Anxiety and Depression Affects Health-Related Quality of Life in Asthma

Man with depression, profile
Man with depression, profile
Anxiety and/or depression in patients with asthma were associated with worse health-related quality of life.

Patients with asthma should be regularly screened for anxiety and depression, according to cross-over study results published in the Journal of Allergy and Clinical Immunology.

Researchers recruited 373 patients from allergy and pulmonology practices across the public healthcare system in Spain. To be included, participants had to be ≥18 years of age and have a diagnosis of asthma from a physician; the diagnosis had to have been made ≥6 months before joining the study. Participants also had to complete the Hospital Anxiety and Depression Scale (HADS), Coping Orientations to Problems Experienced Inventory (COPE), Asthma Control Test (ACT), 36-Item Short-Form Health Survey (SF-36), and St. George’s Respiratory Questionnaire (SGRQ).

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The mean age of the participants was 36.88±14.90 years, and the mean disease duration was 11.98±10.90 years. Asthma was well controlled in 57.7% of participants, according to the results of the ACT questionnaire. A total of 35.4% of patients experienced anxiety and 14.3% of patients experienced depression, according to HADS criteria. Combined anxiety and depression were present in 11% of patients. The most affected dimensions were General Health in the SF-36 form and Symptoms in the SGRQ, respectively, whereas the least-affected dimensions were Social Function in the SF-36 form and Impact in the SGRQ.

The researchers also performed multivariable analyses of the SF-36 form and SGRQ, which demonstrated that younger age, female sex, not actively working, being a former smoker, and obesity were the variables that remained significant predictors of poor health-related quality of life (P <.05). In particular, age was associated with an increase in the Physical Functioning score on the SF-36 form, and that increase was higher in women. When patients were “actively employed,” obesity had a bigger effect on the Activity and Overall score of the SGRQ (P <.05).

Forced expiratory volume in 1 second <80% of the predicted value was the only clinical variable related to the Physical Functioning and General Health score on the SF-36 form (P <.05) and to the Activity score of the SGRQ (P =.038). Anxiety and/or depression were associated with worse health-related quality of life in all the generic and specific scales. For example, depression or depression plus anxiety was associated with poorer health-related quality of life according to the dimensions of the SF-36 form (P <.001) and the SGRQ, as well as the SGRQ overall score (P <.01). Anxiety alone was associated with worse health-related quality of life across the SF-36 form (P <.01, except the Role Physical dimension) and in all the SGRQ dimensions and overall score (P <.05).

The generalizability of the results may have been affected, as most of the participants presented with only intermittent asthma. In addition, the cross-sectional design did not allow for prediction of the direction of causality. The researchers noted that that prospective studies are needed to elucidate the relationships among asthma control, health-related quality of life, and psychological variables.

“Anxiety, depression, and control of asthma (preferably estimated by the patient) should be routinely screened in [patients with asthma], and interventions focused on these potentially modifiable factors should be implemented to improve quality of life,” the researchers concluded.


González-Freire B, Vázquez I, Pértega-Díaz S. The relationship of psychological factors and asthma control to health-related quality of life [published online July 18, 2019]. J Allergy Clin Immunol. doi:10.1016/j.jaip.2019.07.009

This article originally appeared on Pulmonology Advisor