Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 8, pp 1273–1282 | Cite as

Asthma, life events and psychiatric disorders: a population-based study

Original Paper



Although asthma and other chronic physical conditions have been shown to be associated with psychiatric symptoms, the relative contributions of negative life events to this association and impaired quality of life (QOL) are not clear.


This is a cross-sectional study of a nationally representative sample of Singaporean adults aged 20–59 (n = 2,847). Individuals were grouped by asthma, other chronic physical conditions, and no chronic physical conditions. Participants were assessed life events (list of threatening experiences questionnaire), psychiatric disorders [schedule for clinical assessment in neuropsychiatry diagnoses of psychiatric disorder including any psychiatric disorder, major depressive disorder (MDD) and generalized anxiety disorder (GAD)], and QOL (medical outcomes study 12-item short form).


In multivariate analyses controlling for confounding variables, asthma and other chronic physical conditions, compared to no chronic physical conditions, both showed similarly (two- to four-fold) elevated odds ratio (OR) of association with MDD and GAD. However, the asthma group reported more life events as compared to other chronic physical conditions (OR = 4.33, 95 % CI: 2.09–8.95) or no chronic physical conditions (OR = 7.64, 95 % CI: 3.87–15.06). Life events accounted significantly for excess coexistence of psychiatric disorders with asthma over participants without chronic physical conditions. It also contributed significantly to relatively worse QOL observed among individuals with asthma.


In this cross-sectional study, life events among adults in Singapore appeared to mediate the co-occurrence of psychiatric disorders and functional impairment with asthma, more than with other chronic physical conditions. This should be further investigated in longitudinal studies.


Asthma Psychiatric disorder Life events Quality of life National Mental Health Survey 


  1. 1.
    Pearce N, Douwes J, Beasley R (2000) The rise and rise of asthma: a new paradigm for the new millennium? J Epidemiol Biostat 5(1):5–16PubMedGoogle Scholar
  2. 2.
    Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, Gibson P, Ohta K, O’Byrne P, Pedersen SE, Pizzichini E, Sullivan SD, Wenzel SE, Zar HJ (2008) Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31(1):143–178. doi:10.1183/09031936.00138707 PubMedCrossRefGoogle Scholar
  3. 3.
    Barreto do Carmo MB, Neves Santos D, Alves Ferreira Amorim LD, Fiaccone RL, Souza da Cunha S, Cunha Rodrigues L, Barreto ML (2009) Minor psychiatric disorders in mothers and asthma in children. Soc Psychiatry Psychiatr Epidemiol 44(5):416–420. doi:10.1007/s00127-008-0450-x PubMedCrossRefGoogle Scholar
  4. 4.
    Kuehn BM (2008) Asthma linked to psychiatric disorders. JAMA 299(2):158–160. doi:10.1001/jama.2007.54-a PubMedCrossRefGoogle Scholar
  5. 5.
    O’Toole BI, Catts SV (2008) Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. J Psychosom Res 64(1):33–40. doi:10.1016/j.jpsychores.2007.07.006 PubMedCrossRefGoogle Scholar
  6. 6.
    Ortega AN, Feldman JM, Canino G, Steinman K, Alegria M (2006) Co-occurrence of mental and physical illness in US Latinos. Soc Psychiatry Psychiatr Epidemiol 41(12):927–934. doi:10.1007/s00127-006-0121-8 PubMedCrossRefGoogle Scholar
  7. 7.
    Scott KM, Von Korff M, Ormel J, Zhang MY, Bruffaerts R, Alonso J, Kessler RC, Tachimori H, Karam E, Levinson D, Bromet EJ, Posada-Villa J, Gasquet I, Angermeyer MC, Borges G, de Girolamo G, Herman A, Haro JM (2007) Mental disorders among adults with asthma: results from the world mental health survey. Gen Hosp Psychiatry 29(2):123–133. doi:10.1016/j.genhosppsych.2006.12.006 PubMedCrossRefGoogle Scholar
  8. 8.
    Ortega AN, McQuaid EL, Canino G, Ramirez R, Fritz GK, Klein RB (2003) Association of psychiatric disorders and different indicators of asthma in island Puerto Rican children. Soc Psychiatry Psychiatr Epidemiol 38(4):220–226. doi:10.1007/s00127-003-0623-6 PubMedCrossRefGoogle Scholar
  9. 9.
    Lavoie KL, Cartier A, Labrecque M, Bacon SL, Lemiere C, Malo JL, Lacoste G, Barone S, Verrier P, Ditto B (2005) Are psychiatric disorders associated with worse asthma control and quality of life in asthma patients? Respir Med 99(10):1249–1257. doi:10.1016/j.rmed.2005.03.003 PubMedCrossRefGoogle Scholar
  10. 10.
    Afari N, Schmaling KB, Barnhart S, Buchwald D (2001) Psychiatric comorbidity and functional status in adult patients with asthma. J Clin Psychol Med Settings 8(4):245–252. doi:10.1023/a:1011912712262 CrossRefGoogle Scholar
  11. 11.
    Janson C, Bjornsson E, Hetta J, Boman G (1994) Anxiety and depression in relation to respiratory symptoms and asthma. Am J Respir Crit Care Med 149(4 Pt 1):930–934PubMedCrossRefGoogle Scholar
  12. 12.
    Douwes J, Brooks C, Pearce N (2011) Asthma nervosa: old concept, new insights. Eur Respir J 37(5):986–990. doi:10.1183/09031936.00018511 PubMedCrossRefGoogle Scholar
  13. 13.
    Feldman JM, Acosta Perez E, Canino G, McQuaid EL, Goodwin RD, Ortega AN (2011) The role of caregiver major depression in the relationship between anxiety disorders and asthma attacks in island Puerto Rican youth and young adults. J Nerv Ment Dis 199(5):313–318. doi:10.1097/NMD.0b013e3182174e84 PubMedCrossRefGoogle Scholar
  14. 14.
    Lietzen R, Virtanen P, Kivimaki M, Sillanmaki L, Vahtera J, Koskenvuo M (2011) Stressful life events and the onset of asthma. Eur Respir J 37(6):1360–1365. doi:10.1183/09031936.00164609 PubMedCrossRefGoogle Scholar
  15. 15.
    Bloomberg GR, Chen E (2005) The relationship of psychologic stress with childhood asthma. Immunol Allergy Clin North Am 25(1):83–105. doi:10.1016/j.iac.2004.09.001 PubMedCrossRefGoogle Scholar
  16. 16.
    Goodwin RD, Fergusson DM, Horwood LJ (2004) Asthma and depressive and anxiety disorders among young persons in the community. Psychol Med 34(8):1465–1474PubMedCrossRefGoogle Scholar
  17. 17.
    Buske-Kirschbaum A, von Auer K, Krieger S, Weis S, Rauh W, Hellhammer D (2003) Blunted cortisol responses to psychosocial stress in asthmatic children: a general feature of atopic disease? Psychosom Med 65(5):806–810PubMedCrossRefGoogle Scholar
  18. 18.
    Lim L, Ng TP, Chua HC, Chiam PC, Won V, Lee T, Fones C, Kua EH (2005) Generalised anxiety disorder in Singapore: prevalence, co-morbidity and risk factors in a multi-ethnic population. Soc Psychiatry Psychiatr Epidemiol 40(12):972–979. doi:10.1007/s00127-005-0978-y PubMedCrossRefGoogle Scholar
  19. 19.
    Mokdad AH, Stroup DF, Giles WH (2003) Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the Behavioral Risk Factor Surveillance Team. MMWR Recomm Rep 52(RR-9):1–12PubMedGoogle Scholar
  20. 20.
    Nelson DE, Holtzman D, Bolen J, Stanwyck CA, Mack KA (2001) Reliability and validity of measures from the behavioral risk factor surveillance system (BRFSS). Soz Praventivmed 46(Suppl 1):S3–S42PubMedGoogle Scholar
  21. 21.
    Ng TP, Hui KP, Tan WC (1994) Prevalence of asthma and risk factors among Chinese, Malay, and Indian adults in Singapore. Thorax 49(4):347–351PubMedCrossRefGoogle Scholar
  22. 22.
    Hong CY, Ng TP, Wong ML, Koh KT, Goh LG, Ling SL (1994) Lifestyle and behavioural risk factors associated with asthma morbidity in adults. QJM 87(10):639–645PubMedGoogle Scholar
  23. 23.
    Ng TP (2000) Validity of symptom and clinical measures of asthma severity for primary outpatient assessment of adult asthma. Br J Gen Pract 50(450):7–12PubMedGoogle Scholar
  24. 24.
    Goldberg DP (1988) A user’s guide to the general health questionnaire. NFER-NELSON Publishing Company, BerkshireGoogle Scholar
  25. 25.
    Gao F, Luo N, Thumboo J, Fones C, Li SC, Cheung YB (2004) Does the 12-item general health questionnaire contain multiple factors and do we need them? Health Qual Life Outcomes 2:63. doi:10.1186/1477-7525-2-63 PubMedCrossRefGoogle Scholar
  26. 26.
    Sandson NB (1997) Mental illness in general health care: an international study. J Nerv Ment Dis 185(5):352–353CrossRefGoogle Scholar
  27. 27.
    Boey KW (1999) Distressed and stress resistant nurses. Issues Ment Health Nurs 20(1):33–54PubMedCrossRefGoogle Scholar
  28. 28.
    Goldberg DP (1972) The detection of psychiatric illness by questionnaire; a technique for the identification and assessment of non-psychotic psychiatric illness. Maudsley monographs vol no 21. Oxford University Press, LondonGoogle Scholar
  29. 29.
    Hoeymans N, Garssen AA, Westert GP, Verhaak PF (2004) Measuring mental health of the Dutch population: a comparison of the GHQ-12 and the MHI-5. Health Qual Life Outcomes 2:23. doi:10.1186/1477-7525-2-23 PubMedCrossRefGoogle Scholar
  30. 30.
    Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablenski A, Regier D, Sartorius N (1990) SCAN. Schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatry 47(6):589–593PubMedCrossRefGoogle Scholar
  31. 31.
    Guze SB (1995) Diagnostic and statistical manual of mental-disorders, 4th edition (Dsm-Iv)—Amer-Psychiat-Assoc. Am J Psychiat 152:1228Google Scholar
  32. 32.
    Janca A, Ustun TB, Sartorius N (1994) New versions of World Health Organization instruments for the assessment of mental disorders. Acta Psychiatr Scand 90(2):73–83PubMedCrossRefGoogle Scholar
  33. 33.
    Brugha TS, Nienhuis F, Bagchi D, Smith J, Meltzer H (1999) The survey form of SCAN: the feasibility of using experienced lay survey interviewers to administer a semi-structured systematic clinical assessment of psychotic and non-psychotic disorders. Psychol Med 29(3):703–711PubMedCrossRefGoogle Scholar
  34. 34.
    Rijnders CA, van den Berg JF, Hodiamont PP, Nienhuis FJ, Furer JW, Mulder J, Giel R (2000) Psychometric properties of the schedules for clinical assessment in neuropsychiatry (SCAN-2.1). Soc Psychiatry Psychiatr Epidemiol 35(8):348–352PubMedCrossRefGoogle Scholar
  35. 35.
    Ware JE, Kosinski M, Keller SD, QualityMetric I, New England Medical Center Hospital. Health Assessment L (2002) SF-12: how to score the SF-12 physical and mental health summary scales. QualityMetric Inc., Health Assessment Lab, Lincoln, R.I., Boston, MassGoogle Scholar
  36. 36.
    Thumboo J, Chan SP, Machin D, Soh CH, Feng PH, Boey ML, Leong KH, Thio ST, Fong KY (2002) Measuring health-related quality of life in Singapore: normal values for the English and Chinese SF-36 health survey. Ann Acad Med Singapore 31(3):366–374PubMedGoogle Scholar
  37. 37.
    Opolski M, Wilson I (2005) Asthma and depression: a pragmatic review of the literature and recommendations for future research. Clin Pract Epidemiol Ment Health 1:18. doi:10.1186/1745-0179-1-18 PubMedCrossRefGoogle Scholar
  38. 38.
    Brugha TS, Cragg D (1990) The list of threatening experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatr Scand 82(1):77–81PubMedCrossRefGoogle Scholar
  39. 39.
    Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182PubMedCrossRefGoogle Scholar
  40. 40.
    Ng TP, Tan WC (1999) Temporal trends and ethnic variations in asthma mortality in Singapore, 1976–1995. Thorax 54(11):990–994PubMedCrossRefGoogle Scholar
  41. 41.
    Rai D, Kerr MP, McManus S, Jordanova V, Lewis G, Brugha TS (2012) Epilepsy and psychiatric comorbidity: a nationally representative population-based study. Epilepsia 53(6):1095–1103. doi:10.1111/j.1528-1167.2012.03500.x PubMedCrossRefGoogle Scholar
  42. 42.
    Eisner MD, Katz PP, Lactao G, Iribarren C (2005) Impact of depressive symptoms on adult asthma outcomes. Annals of allergy, asthma & immunology: official publication of the American College of Allergy. Asthma Immunol 94(5):566–574. doi:10.1016/S1081-1206(10)61135-0 CrossRefGoogle Scholar
  43. 43.
    Goodwin RD, Olfson M, Shea S, Lantigua RA, Carrasquilo O, Gameroff MJ, Weissman MM (2003) Asthma and mental disorders in primary care. Gen Hosp Psychiatry 25(6):479–483PubMedCrossRefGoogle Scholar
  44. 44.
    Perna G, Bertani A, Politi E, Colombo G, Bellodi L (1997) Asthma and panic attacks. Biol Psychiatry 42(7):625–630. doi:10.1016/S0006-3223(96)00436-2 PubMedCrossRefGoogle Scholar
  45. 45.
    Nascimento I, Nardi AE, Valenca AM, Lopes FL, Mezzasalma MA, Nascentes R, Zin WA (2002) Psychiatric disorders in asthmatic outpatients. Psychiatry Res 110(1):73–80PubMedCrossRefGoogle Scholar
  46. 46.
    DeVito AJ (1990) Dyspnea during hospitalizations for acute phase of illness as recalled by patients with chronic obstructive pulmonary disease. Heart Lung 19(2):186–191PubMedGoogle Scholar
  47. 47.
    Gurney-Smith B, Cooper MJ, Wallace LM (2002) Anxiety and panic in chronic obstructive pulmonary disease: the role of catastrophic thoughts. Cognit Ther Res 26(1):143–155. doi:10.1023/a:1013854023665 CrossRefGoogle Scholar
  48. 48.
    Sandberg S, Jarvenpaa S, Penttinen A, Paton JY, McCann DC (2004) Asthma exacerbations in children immediately following stressful life events: a Cox’s hierarchical regression. Thorax 59(12):1046–1051. doi:10.1136/thx.2004.024604 PubMedCrossRefGoogle Scholar
  49. 49.
    Miller BD, Wood BL (1997) Influence of specific emotional states on autonomic reactivity and pulmonary function in asthmatic children. J Am Acad Child Adolesc Psychiatry 36(5):669–677. doi:10.1097/00004583-199705000-00018 PubMedCrossRefGoogle Scholar
  50. 50.
    McCauley E, Katon W, Russo J, Richardson L, Lozano P (2007) Impact of anxiety and depression on functional impairment in adolescents with asthma. Gen Hosp Psychiatry 29(3):214–222. doi:10.1016/j.genhosppsych.2007.02.003 PubMedCrossRefGoogle Scholar
  51. 51.
    Nogueira KT, Silva JR, Lopes CS (2009) Quality of life of asthmatic adolescents: assessment of asthma severity, comorbidity, and life style. J Pediatr (Rio J) 85(6):523–530. doi:10.2223/JPED.1957 Google Scholar
  52. 52.
    Feldman JM, Siddique MI, Morales E, Kaminski B, Lu SE, Lehrer PM (2005) Psychiatric disorders and asthma outcomes among high-risk inner-city patients. Psychosom Med 67(6):989–996. doi:10.1097/01.psy.0000188556.97979.13 PubMedCrossRefGoogle Scholar
  53. 53.
    Stein MB, Cox BJ, Afifi TO, Belik SL, Sareen J (2006) Does co-morbid depressive illness magnify the impact of chronic physical illness? A population-based perspective. Psychol Med 36(5):587–596. doi:10.1017/s0033291706007239 PubMedCrossRefGoogle Scholar
  54. 54.
    Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ (1996) Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol 49(12):1407–1417PubMedCrossRefGoogle Scholar
  55. 55.
    Haapanen N, Miilunpalo S, Pasanen M, Oja P, Vuori I (1997) Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. Am J Epidemiol 145(8):762–769PubMedCrossRefGoogle Scholar
  56. 56.
    ten Brinke A, Ouwerkerk ME, Bel EH, Spinhoven P (2001) Similar psychological characteristics in mild and severe asthma. J Psychosom Res 50(1):7–10PubMedCrossRefGoogle Scholar
  57. 57.
    Lavoie KL, Bacon SL, Barone S, Cartier A, Ditto B, Labrecque M (2006) What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both? Chest 130(4):1039–1047. doi:10.1378/chest.130.4.1039 PubMedCrossRefGoogle Scholar
  58. 58.
    Valenca AM, Falcao R, Freire RC, Nascimento I, Nascentes R, Zin WA, Nardi AE (2006) The relationship between the severity of asthma and comorbidities with anxiety and depressive disorders. Rev Bras Psiquiatr 28(3):206–208PubMedCrossRefGoogle Scholar
  59. 59.
    Van De Ven MO, Engels RC (2011) Quality of life of adolescents with asthma: the role of personality, coping strategies, and symptom reporting. J Psychosom Res 71(3):166–173. doi:10.1016/j.jpsychores.2011.03.002 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Yanxia Lu
    • 1
    • 2
  • Liang Feng
    • 1
    • 2
  • Leslie Lim
    • 3
  • Tze Pin Ng
    • 1
    • 2
  1. 1.Gerontological Research Programme, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  2. 2.Department of Psychological MedicineNational University HospitalSingaporeSingapore
  3. 3.Department of PsychiatrySingapore General HospitalSingaporeSingapore

Personalised recommendations