The Relationship of Illness Uncertainty, Illness Intrusiveness, and Asthma Severity to Depression in Young Adults with Long-Standing Asthma

  • Larry L. Mullins
  • John M. Chaney
  • Benjamin Balderson
  • Kevin A. Hommel


This study examined the potential mediating/moderating influence of both illness intrusiveness and asthma severity on the association between illness uncertainty and depression in a college sample of older adolescents and young adults (N = 40) with histories of childhood asthma. There was a significant association between increased illness uncertainty and increased levels of depression. However, analyses indicated that neither illness intrusiveness nor asthma severity served as mediators in the uncertainty–depression relationship. Examination of moderator effects of intrusiveness and severity on the uncertainty–depression relationship revealed an interaction for severity only; thus, the significant effect of uncertainty on depression was at its maximim under conditions of increased illness severity. Results suggest that cognitive appraisal mechanisms involving decreasing ambiguity about illness may be worthwhile targets for intervention.

Asthma illness uncertainty illness intrusiveness depression 


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  1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., Washington, DC: American Psychiatric Association.Google Scholar
  2. Baron, R., and Kenny, D. (1986). The moderator-mediator distinction in social psychological research: Conceptual, strategic, and statistical considerations. J. Pers. Soc. Psychol. 51: 1173-1182.Google Scholar
  3. Bennett, D. (1994). Depression among children with chronic medical problems: A meta-analysis. J. Pediatr. Psychol. 19: 149-169.Google Scholar
  4. Centers for Disease Control. (1992). Asthma-United States, 1980-1990. Mortality and Morbidity Weekly Review, 41(39): 733-735.Google Scholar
  5. Centers for Disease Control. (1998). Surveillance for Asthma-United States, 1960-1995. Mortality and Morbidity Weekly Review 47: 1-28.Google Scholar
  6. Chaney, J., Mullins, L., Uretsky, D., Pace, T., Werden, D., and Hartman, V. (1999). An experimental examination of learned helplessness in older adolescents and young adults with long-standing asthma. J. Pediatr. Psychol. 24(3): 259-270.Google Scholar
  7. Cohen, J., and Cohen, P. (1983). Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences, 2nd edn., Erlbaum, Hillsdale, NJ.Google Scholar
  8. Creer, T. (1994). Asthma: Psychological issues. In Olson, R., Mullins, L., Gillman, J., and Chaney, J. (eds.), The Sourcebook of Pediatric Psychology Allyn & Bacon, Needham Heights, MA, pp. 61-69.Google Scholar
  9. Creer, T., and Bender, B. (1993). Asthma. In Gatchel, R., and Blanchard, E. (eds.), Psychophysiological Disorders: Research and Clinical Applications American Psychological Association, Washington, DC, pp. 151-203.Google Scholar
  10. Cronbach, L. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16: 297-334.Google Scholar
  11. Devins, G. M. (1991). Illness intrusiveness and the psychosocial impact of end-stage renal disease. In Hardy, M. A., Kierman, J., Kutscher, A. H., Cahill, L., and Bevenitsky, A. I. (eds.), Psychosocial Aspects of End-Stage Renal Disease: Issues of Our Times, Haworth Press, New York, pp. 83-102.Google Scholar
  12. Devins, G. M., Beanlands, H., Mandin, H., and Paul, L. C. (1997). Psychosocial impact of illness intrusiveness moderated by self-concept and age in end-stage renal disease. Health Psychol. 16: 529-538.Google Scholar
  13. Devins, G. M., Binik, Y. M., Hutchinson, T. A., Hollomby, D. J., Barre, P. E., and Guttmann, R. D. (1983). The emotional impact of end-stage renal disease: Importance of patients' perceptions of intrusiveness and control. Int. J. Psychiatry Med. 13: 327-343.Google Scholar
  14. Devins, G. M., Edworthy, S. M., Guthrie, N. G., and Martin, L. (1992). Illness intrusiveness in rheumatoid arthritis: Differential impact on depressive symptoms over the adult life span. J. Rheumatol. 19: 709-715.Google Scholar
  15. Devins, G. M., Edworthy, S. M., Seland, T. P., Klein, G. M., Leendert, C. P., and Mandin, H. (1993). Differences in illness intrusiveness across rheumatoid arthritis, end-stage renal disease, and multiple sclerosis. J. Nerv. Men. Dis. 181: 377-381.Google Scholar
  16. Devins, G. M., Stam, H. J., and Koopmans, J. P. (1994). Psychosocial impact of laryngectomy mediated by perceived stigma and illness intrusiveness. Can. J. Psychiatry 39: 608-616.Google Scholar
  17. Friday G., and Fireman, P. (1988). Morbidity and mortality of asthma. Pediatr. Allergy Dis. 35: 1149-1155.Google Scholar
  18. Gergen, P., and Weiss, K. (1990). Changing patterns of asthma hospitalization among children: 1979 to 1987. JAMA 264: 1688-1692.Google Scholar
  19. Hollingshead, A. (1957). Two Factor Index of Social Position, A. Hollingshead, New Haven, CT.Google Scholar
  20. Ireys, H., Werthamer-Larsson, L., Kolodner, K., and Gross, S. (1994). Mental health of young adults with chronic illness: The mediating effect of perceived impact. J. Pediatr. Psychol. 19: 205-222.Google Scholar
  21. Jolicoeur, L., Boyer, J., Reeder, C., and Turner, J. (1994). Influence of asthma or allergies on the utilization of health care resources and quality of life of college students. J. Asthma 31: 251-267.Google Scholar
  22. Lehrer, P., Isenberg, S., and Hochron, S. (1993). Asthma and emotion: A review. J. Asthma 30: 5-21.Google Scholar
  23. MacLean, W. E., Perrin, J. M., Gortmaker, S., and Pierre, C. B. (1992). Psychological adjustment of children with asthma: Effects of illness severity and recent stressful life events. J. Pediatr. Psychol. 17: 159-171.Google Scholar
  24. Miller, B. (1987). Depression and asthma: A potentially lethal mixture. J. Allergy Clin. Immunol. 80: 481-486.Google Scholar
  25. Miller, B., and Wood, B. (1991). Childhood asthma in interaction with family, school, and peer systems: A developmental model for primary care. J. Asthma 28: 405-414.Google Scholar
  26. Mishel, M. (1984). Perceived uncertainty and stress in illness. Res. Nurs. Health 3: 163-171.Google Scholar
  27. Mishel, M., and Braden, C. (1988). Finding meaning: Antecedents of uncertainty in illness. Nurs. Res. 37: 98-127.Google Scholar
  28. Mishel, M., and Sorenson, D. (1991). Uncertainty in gynecological cancer: A test of the mediating function of mastery and coping. Nurs. Res. 40: 167-171.Google Scholar
  29. Mullins, L., Chaney, J., Hartman, V., Albin, K., Miles, B., and Roberson, S. (1995). Cognitive and affective features of post-polio syndrome: Illness uncertainty, attributional style, and adaptation. Int. J. Rehabil. Health, 1: 211-222.Google Scholar
  30. Mullins, L., Chaney, J., Pace, T., and Hartman, V. (1997). Illness uncertainty, attributional style, and pscyhological adjustment in older adolescents and young adults with asthma. J. Pediatr. Psychol. 22: 871-880.Google Scholar
  31. Peyrot, M. (1996). Causal analysis: Theory and application. J. Pediatr. Psychol. 21: 3-24.Google Scholar
  32. Sorrentino, R. M., Holmes, J. G., Hanna, S. E., and Sharp, A. (1995). Uncertainty orientation and trust in close relationships: Individual differences in cognitive styles. J. Pers. Soc. Psychol. 68: 314-327.Google Scholar
  33. Steele, R. G., Tripp, G., Kotchick, B. A., Summers, P., and Forehand, R. (1997). Family members' uncertainty about parental chronic illness: The relationship of hemophilia and HIV infection to child functioning. J. Pediatr. Psychol. 22: 577-591.Google Scholar
  34. Talbot, F., Nouwen, A., Gingras, J., Belanger, A., and Audet, J. (1999). Relations of diabetes intrusiveness and personal control to symptoms of depression among adults with diabetes. Health Psychol. 19: 537-542.Google Scholar
  35. Weiss, K., Gergen, P., and Hodgson, T. (1992). An economic evaluation of asthma in the United States. N. Engl. J. Med. 326, 862.Google Scholar
  36. Weiss, K., and Wegener, D. (1990). Changing patterns of asthma mortality: Identifying a target population at risk. JAMA 264: 1683-1687.Google Scholar
  37. Weitzman, M., Gortmaker, S., Sobol, A., and Perrin, T. (1992). Recent trends in the prevalence and severity of childhood asthma. JAMA 268: 2673-2677.Google Scholar
  38. Young, G. (1994). Asthma: Medical issues. In Olson, R., Mullins, L., Gillman, J., and Chaney, J. (eds.), The Sourcebook of Pediatric Psychology Allyn & Bacon, Needham Heights, MA, pp. 57-60.Google Scholar
  39. Zimmerman, M., and Coryell, W. (1987). The Inventory to Diagnose Depression: A self-report scale to diagnose major depressive disorder. J. Consult. Clin. Psychol. 55: 55-59.Google Scholar
  40. Zimmerman, M., and Coryell, W. (1994). Screening for major depressive disorder in the community:Acomparison of measures. Psychol. Assess. 6: 71-74.Google Scholar
  41. Zimmerman, M., Coryell, W., Wilson, S., and Corenthal, C. (1986). Evaluation of symptoms of major depressive disorder: Self-report vs. clinician ratings. J. Nerv. Ment. Dis. 174: 150-153.Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Larry L. Mullins
    • 1
  • John M. Chaney
    • 1
  • Benjamin Balderson
    • 1
  • Kevin A. Hommel
    • 1
  1. 1.Department of PsychologyOklahoma State UniversityStillwater

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