The High Prevalence of Depression Among Adolescents With Asthma in Iran

Abstract

A recent study in Psychosomatic Medicine by Smith and colleagues (1) showed the effectiveness of expressive writing on lung function, quality of life, medication use, and symptoms in individuals with asthma. These findings suggest that cognitive and emotional processes might be involved in physiological demands associated with asthma. Therefore, behavioral and pharmacological interventions targeting psychological disorders could result in improved asthma control. Asthma and depression are two major health problems particularly in adolescence, with several impacts such as negative and poor school performance, and impaired social, work, and family functioning (2,3). The prevalence of major depressive disorder is increased significantly across adolescence (3). Regarding the high prevalence of asthma and mood disorders in adolescents in our area (3-6), we evaluated the frequency of depression in adolescents with asthma in comparison to adolescents without asthma in the city of Zanjan, Iran.Our study consisted of 1500 children aged 13 to 14 years who had been randomly selected by multivariate cluster sampling from 20 guidance schools of the city of Zanjan from March to July 2013. After written informed consent was provided by participants and their parents, the children completed the International Study of Asthma and Allergies in Childhood (7) questionnaire modified for face-to-face interview. Asthma was defined as present if the participant reported the presence of a physician-based diagnosis of asthma, or if the International Study of Asthma and Allergies in Childhood revealed a) symptoms of dry cough with a duration of longer than two weeks, b) symptoms also occurring at night; and c) symptoms of wheezing or whistling sounds in the chest that were not attributable to the common cold or other diseases. The severity of asthma was assessed and classified into mild ("as waking up at night less than one night per week and no limitation in activity") and moderate to severe asthma ("as having wheezing attack in the last 12 months, sleep disturbance more than one night per week and limitation in speaking and activity.) The control group consisted of randomly selected classmates who did not suffer from atopy and asthma. The depression status and its severity in students with asthma and controls were measured by using the Beck Depression Inventory.Two hundred twenty-five (15%) students had asthma symptoms, with a prevalence of 13.7% and 16.2% in boys and girls, respectively. One hundred ninety-four (86%) adolescents had mild and 31 (13.7%) had moderate asthma. The frequency of depression among adolescents with asthma and controls was 61.8% and 36%, respectively ( p < .001). Major depression was found in 20% and 7.6% of asthmatic patients and controls ( p < .001). There was a significant correlation between severity of asthma and depression ( p < .001). The odds ratio (OR) for depression associated with asthma was 2.82 (95% confidence interval [CI] = 1.96-4.21), which was higher in girls (OR = 4.55, 95% CI = 2.54-7-44) than i...

Paediatric asthma and non‐allergic comorbidities: A review of current risk and proposed mechanisms

“…A number of studies have shown that among children with asthma, those comorbid for depression and/or anxiety have increased risks of exacerbations, 55,56 poorly controlled asthma 57–61 and increased medical costs including hospital stays 56,62,63 compared to children without comorbidity. There is also some evidence to suggest that these risks are greater in girls than boys, 59,61,62,64 and in adolescents than younger children 62,65 . From a clinical perspective, this means that adolescent girls should be monitored carefully for depression and anxiety comorbidities, especially in regards to their asthma management.…”