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This Article Full Text (PDF) All Versions of this Article: chest.07-2243v1 133/5/1142    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Mancuso, C. A. Articles by Charlson, M. E. PubMed PubMed Citation Articles by Mancuso, C. A. Articles by Charlson, M. E.

Patient-reported and Physician-reported Depressive Conditions in Relation to Asthma Severity and Control

Carol A. Mancuso MD, Hospital for Special Surgery, New York, NY, Weill Cornell Medical College, New York, NY, mancusoc@hss.edu; Suzanne Wenderoth MD, Weill Cornell Medical College, New York, NY, swendero@med.cornell.edu; Heidi Westermann BA, Weill Cornell Medical College, New York, NY, heidi.westermann@gmail.com; Tiffany N. Choi BA

mancusoc{at}hss.edu

Abstract

Background Depressive conditions in asthma patients have been described mostly from patients' reports and less often from physicians' reports. While patients' reports can encompass multiple symptoms, physicians' 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 0-30, higher is more depressive symptoms). Patients were categorized as having a physician-reported depressive disorder if they had: 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 0-28, higher is more severe) and the Asthma Control Questionnaire (ACQ) (possible score 0-6, higher is worse control).

Results 257 patients were included in this analysis, mean age 42 years, 75% women. Mean SOA and ACQ scores were 5.9± 4.2 and 1.4±1.2, respectively; 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=.007) and with asthma control (p=.0007). In contrast, physician-reported depressive disorders were associated with asthma severity (p=.04) but not with asthma control (p=.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. (ClinicalTrials.gov NCT00195117)

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