Asthma and DepressionA study of 18 to 45 year old asthma patients?

Marre Andrée Wiltens

10 February 2011

• Netherlands– Maastricht University

• Background• Thesis• Hypothesis• Relevance• Survey• Data collection

– Caroline Theunissen– Marre Andrée Wiltens

• Analysis• Answers• Discussion• Literature• Questions?

Content

• Geography– 16,033 sq mi– 12 provinces– Lowest point: -23 ft– Highest point: 2877 ft

• General information– Capital: Amsterdam– Democracy– Queen Beatrix– Inhabitants:16,661,047

The Netherlands

The Netherlands

• Medical Faculty– Curriculum

• 6 year• Bachelor-Master

– Educational system• Problem Based Learning

– Students• +/- 320 per year

• Final year:– Research (WESP)– Clinical (GEZP)

• Depression– Major health problem• Lifetime risk of depression is 17%1 in the general

population

– Association with increased prevalence of:• Chronic diseases• Unhealthy lifestyle

– Precipitates and exacerbates chronic conditions

Background

1 Kessler et al. (2005), Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Co-morbidity Survey Replication.

• Depression– Rate of depression is four times higher1 in cancer patients.– Patients with:

• Cardiovascular diseases• Diabetes • Obesity• Asthma

are more likely to have:• Current depression• A lifetime diagnosis of depression• A lifetime diagnosis of anxiety

Background

1 Pril (2004) Evidence report on the occurrence, assesment and treatment of depression in cancer patients.

• Asthma– Common chronic inflammatory disease of the airway

• In 2008 7%1 of the adults

– Characterised by:• Breathlessness• Chest tightmess• Wheezing• Coughing

– Psychosomatic disease• Association between asthma and psychological factors

Background

1 U.S. department of health and human services (2009), Summary Health Statistics for U.S. Adults: National Health Interview Survey 2008.

• Asthma and depression 1– Asthma patients are more

likely to have:• Current depression

– Psychological factors such as depression influence:• Onset of asthma• Course of asthma

– 18-25 year old asthma patients more likely to develop depression then 50 to 65 years

• Asthma and depression 2– Patients with regular

complaints are more likely to develop psychiatric disorders such as:• Depression• Sleeplessness• Anxiety

– Severity of asthma is an index for the severity of the psychiatric complaints.

Background

• Asthma and depression 3– Considerable literature about treatment of

depression in asthma patients– Asthma patients that suffer a depression have:

• Higher medical utilization costs• Shorter life expactancy

– Depression is related to • More severe asthma• Poor asthma control• Non-compliance of medication• Higher frequencies of doctor’s visits

Background

• Relationship between Asthma, depression and the specefic factors:– Asthma coping strategies– Asthma knowledgeis scarce

Relevance

Research:• Better understanding• More awareness

Better:• Screening possibilities• Treatment options

Relevance

Depression

Poor coping

Less asthma knowledge

Lower self rated health

status

Study questions:

1. What is the correlation between asthma severity and being depressed?

2. What is the correlation between the level of knowledge about asthma and being depressed?

3. What is the correlation between asthma coping skills and being depressed?

Thesis

• The severity of asthma will contribute to the risk of being depressed.

• Patients with a higher level of knowledge about asthma will be less likely to be depressed.

• Individuals with better asthma coping skills will be less likely to be depressed.

Hypothesis

• Survey components– 7 instruments:

• 3 validated – KASE-AQ (knowledge)– DURHAM (depression)– ASCS (coping)

• 4 non-validated– Asthma severity– General

understanding/motivation– Lifestyle– Socio-demographic

information

Survey

Eligibility• Inclusion criteria:

– 18 to 45 years old– Asthma diagnosis– Understanding of and able to

read the English language

• Exclusion criteria:– Prior participation in this

research project

Difficulties• Validation• Lengthy

• KASE-AQ (knowledge):– Difficult language– Outdated questions– 2 questions excluded

Survey

Caroline Theunissen• 3 clinics

– Rockford– Freeport– DeKalb

• Enlisted 80 patients

Marre Andrée Wiltens• 2 clinics:

– Rockford– Freeport

• Enrolled 25 patients

Data Collection

• There is a correlation between depression and– Asthma severity– Asthma coping skills

• There is no correlation between depression and– Asthma knowledge

• However, the mean score of the DURHAM is significant higher in patients with low knowledge

Answers

• Next steps:

Discussion

1. Kessler, R.C., Berglund, P., Demler, O., Jin, R, Merikangas, K.R., Walters, E.E.; Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication; Arch Gen Psychiatry 2005; 62(7):593-602.

2. Donohue, J.M., Pincus, H.A.; Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment; Pharmacoeconomics 2007; 25(1):7-24.

3. Fan, A.Z., Strine, T.W., Huang, Y., Murray, M.R., Musingo,S. Jiles,R., Mokdad, A.H.; Self-rated Depression and Physician-Diagnosed Depression and Anxiety in Florida Adults: Behavioral Risk Factor Surveillance System, 2006; Prev Chron Dis 2009; 6(1):1-14.

4. Pril, W.; Evidence report on the occurrence, assessment and treatment of depression in cancer patients; J Natl Cancer Inst Monogr 2004; 2004(32):32-39.

5. Snyderman, D., Wynn, D.; Depression in Cancer Patients; Prim Care Clin Office Pract 2009; 36(4):703-719.

6. Strine, T.W., Mokdad, A.H., Balluz, L.S., Gonzalez, O., Crider, R., Berry, J.T., Kroenke, K.; Depression and Anxiety in the United States: Findings From the 2006 Behavioral Risk Factor Surveillance System; 2008; 59(12): 1383-1390.

7. Corbridge, S., Corbridge, T.C.; Asthma in Adolescents and Adults; AJN 2010; 110(5):28-38.

8. U.S. Department of health and human services; Summary Health Statistics dor U.S. Adults: National Health Interview Survey 2008; Hyatsville: Centers for disease Control and

Prevention 2009.9. Dunbar, F.; Mind and body: psychosomatic medicine; New

York, Random House; 1947.10. Opolski, M., Wilson, I.; Asthma and depression: a pragmatic

review of the literature and reccomendations for future research; Clin Pract Epidemiol Ment Health 2005; 1:18-24.

11. Strine, T.W., Mokdad, A.H., Balluz, L.S., Berry, J.T., Gonzales, O.; Impact of Depression and anxiety on quality of life, health behaviors and asthma control among adults in the United States with asthma, 2006; J Asthma 2008; 45(2):123-133.

12. Katon, W., Lozano, P., Russo, J., McCauley, E., Ridchardson, L., Bush, T.; The prevalence of DSM-IV anxiety and depressive disorders in Youth with Asthma to controls; J Adolesc Health 2007; 41(5):455-463.

13. Aalto, A-M., Härkäpää, K., Aro, A.R., Rissanen, P.; Ways of coping with asthma in everyday life Validation of the Asthma Specific Coping Scale; J Psychosom Res 2002; 53(6):1061-1069.

14. Wigal, J.K., Stout, C., Brandon, M., Winder, J.A., McCounnaughy, K., Creer, T.L., Kotses, H.; Knowledge, Attitude and Self-Efficacy Asthma Questionnaire for asthma knowledge; Chest 1993; 104(4):1144-1148.

15. Doetch, T.M., Alger, B.H., Glasser, M., Levenstein, J.; Detecting Depression In Elderly outpatients: Findings From Depression Sympotom Scales and the Darthmouth COOP Charts; Fam Med 1994; 26(8):519-523.

Literature

Questions