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Depressive Symptoms and Adherence to Asthma Therapy After Hospital Discharge^*

^* From the Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore MD.

Correspondence to: Susan J. Bartlett, PhD, Johns Hopkins AAC, 5501 Hopkins Bayview 1B.15, Baltimore, MD 21224; e-mail: bartlett{at}jhmi.edu

Abstract

Study objectives: To evaluate the effect of depressive symptoms on adherence to therapy after discharge in patients hospitalized for asthma exacerbations.

Design: Prospective cohort study in which depressive symptoms were assessed during hospitalization and use of asthma medications was electronically monitored for 2 weeks after discharge.

Setting: Inner-city academic hospital in Baltimore, MD.

Patients: Patients were 59 adults with a mean age of 43.2 ± 10.9 years (± SD), who were mostly female (64%), African American (80%), and were hospitalized for an asthma exacerbation.

Measurement and results: Depressive symptoms were assessed with the Center for Epidemiological Studies-Depression scale. Electronic monitors were used to evaluate inhaled corticosteroid and oral corticosteroid use for up to 2 weeks after discharge. Forty-one percent of patients had high levels of depressive symptoms. Mean adherence to therapy was significantly lower in patients with (vs without) high levels of depressive symptoms (60 ± 26% vs 74 ± 21%, p + 0.02). Even after controlling for age, gender, and education, depressive symptoms were a significant and independent predictor of poorer adherence. High levels of depressive symptoms were associated with a 11.4-fold increase (95% confidence interval, 2.2 to 58.2) in the odds of poor adherence to therapy after adjustment for potential confounders.

Conclusions: Depressive symptoms are common in inner-city adults hospitalized for asthma exacerbations and identify a subset of patients at high risk for poor adherence to asthma therapy after discharge. Further research is needed to determine if screening for and treating depression improves adherence and asthma outcomes in this population.

Key Words: adherence • asthma • depression • inner city

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