Objectives Psychological comorbidities have been associated with asthma in adults and children, but have not been studied in a population of children with severe asthma. The aim of this study was to test the hypothesis that symptoms of anxiety or depression are highly prevalent in pediatric severe asthma and negatively effects asthma control. Methods Longitudinal assessments of anxiety or depression symptoms (Patient Health Questionnaire‐4 [PHQ‐4]), asthma control (Asthma Control Test [ACT]), and lung function were performed in a single‐center pediatric severe asthma clinic. Participant data were collected during routine clinical care. Primary outcomes were ACT and forced expiratory volume in 1 s per forced vital capacity (FEV1/FVC). Results Among 43 subjects (with total 93 observations), 58.1% reported at least one anxious or depressive symptom and 18.6% had a PHQ‐4 more than 2, the threshold for an abnormal test result. After adjusting for age, sex, race, and asthma medication step, there was a significant reduction in ACT for girls with PHQ‐4 more than 2 (adjusted mean [SE] ACT for PHQ‐4 > 2: 13.64 [0.59], ACT for PHQ‐4 ≤ 2: 20.64 [1.25], p = .02) but not boys. Moreover, there was a significant differential effect of mental health impairment for girls than boys. ACT for girls with PHQ more than 2: 13.64 (0.59) compared with boys with PHQ‐4 more than 2: 17.82 (0.95), adjusted mean difference ACT by sex = 4.18 points; 95% confidence interval, 0.63–7.73; p = .033. In adjusted models, there was no association between PHQ‐4 more than 2 and FEV1/FVC. Conclusions Symptoms of anxiety and depression are common. In children with severe asthma, a PHQ‐4 score more than 2 is associated with worse asthma symptom control in girls, but not boys.

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