Associated factors for depression, suicidal ideation and suicide attempt among asthmatic adolescents with experience of electronic cigarette use

Abstract

INTRODUCTION While electronic cigarette (EC) use is rapidly increasing among asthmatic adolescents, little is known about the links between EC use and depression or suicidality. We assessed associated factors for depression and suicidality in asthmatic adolescents with experience of EC use. METHODS We analyzed the data from the 11th to 13th Korea Youth Risk Behavior Web-based Surveys, which were completed from 2015 to 2017. Data were obtained from a stratified, multistage, clustered sample. Students supplied ‘yes or no’ answers to questions about previous asthma diagnosis by a doctor. Associated factors for depression and suicidality were evaluated by logistic regression models after controlling for potential confounding factors. We targeted 203336 adolescents, and 195847 completed the survey. RESULTS The proportion of asthma among the respondents was 8.9%. The rate of experience of EC use was higher among asthmatic respondents than non-asthmatic respondents (10.3% vs 8.6%). Asthmatic respondents with experience of EC use had a much higher proportion of negative mental health states including depression and suicidality than subjects without EC experience. In our adjusted models, perception of stress was most strongly associated with depression (adjusted odds ratio, AOR=4.79; 95% CI: 4.12–5.58), and perception of unhappiness was most strongly associated with suicidal ideation (AOR=5.24; 95% CI: 4.51–6.09) and suicide attempt (AOR=4.37; 95% CI: 3.36–5.69). CONCLUSIONS Many Korean asthmatic adolescents with experience of EC use report relatively high depression and suicidal behaviors. A multidisciplinary approach, including psychological help, may be required to prevent suicide among this population, especially those who report associated factors.

Electronic Cigarettes and Asthma: What Do We Know So Far?

“…Moreover, EC use was associated with lower general health scores, higher breathing difficulty scores and a greater proportion of reporting asthma [ 95 ]. A large epidemiological study in USA with a weighted sample size of 31,721,603 adults between 18 and 24 years (2,503,503 with former and 3,200,681 with current asthma) found that the prevalence of EC use was significantly higher among young adults with current or former asthma and that asthma combined with EC use was significantly associated with worse mental health [ 96 ], a finding similar to that of another study from Korea [ 72 ].…”

“…Several investigators have concluded that EC could be associated with the development of pulmonary disorders, including asthma and might increase asthma severity and exacerbations [ 18 , 31 , 61 , 62 , 63 , 64 ]. Numerous cross-sectional studies with a large number of participants have described the significant association between EC use and even secondhand exposure and asthma diagnosis and severity [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ], compared to the few studies which found no association [ 75 , 76 ], or even negative association between EC use and asthma [ 77 , 78 ]. A prospective cohort study also found that EC use was associated with an increased risk of developing respiratory disease, including asthma, independent of cigarette smoking [ 79 ].…”

Lived Experiences of Adolescents with Asthma: Struggle to Maintain Daily Life

“…Illness uncertainty may be an important factor that influences psychological functioning and distress and coping in the context of pediatric chronic illness [33]. Adolescents reported predominantly negative feelings associated with their symptoms such as afraid, challenging, difficulty, frustration, panic, scared, sad, upset, and like crap [34]; frustration, being left out, anger, worry, concern, discomfort, and fear from asthma attacks [15]; arguing, bullying and sad feeling had lower flourishing [42]; and depression and suicidality [35]. These conditions must be managed wisely in order to keep a strong mind for treating the disease and their symptoms [36].…”