Abstract
The goals of this study were to characterize the frequency of psychiatric disorders among patients with asthma, and to compare differences in functional status among asthma patients with and without comorbid depression and anxiety disorders. Fifty patients with confirmed asthma were administered the Diagnostic Interview Schedule for DSM-III-R and completed the Medical Outcomes Study Short Form-36 Health Survey. Patients with asthma had a higher lifetime prevalence of major depression, panic disorder, and agoraphobia, but a lower prevalence of social phobia, compared to lifetime prevalence rates for psychiatric disorders in a national probability sample. Participants with comorbid asthma and major depression had poorer physical and mental health functioning and health perception than did asthma patients without major depression. The results suggest that certain psychiatric disorders are common among patients with asthma and that depression is associated with significantly increased functional morbidity. These findings underscore the need for the appropriate detection and treatment of these comorbid conditions.
Similar content being viewed by others
REFERENCES
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised).Washington DC: Author.
American Thoracic Society. (1993). Guidelines for the evaluation of impairment/disability in patients with asthma. American Review of Respiratory Disease, 147, 1056–1061.
Bousquet, J., Knani, J., Dhivert, H., Richard, A., Chicoye, A., Ware, J. E., Jr, & Michel, F. B. (1994). Quality of life in asthma. I. Internal consistency and validity of the SF–36 questionnaire. American Journal of Respiratory and Critical Care Medicine, 149, 371–375.
Carr, R. E., Lehrer, P. M., & Hochron, S. M. (1992). Panic symptoms in asthma and panic disorder: A preliminary test of the dyspnea–fear theory. Behaviour Research and Therapy, 30, 251–261.
Carr, R. E., Lehrer, P. M., Rausch, L. L., & Hochron, S. M. (1994). Anxiety sensitivity and panic attacks in an asthmatic population. Behaviour Research and Therapy, 32, 411–418.
Cassem, E. H. (1990). Depression and anxiety secondary to medical illness. Psychiatric Clinics of North America, 13, 597–612.
Centers for Disease Control and Prevention. (1997). Asthma surveillance programs in public health departments—United States. Morbidity and Mortality Weekly Reports, 45, 802–804.
Dyer, C. A. E., Hill, S. L., Stockley, R. A., & Sinclair, A. J. (1999). Quality of life in elderly subjects with a diagnostic label of asthma from general practice registers. European Respiratory Journal, 14, 39–45.
Helzer, J. E., Robins, L. N., McEvoy, L. T., Spitznagel, E. L., Stoltzman, R. K., Farmer, A., & Brockington, I. F. (1985). A comparison of clinical and diagnostic interview schedule diagnoses. Archives of General Psychiatry, 42, 657–666.
Janson, C., Bjornsson, E., Hetta, J., & Boman, G. (1994). Anxiety and depression in relation to respiratory symptoms and asthma. American Journal of Respiratory and Critical Care Medicine, 149, 930–934.
Karajgi, B., Rifkin, A., Doddi, S., & Kolli, R. (1990). The prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease. American Journal of Psychiatry, 147, 200–201.
Katon, W. J., Buchwald, D. S., Simon, G. E., Russo, J. E., & Mease, P. J. (1991). Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis. Journal of General Internal Medicine, 6, 277–285.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., Wittchen, H. A., & Kendler, K. S. (1994). Lifetime and 12–month prevalence of DSM–III–R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8–19.
Lyons, R. A., Lo, S. V., & Littlepage, B. N. (1994). Comparative health status of patients with 11 common illnesses in Wales. Journal of Epidemiology and Community Health, 48, 388–390.
Marcus, S., Robins, L. N., & Bucholz, K. (1988). Quick Diagnostic Interview Schedule III–R, Version 1.0. St. Louis, Missouri: Washington University School of Medicine.
Mawhinney, H., Spector, S. L., Heitjan, D., Kinsman, R. A., Dirks, J. F., & Pines, I. (1993). As–needed medication use in asthma usage patterns and patient characteristics. Journal of Asthma, 30, 61–71.
Miller, T. P., Greenberger, P. A., & Patterson, R. (1992). The diagnosis of potentially fatal asthma in hospitalized adults. Patient characteristics and increased severity of asthma. Chest, 102, 515–518.
Osman, L. M., Calder, C., Robertson, R., Friend, J. A. R., Legge, J. S., & Douglas, J. G. (2000). Symptoms, quality of life, and health service contact among young adults with mild asthma. American Journal of Respiratory and Critical Care Medicine, 161, 498–503.
Perna, G., Bertani, A., Politi, E., Colombo, G., & Bellodi, L. (1997). Asthma and panic attacks. Biological Psychiatry, 42, 625–630.
Priel, B., Heimer, D., Rabinowitz, B., & Hendler, N. (1994). Perceptions of asthma severity: The role of negative affectivity. Journal of Asthma, 31, 479–484.
Ried, L. D., Nau, D. P., & Grainger–Rousseau, T. J. (1999). Evaluation of patient's health–related quality of life using a modified and shortened version of the Living with Asthma Questionnaire (ms–LWAQ) and the Medical Outcomes Study, Short–Form 36 (SF–36). Quality of Life Research, 8, 491–499.
Schmaling, K. B., Afari, N., Barnhart, S., & Buchwald, D. S. (1997). The association of disease severity, functional status, and medical utilization with relationship satisfaction among asthma patients and their partners. Journal of Clinical Psychology in Medical Settings, 4, 373–382.
Schmaling, K. B., Afari, N., & Blume, A. W. (1998). Predictors of treatment adherence among asthma patients in the emergency department. Journal of Asthma, 35, 631–636.
Schmaling, K. B. & Bell, J. (1997). Asthma and panic disorder. Archives of Family Medicine, 6, 20–23.
Shavitt, R. G., Gentil, V., & Mandetta, R. (1992). The association of panic/agoraphobia and asthma: Contributing factors and clinical implications. General Hospital Psychiatry, 14, 420–423.
Sherbourne, C. D., Jackson, C. A., Meredith, L. S., Camp, P., & Wells, K. B. (1996). Prevalence of comorbid anxiety disorders in primary care outpatients. Archives of Family Medicine, 5, 27–34.
Sherbourne, C. D., Wells, K. B., Meredith, L. S., Jackson, C. A., & Camp, P. (1996). Comorbid anxiety disorder and the functioning and well–being of chronically ill patients of general medical providers. Archives of General Psychiatry, 53, 889–895.
Sly, R. M. (1988). Mortality from asthma, 1979–1984. Journal of Allergy and Clinical Immunology, 82, 705–717.
SPSS Inc. (1997). SPSS for windows release 9.0. Chicago, IL: SPSS, Inc.
Sterk, P. J., Fabbri, L. M., Quanjer, P. H., Cockcroft, P. W., O'Byrne, P. M., Anderson, S. D., Juniper, E. F., & Malo, J. L. (1993). Airway responsiveness: Standardized challenge testing with pharmacological, physical, and sensitizing stimuli in adults. European Respiratory Journal, 6 (Supp 16), 53–83.
Stewart, A. L., Greenfield, S., Hays, R. D., Wells, K., Rogers, W. H., Berry, S. D., McGlynn, E. A., & Ware, J. E. (1989). Functional status and well–being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA, 262, 907–913.
Stewart, A. L., Hays, R., & Ware, J. E. (1988). The MOS shortform general health survey: Reliability and validity in a patient population. Medical Care, 26, 724–732.
Tough, S. C., Hessel, P. A., Ruff, M., Green, F. H. Y., Mitchell, I., & Butt, J. C. (1998). Features that distinguish those who die from asthma from community controls with asthma. Journal of Asthma, 35, 657–665.
Van Peski–Oosterbaan, A. S., Spinhoven, P., Van der Does, A. J. W., Willems, L. N. A., & Sterk P. J. (1996). Is there a specific relationship between asthma and panic disorder? Behaviour Research and Therapy, 34, 333–340.
Walker, E. A., Katon, W. J., Jemelka, R. P., & Roy–Byrne, P. P. (1992). Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchment Area (ECA) study. American Journal of Medicine, 92 (Suppl 1A), 26S–30S.
Wampole, R. E. (1974). Introduction to statistics. New York: MacMillan Publishing Co.
Ware, J. E. (1993). SF–36 health survey. Manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Center.
Weissman, M. M. (1987). Advances in psychiatric epidemiology: Rates and risks for major depression. American Journal of Public Health, 77, 445–451.
Wells, K.B., Golding, J. M., & Burnam, M.A. (1988). Psychiatric disorders in a sample of the general population with and without chronic medical conditions. American Journal of Psychiatry, 145, 976–981.
Wells, K. B., Stewart, A., Hays, R. D., Burnam, A., Rogers, W., Daniels, M., Berry, S., Greenfield, S., & Ware, J. (1989). The functioning and well–being of depressed patients. Results from the Medical Outcomes Study. JAMA, 262, 914–919.
Yellowlees, P. M., Alpers, J. H., Bowden, J. J., Bryant, G. D., & Ruffin, R. E. (1987). Psychiatric morbidity in patients with chronic airflow obstruction. The Medical Journal of Australia, 146, 305–307.
Yellowlees, P. M., Haynes, S., Potts, N., & Ruffin, R. E. (1988). Psychiatric morbidity in patients with life–threatening asthma: Initial report of a controlled study. The Medical Journal of Australia, 149, 246–249.
Young, M. A., Meaden, P. M., Fogg, L. F., Cherin, E. A., & Eastman, C. I. (1997).Which environmental variables are related to the onset of seasonal affective disorder? Journal of Abnormal Psychology, 106, 554–562.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Afari, N., Schmaling, K.B., Barnhart, S. et al. Psychiatric Comorbidity and Functional Status in Adult Patients with Asthma. Journal of Clinical Psychology in Medical Settings 8, 245–252 (2001). https://doi.org/10.1023/A:1011912712262
Issue Date:
DOI: https://doi.org/10.1023/A:1011912712262