on the GOS (p = 0.052), Rankin Scale (p < 0.001), and Barthel Index (p = 0.002).
Conclusions. Patients with cerebral aneurysms have increased levels of anxiety and depression and poor general mental health. Those who have experienced an SAH and harbor an unsecured cerebral aneurysm demonstrate increased levels of anxiety. A lower functional status in patients with aneurysms is associated with depression and decreased general mental health.
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Affiliation(s)
- Joseph T King
- Section of Neurosurgery, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA.
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Stoffman MR, Roberts MS, King JT. Cervical Spondylotic Myelopathy, Depression, and Anxiety: A Cohort Analysis of 89 Patients. Neurosurgery 2005; 57:307-13; discussion 307-13. [PMID: 16094160 DOI: 10.1227/01.neu.0000166664.19662.43] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE:
To determine the prevalence of depressed and anxious mood states in patients with cervical spondylotic myelopathy (CSM), a degenerative spine condition with symptoms of neck pain, numb clumsy hands, gait difficulties, sphincter dysfunction, and impotence. To examine the relation between mood and functional deficits produced by CSM.
METHODS:
We surveyed a cohort of 89 patients with CSM recruited during 1 year from a neurosurgery clinic. Patients underwent a structured interview to collect information on demographics, personal habits, CSM symptoms, comorbid diseases, and symptoms of depression and anxiety. Patients self-completed the Hospital Anxiety and Depression scale and were scored on the Nurick, Cooper, Harsh, and modified Japanese Orthopaedic Association (mJOA) scales.
RESULTS:
According to the Hospital Anxiety and Depression scale threshold value of 11, 29% of the cohort had a depressed mood and 38% had an anxious mood. Higher depression scores were associated with worse myelopathy, as measured by the Nurick scale (P = 0.01), the Cooper leg subscale (P = 0.006), the Harsh scale (P = 0.02), the mJOA arm subscale (P = 0.006), and the mJOA leg subscale (P = 0.004). There was no relation between depression scores and the Cooper arm subscale, Harsh sphincter scale, mJOA sensory subscale, or mJOA bladder subscale. Similar patterns were seen in the relations between myelopathy and anxiety.
CONCLUSION:
More than one-third of patients with CSM have a depressed or anxious mood. In patients with CSM, depression and anxiety scores are strongly associated with decreased mobility, inconsistently associated with arm dysfunction, and not associated with sensory deficits or sphincter dysfunction, suggesting that ambulatory dysfunction may cause or exacerbate the symptoms of depression and anxiety in patients with CSM.
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Affiliation(s)
- Michael R Stoffman
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
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25
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Eisner MD, Katz PP, Lactao G, Iribarren C. Impact of depressive symptoms on adult asthma outcomes. Ann Allergy Asthma Immunol 2005; 94:566-74. [PMID: 15948301 DOI: 10.1016/s1081-1206(10)61135-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Psychological disorders, including depression, are common in adults with asthma. Although depression is treatable, its impact on longitudinal asthma outcomes is not clear. OBJECTIVE To elucidate the impact of depressive symptoms on patient-centered outcomes and emergency health care use in adults with asthma. METHODS We conducted a prospective cohort study of 743 adults with asthma who were recruited after hospitalization for asthma. Depressive symptoms were defined as having a score of 16 or more on the Center for Epidemiologic Studies Depression Scale. We examined the impact of depressive symptoms on patient-centered outcomes (validated severity-of-asthma score, Marks Asthma Quality of Life Questionnaire, and 12-Item Short-Form Health Survey physical component summary score) and on future emergency health care use for asthma ascertained from computerized databases. RESULTS The prevalence of depressive symptoms was 18% (95% confidence interval [CI], 15%-21%) among adults with asthma. Depressive symptoms were associated with greater severity-of-asthma scores after controlling for age, sex, race/ ethnicity, educational attainment, and cigarette smoking (mean score increment, 2.6 points; 95% CI, 1.8-3.4 points). Furthermore, depressive symptoms were associated with poorer asthma-specific quality of life (mean score increment, 19.9 points; 95% CI, 17.7-22.1 points) and poorer physical health status (mean score decrement, 3.7 points; 95% CI, 1.5-5.8 points). Depressive symptoms were associated with a greater longitudinal risk of hospitalization for asthma (hazard ratio, 1.34; 95% CI, 0.98-1.84). After controlling for differences in preventive care for asthma, the relationship was stronger (hazard ratio, 1.45; 95% CI, 1.05-2.0). CONCLUSION Depressive symptoms are common in adults with asthma and are associated with poorer health outcomes, including greater asthma severity and risk of hospitalization for asthma.
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Affiliation(s)
- Mark D Eisner
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California 94117, USA.
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Schatz M, Chen PT, Macy E, Zeiger RS. Dispensing of proton pump inhibitor medication is independently associated with subsequent asthma emergency hospital utilization. Am J Med 2005; 118:431-4. [PMID: 15808144 DOI: 10.1016/j.amjmed.2005.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser-Permanente Medical Center, 7060 Clairemont Mesa Boulevard, San Diego, CA 92111, USA.
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Goodwin RD, Lewinsohn PM, Seeley JR. Respiratory symptoms and mental disorders among youth: results from a prospective, longitudinal study. Psychosom Med 2004; 66:943-9. [PMID: 15564362 DOI: 10.1097/01.psy.0000138123.70740.92] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the relationship between respiratory symptoms and mental disorders among youth in the community, and to investigate possible mechanisms of these linkages. METHODS Data were drawn from the Oregon Adolescent Depression Project (n = 1,709), a longitudinal study of adolescents in the community. Multiple logistic regression analyses were used to examine the cross-sectional and longitudinal associations between respiratory symptoms and mental disorders at baseline, and linkages between respiratory symptoms at baseline and the onset of specific mental disorders at follow-up. Additional analyses were performed to examine the strength and specificity of the relationship between respiratory symptoms and mental disorders. The potential roles of hypochondriasis, functional impairment, and cigarette smoking in the associations between respiratory symptoms and mental disorders were investigated. RESULTS Respiratory symptoms were associated with a significantly increased odds of any mental disorder (odds ratio (OR) = 1.9), specifically any depressive disorder (OR = 1.9), major depression (OR = 1.9), any substance use disorders (OR = 1.6), panic attacks (OR = 3.1), and attention deficit/hyperactivity disorder (ADHD) (OR = 5.8) at baseline. Respiratory symptoms at between 1987 and 1989 (Time 1) were associated with significantly increased risk of the onset of any mental disorder a year later (Time 2) (OR = 2.1). While demographic differences, hypochondriasis, functional impairment, and cigarette smoking contributed to the relationships between respiratory symptoms and mental disorders, these associations persisted after adjusting for these factors. CONCLUSIONS The results suggest evidence of an association between respiratory symptoms and mental disorders among youth in the community. While demographic differences, hypochondriasis, functional impairment, and cigarette smoking may contribute to the linkage, these factors do not appear to completely explain the association. Future studies that can replicate these findings and include an examination of other possible mechanisms for these patterns of comorbidity, such as shared familial vulnerability or other environmental risk factors (e.g., childhood behavioral risk factors), are needed next.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Columbia University and the Oregon Research Institute, USA.
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Bartlett SJ, Krishnan JA, Riekert KA, Butz AM, Malveaux FJ, Rand CS. Maternal depressive symptoms and adherence to therapy in inner-city children with asthma. Pediatrics 2004; 113:229-37. [PMID: 14754931 DOI: 10.1542/peds.113.2.229] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Little is known about how depressive symptoms in mothers affects illness management in inner-city children with asthma. OBJECTIVE Our goal was to determine how maternal depressive symptoms influence child medication adherence, impact of the child's asthma on the mother, and maternal attitudes and beliefs. METHODS Baseline and 6-month surveys were administered to 177 mothers of young minority children with asthma in inner-city Baltimore, MD and Washington, DC. Medication adherence, disruptiveness of asthma, and select attitudes toward illness and asthma therapy were measured. Six-month data (N = 158) were used to prospectively evaluate long-term symptom control and emergency department use. Independent variables included asthma morbidity, age, depressive symptoms, and other psychosocial data. RESULTS No difference in child asthma morbidity was observed between mothers high and low in depressive symptoms. However, mothers with high depressive symptoms reported significantly more problems with their child using inhalers properly (odds ratio [OR]: 5.0; 95% confidence interval [CI]: 1.3-18.9) and forgetting doses (OR: 4.2; 95% CI: 1.4-12.4). Depressive symptoms were also associated with greater emotional distress and interference with daily activities caused by the child's asthma, along with less confidence in asthma medications, ability to control asthma symptoms, and self-efficacy to cope with acute asthma episodes. In addition, depressed mothers reported less understanding about their child's medications and use (OR: 7.7; 95% CI: 1.7-35.9). Baseline asthma morbidity, maternal depression scores, and family income were independently associated with asthma symptoms 6 months later, whereas medication adherence was not predictive of subsequent asthma morbidity or emergency department use. CONCLUSIONS Maternal depressive symptoms were not associated with child asthma morbidity but were associated with a constellation of beliefs and attitudes that may significantly influence adherence to asthma medications and illness management. Identifying and addressing poor psychological adjustment in mothers is important when developing a child's asthma treatment and may facilitate parent-provider communication, medication adherence, and asthma management among inner-city children.
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Affiliation(s)
- Susan J Bartlett
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Timonen M, Jokelainen J, Hakko H, Silvennoinen-Kassinen S, Meyer-Rochow VB, Herva A, Räsänen P. Atopy and depression: results from the Northern Finland 1966 Birth Cohort Study. Mol Psychiatry 2003; 8:738-44. [PMID: 12888802 DOI: 10.1038/sj.mp.4001274] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Several studies have suggested an association between IgE-mediated atopic allergies and depression. The present study extends our understanding about putative gender differences of this association and provides further epidemiological evidence for our previous finding that the association between atopy and depression may be characteristic for females only. In order to clearly determine the presence of atopic disorders and depression, we used more valid tools than had been employed earlier and we had access to a database (the Northern Finland 1966 Birth Cohort), in which individuals were followed up prospectively until the age of 31 years. The information on allergic symptoms, verified by skin-prick tests and comprising data of 5518 individuals, was used to ascertain the presence of atopy. Depression was assessed with the help of Hopkins' Symptom Checklist-25 and self-reported doctor-diagnosed depression. After adjusting for a father's social class, mother's parity, and place of residence, logistic regression analyses showed that the risk of developing depression increased in parallel with the increasing severity of depression and, when compared with nonatopic subjects, was 3.0 to 4.7-fold up in atopic females and statistically significant. In atopic males, the association between atopy and depression was statistically significant only in the highest depression scores, the odds ratio being 6.3-fold. The results indicate that females suffering from atopic diseases might possess an elevated risk of developing depression already during early adulthood. In males, the association between these two disorders is evident only among the most severe manifestations of depression. Possible background theories, that is, genetic abnormalities in serotonin metabolism, HPA-axis dysfunction, and histamine theory are discussed.
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Affiliation(s)
- M Timonen
- Health Center, City of Oulu, Finland.
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Abstract
Asthmatic children living in low-income families in United States inner city communities continue to have disproportionately high rates of hospitalizations, emergency department visits, disability, and death. Current research implicates a combination of environmental, biologic, and disease mismanagement factors that underlie these poor outcomes. Multifaceted studies are underway to better understand this inner-city path to severe asthma. Efforts to optimize interventions, to implement them broadly, and to sustain them are also underway on local and national levels. It is hoped that these efforts will limit the severe consequences of asthma, narrow disparities in outcomes, and substantially reduce medical expenditures for asthma.
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Affiliation(s)
- Monica J Federico
- Division of Pediatric Pulmonary, The Children's Hospital, 1056 East 19th Avenue, Denver, CO 80262 USA.
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Clary GL, Palmer SM, Doraiswamy PM. Mood disorders and chronic obstructive pulmonary disease: current research and future needs. Curr Psychiatry Rep 2002; 4:213-21. [PMID: 12003685 DOI: 10.1007/s11920-002-0032-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The following review examines the interrelationships between chronic obstructive pulmonary disease (COPD), psychiatric illness, and tobacco use. The influence that these three entities have is very unclear, and this article attempts to address the current knowledge of how each contributes to the other and postulates future directions to explore regarding diagnosis, treatment, and predictive values. Other issues discussed include the pharmacologic treatment of patients with COPD and depression, and an overview of the clinical trial data regarding several different classes of antidepressants. Also reviewed is the impact of pulmonary rehabilitation on psychologic status and quality of life issues in the daily functioning of the COPD patient.
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Affiliation(s)
- Greg L Clary
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, PO Box 3519 Medical Center, Durham, NC 27710, USA.
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