Impact of depressive symptoms on adult asthma outcomes.

BACKGROUND: Psychological disorders, including depression, are common in adults with asthma. Although depression is treatable, its impact on longitudinal asthma outcomes is not clear. OBJECTIVE: To elucidate the impact of depressive symptoms on patient-centered outcomes and emergency health care use in adults with asthma. METHODS: We conducted a prospective cohort study of 743 adults with asthma who were recruited after hospitalization for asthma. Depressive symptoms were defined as having a score of 16 or more on the Center for Epidemiologic Studies Depression Scale. We examined the impact of depressive symptoms on patient-centered outcomes (validated severity-of-asthma score, Marks Asthma Quality of Life Questionnaire, and 12-Item Short-Form Health Survey physical component summary score) and on future emergency health care use for asthma ascertained from computerized databases. RESULTS: The prevalence of depressive symptoms was 18% (95% confidence interval [CI], 15%-21%) among adults with asthma. Depressive symptoms were associated with greater severity-of-asthma scores after controlling for age, sex, race/ ethnicity, educational attainment, and cigarette smoking (mean score increment, 2.6 points; 95% CI, 1.8-3.4 points). Furthermore, depressive symptoms were associated with poorer asthma-specific quality of life (mean score increment, 19.9 points; 95% CI, 17.7-22.1 points) and poorer physical health status (mean score decrement, 3.7 points; 95% CI, 1.5-5.8 points). Depressive symptoms were associated with a greater longitudinal risk of hospitalization for asthma (hazard ratio, 1.34; 95% CI, 0.98-1.84). After controlling for differences in preventive care for asthma, the relationship was stronger (hazard ratio, 1.45; 95% CI, 1.05-2.0). CONCLUSION: Depressive symptoms are common in adults with asthma and are associated with poorer health outcomes, including greater asthma severity and risk of hospitalization for asthma.     

Emotional and functional impact of DNA testing on patients with symptoms of Huntington''s disease.

The potential impact of DNA testing on asymptomatic subjects at risk for Huntington's disease (HD) has been addressed by numerous studies, but the effect of revealing the genetic results to patients with a clinically established diagnosis of HD has not been previously evaluated. We studied 36 patients, with equal distribution of men and women, mean age 53.9 (SD 12.3) years (range 25-76) and mean duration of symptoms of 11.2 (SD 7.7) years (range 2-33), whose clinical diagnosis of HD was confirmed by expanded CAG repeats (> 40). Coping strategies and depression levels were assessed before the results of DNA testing were imparted. The assessments were repeated two weeks and three months after the results were explained to the patients and their relatives and were compared to the baseline assessments. This group of HD patients was compared with 10 patients who had similar symptoms but the diagnosis of HD was excluded by normal CAG repeats (< 30). Although some patients with HD expressed a subjective reaction to the positive result (four were "surprised", one was "frustrated", and one "devastated"), there were no differences in any psychological scores including Beck Depression Inventory, functional capacity, symptom interference, independence scale, and other measures of mood and behaviour two weeks and three months later. Similarly, no change was noted in any of these measures in the non-HD group. These results suggest that mood and coping strategies are unaffected by DNA confirmation of diagnosis in symptomatic patients with HD.     

Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma

BACKGROUND: Environmental tobacco smoke (ETS) is a frequent exposure and is linked to asthma among inner-city children. OBJECTIVE: We sought to examine the relationship among ETS exposure, select asthma symptoms, and consequences among inner-city children with asthma. METHODS: Data from interviews with primary caregivers of inner-city elementary school children with asthma were evaluated (n = 590). Caregiver reports of child asthma symptoms, exercise limitations, asthma management, health care use, and ETS exposure were examined. RESULTS: Smoking in the home was reported by 29.4% of primary caregivers. ETS exposure (yes/no) was not related to frequency of child nocturnal symptoms or other select asthma morbidity markers. However, among children exposed to ETS, the frequency and severity of child nocturnal symptoms were highest among children exposed to moderate-to-heavy levels of ETS. After controlling for child age, anti-inflammatory medication use, asthma primary care, and caregiver's education, exposure to higher levels of ETS was associated with nearly a 3-fold increase in nocturnal symptoms in children (odds ratio, 2.83; 95% CI, 1.22-6.55). CONCLUSION: Among elementary school inner-city children with asthma, exposure to higher levels of ETS was associated with increased frequency of nocturnal symptoms. Reducing the exposure of children with asthma to ETS should be a clear priority in developing effective asthma management plans for inner-city families.     

Pituitary-adrenal function in adolescent psychiatric patients: impact of depressive symptoms

BACKGROUND: The aim of this study was to determine whether depressive symptoms affect pituitary-adrenal function in adolescents, as they do in adults. METHODS: Salivary cortisol was measured before and after physical exercise in 23 hospitalized adolescent psychiatric patients and 13 age- and sex-matched healthy controls in a placebo-controlled design. In patients, cortisol profiles were assessed from 08:00 to 20:00 h before and after administration of low doses of dexamethasone or the natural steroid hydrocortisone. Patients were classified according to DSM III-R criteria and assigned to either a depressed group (n=10) or a non-depressed group (n=13). Subjective depressive symptoms were rated with the 90-item symptom checklist. RESULTS: Physical exercise increased cortisol output significantly in all subjects, but there were no differences between groups. In patients, no differences in basal cortisol levels were found between the depressed and non-depressed groups. Dexamethasone, but not hydrocortisone, was able to suppress cortisol levels in both groups. Differences between groups were only found in total cortisol output over the 3 days when data were analyzed according to the patients 'subjective' feelings of depression, with the highest cortisol levels in the 'subjectively more depressed' patients. CONCLUSIONS: The results obtained only partially support the hypothesis that depressive symptoms in adolescent psychiatric patients determine pituitary-adrenal (mal)function, and appear to depend on the strategy used.     

The impact of marital status and employment status on depressive affect for hispanic Americans

Considerable evidence has accumulated in recent years showing that different family structures and supports have an impact on the emotional well-being of individual members of the family. Most of the research has focused on marital status as a key variable. Using the Hispanic Health and Nutrition Examination Survey (HHANES) we examined the combined effects of marital status and employment status on levels of depressive affect for Puerto Rican, Mexican-American, and Cuban-American adults in the United States. The results reveal an interaction between culture, marital status, and employment for all three groups. In general, married, employed males and females have the lowest overall depressive affect scores whereas unmarried, unemployed individuals have the highest scores.     

Hyperventilation in patients with recurrent functional symptoms.

In view of the similarity between the reported effects of hyperventilation and recurrent functional symptom presented in primary care, a study was undertaken to establish whether such symptoms are attributable to hyperventilation. Twenty patients with two or more recurrent functional symptoms which their doctors found difficult to diagnose or treat, and 30 controls, were studied using symptom questionnaires and a series of hyperventilation provocation tests during which the partial pressure of carbon dioxide (PCO2) and symptoms were recorded. Sixteen cases (80%) had unexplained breathlessness compared with two of the controls (7%). All of the cases recognized familiar functional symptoms during provoked hyperventilation, and in 16 (80%), these included primary physical symptoms; only 23% of the controls recognized any previously experienced symptom. Considerable overlap of PCO2 values between groups meant that absolute values of PCO2 were not useful in differentiating between groups, but cases were more likely than controls to have a PCO2 of less than 4 kPa at rest, three minutes after hyperventilation, or during mental stress (75% of cases fulfilled one or more of these criteria versus 40% of controls). This is the first study in primary care to examine the effect of hyperventilation in a group of patients with multiple somatic symptoms. The findings have implications for the recognition and management of such patients.     

Characteristics of inner-city children with life-threatening asthma

Background

Intensive care unit (ICU) admission is a risk factor for fatal asthma. Little is known about risk factors for pediatric ICU admissions for asthma.

The impact of depressive symptoms and psychosocial factors on medication adherence in cardiovascular disease

OBJECTIVE: This study sought to determine the influence of depression and psychosocial factors on medication adherence in cardiovascular disease. METHODS: A questionnaire including measures of depression, beliefs about medicines, health locus of control and adherence to medication (self-report) was completed by 122 outpatients attending a cardiac clinic. RESULTS: Analysis revealed that 14.8% of participants were non-adherent with their cardiovascular medication and 41.7% had scores indicative of depressive symptoms as determined by the Center for Epidemiological Studies Depression Scale (CES-D). Higher scores on this scale and strong concern scores on the Beliefs about Medicines Questionnaire about the potential adverse effects of using medication as prescribed were found to be associated with self-reported non-adherence. DISCUSSION AND CONCLUSION: These findings imply that the relationship between depressive symptoms in cardiovascular patients, together with certain psychosocial factors, could have negative consequences for adherence to medication. PRACTICE IMPLICATIONS: Given that there is emerging evidence to suggest an association between depression and medication non-adherence, healthcare professionals should consider this when dealing with cardiovascular patients.     

Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic.

BACKGROUND: Depressive symptoms are associated with noncompliance and even sudden death in asthma patients. Some studies suggest that low-income, minority, inner-city asthma patients may be at high risk for asthma-related morbidity and mortality in which depression may be a risk factor. Minimal data are available on the prevalence of depression and other mood disorders in asthma patients. OBJECTIVE: In this pilot study, we examined the prevalence of depression and the association between depression and measures of asthma severity in patients at an inner-city asthma clinic. METHODS: Mood disorders were diagnosed using a diagnostic interview given to patients (N = 44) at asthma clinic visits. Inhaled steroid dose, FEV1 percentage, and asthma severity were also obtained. RESULTS: Eighteen patients (41%) had a lifetime mood disorder but only seven of these patients received pharmacotherapy. Patients with a past mood disorder had significantly higher FEV1 percentage predicted values (P = 0.03) than those without a mood disorder. Trends toward less severe asthma (P = 0.13) and lower inhaled steroid dose (P = 0.13) in patients with a mood disorder history were also found. CONCLUSIONS: The data suggest that mood disorders are common, but often unrecognized and untreated in asthma patients. The data also suggest that mood disorders are not necessarily associated with more severe asthma, at least in the population studied.     

GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms.

BACKGROUND: Frequent attendance in general practice increases workload and affects doctor-patient relationships. It is a complex phenomenon, but patients' psychological problems appear to be important. AIM: To assess whether frequent attendance is more likely to be associated with depressive symptoms than with physical health problems. METHOD: The study was carried out in two general practices: one in Liverpool and one in Granada. Subjects comprised 127 frequent attenders (FAs) plus 175 matched controls, stratified by age and sex. Measures included demographic factors, Beck Depression Inventory (BDI), self-reported health, and current health problems classified by ICHPPC-2 criteria. RESULTS: Seventy-five (59%) FAs had a BDI score > or = 13, compared with 9 (5%) controls (odds ratio [OR] = 26.6, 95% confidence interval [CI] = 12.4 to 56.8, P < 0.001). A total of 136 (78%) controls reported their health to be good or excellent, compared with 40 (31%) FAs (OR = 7.6, 95% CI = 4.5 to 12.7, P < 0.001). Respiratory problems were present in 50 (39%) FAs and 47 (27%) controls (chi 2 = 6.992, P < 0.03). Depression rates were similar in Liverpool and Granada, although Liverpool subjects were less likely to report good health. On logistic regression, BDI status was the major predictor of frequent attendance (OR = 17.18, 95% CI = 7.54 to 39.01). Self-reported ill health (OR = 2.67, 95% CI = 1.40 to 5.10) and respiratory problems (OR = 2.20, 95% CI = 1.11 to 4.37) were also associated with frequent attendance. CONCLUSION: Depressive symptoms were the major predictor of frequent attendance in this study. Clinical and research activity should therefore concentrate on the identification and management of psychological problems among FAs in general practice.     

The evaluation of gastroesophageal reflux symptoms in patients with bronchial asthma

Lower esophageal sphincter pressure (LESP) and extended pH monitoring of the distal esophagus were assessed in 15 asthmatic children in order to evaluate the most important symptoms of suspected gastroesophageal reflux (GER)-asthma. As a result, episodes of asthmatic attacks after overeating were closely correlated with GER as determined by decreased LESP and high pH score.