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Patient-Reported and Physician-Reported Depressive Conditions in Relation to Asthma Severity and Control^*

^* From the Hospital for Special Surgery (Dr. Mancuso) and Weill Cornell Medical College (Drs. Wenderoth, Ms. Westermann, Ms. Choi, Dr. Briggs, and Dr. Charlson), New York, NY.

Correspondence to: Carol A. Mancuso, MD, Hospital for Special Surgery, 535 East Seventieth St, New York, NY 10021; e-mail: mancusoc{at}hss.edu

Abstract

Background: Depressive conditions in asthma patients have been described mostly from patient reports and less often from physician reports. While patient reports can encompass multiple symptoms, physician assessments can attribute symptoms to a mental health etiology. Our objectives were to identify associations between patient- and physician-reported depressive conditions and asthma severity and control.

Methods: Patient-reported depressive symptoms were obtained using the Geriatric Depression Scale (GDS) [possible score 0 to 30; higher score indicates more depressive symptoms]. Patients were categorized as having a physician-reported depressive disorder if they had the following: a diagnosis of depression, depressive symptoms described in medical charts, or were prescribed antidepressants at doses used to treat depression. Patients also completed the Severity of Asthma Scale (SOA) [possible score 0 to 28; higher score indicates more severe] and the Asthma Control Questionnaire (ACQ) [possible score 0 to 6; higher score indicates worse control].

Results: Two hundred fifty-seven patients were included in this analysis (mean age, 42 years; 75% women). Mean SOA and ACQ (± SD) scores were 5.9 ± 4.2 and 1.4 ± 1.2, respectively; and mean GDS score was 6.3 ± 6.4. After adjusting for age, sex, race, Latino ethnicity, education, medication adherence, body mass index, and smoking status, patient-reported depressive symptoms were associated with asthma severity (p = 0.007) and with asthma control (p = 0.0007). In contrast, physician-reported depressive disorders were associated with asthma severity (p = 0.04) but not with asthma control (p = 0.22) after adjusting for covariates.

Conclusions: Physician- and patient-reported depressive conditions were associated with asthma severity. In contrast, patient-reported depressive symptoms were more closely associated with asthma control than were physician-reported depressive disorders. Identifying associations between depressive conditions and asthma severity and control is necessary to concurrently treat these conditions in this population.

Trial registration: Clinicaltrials.gov Identifier: NCT00195117 [ClinicalTrials.gov] .

Key Words: asthma control • asthma severity • depression • depressive symptoms • dysthymia