Journal of Clinical Psychology in Medical Settings

, Volume 8, Issue 4, pp 245–252

Psychiatric Comorbidity and Functional Status in Adult Patients with Asthma

  • Niloofar Afari
  • Karen B. Schmaling
  • Scott Barnhart
  • Dedra Buchwald
Article
  • 123 Downloads

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.

asthma psychiatric depression anxiety health functioning SF-36 

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REFERENCES

  1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised).Washington DC: Author.Google Scholar
  2. American Thoracic Society. (1993). Guidelines for the evaluation of impairment/disability in patients with asthma. American Review of Respiratory Disease, 147, 1056–1061.Google Scholar
  3. 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.Google Scholar
  4. 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.Google Scholar
  5. 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.Google Scholar
  6. Cassem, E. H. (1990). Depression and anxiety secondary to medical illness. Psychiatric Clinics of North America, 13, 597–612.Google Scholar
  7. Centers for Disease Control and Prevention. (1997). Asthma surveillance programs in public health departments—United States. Morbidity and Mortality Weekly Reports, 45, 802–804.Google Scholar
  8. 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.Google Scholar
  9. 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.Google Scholar
  10. 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.Google Scholar
  11. 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.Google Scholar
  12. 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.Google Scholar
  13. 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.Google Scholar
  14. 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.Google Scholar
  15. 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.Google Scholar
  16. 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.Google Scholar
  17. 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.Google Scholar
  18. 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.Google Scholar
  19. Perna, G., Bertani, A., Politi, E., Colombo, G., & Bellodi, L. (1997). Asthma and panic attacks. Biological Psychiatry, 42, 625–630.Google Scholar
  20. Priel, B., Heimer, D., Rabinowitz, B., & Hendler, N. (1994). Perceptions of asthma severity: The role of negative affectivity. Journal of Asthma, 31, 479–484.Google Scholar
  21. 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.Google Scholar
  22. 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.Google Scholar
  23. 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.Google Scholar
  24. Schmaling, K. B. & Bell, J. (1997). Asthma and panic disorder. Archives of Family Medicine, 6, 20–23.Google Scholar
  25. 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.Google Scholar
  26. 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.Google Scholar
  27. 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.Google Scholar
  28. Sly, R. M. (1988). Mortality from asthma, 1979–1984. Journal of Allergy and Clinical Immunology, 82, 705–717.Google Scholar
  29. SPSS Inc. (1997). SPSS for windows release 9.0. Chicago, IL: SPSS, Inc.Google Scholar
  30. 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.Google Scholar
  31. 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.Google Scholar
  32. 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.Google Scholar
  33. 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.Google Scholar
  34. 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.Google Scholar
  35. 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.Google Scholar
  36. Wampole, R. E. (1974). Introduction to statistics. New York: MacMillan Publishing Co.Google Scholar
  37. Ware, J. E. (1993). SF–36 health survey. Manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Center.Google Scholar
  38. Weissman, M. M. (1987). Advances in psychiatric epidemiology: Rates and risks for major depression. American Journal of Public Health, 77, 445–451.Google Scholar
  39. 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.Google Scholar
  40. 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.Google Scholar
  41. 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.Google Scholar
  42. 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.Google Scholar
  43. 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.Google Scholar

Copyright information

© Plenum Publishing Corporation 2001

Authors and Affiliations

  • Niloofar Afari
    • 1
  • Karen B. Schmaling
    • 1
  • Scott Barnhart
    • 2
  • Dedra Buchwald
    • 2
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattle, Washington
  2. 2.Department of MedicineUniversity of WashingtonSeattle, Washington

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