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Comorbidity of Asthma and Anxiety and Depression

CITATION:  Ortega, A.N., McQuaid, E.L., et al.  (2004). Comorbidity of Asthma and Anxiety and Depression in Puerto Rican Children .  Psychosomatics 45:93-99.

ABSTRACT:   Studies have reported that childhood asthma is associated with internalizing disorders, but most of these studies have used global measures of depressive and anxiety symptoms. The Diagnostic Interview Schedule for Children was administered to a group of 1,891 youth ages 4 to 17 and their caregivers in Puerto Rico to determine DSM-IV symptoms and diagnoses. Asthma diagnosis and having had an asthma attack were assessed by parental report. A diagnosis of asthma was associated with having any depressive disorder and one symptom of separation anxiety. An asthma attack was associated with any depressive disorder and any anxiety disorder and, more specifically, with separation anxiety disorder, major depressive disorder, and symptoms of depression, separation anxiety, and generalized anxiety. Possible explanations for the findings are discussed.


1. Klinnert MD, Price MR, Liu AH, Robinson JL: Unraveling the ecology of risks for early childhood asthma among ethnically diverse families in the southwest. Am J Public Health 2002; 92:792–798[Abstract/Free Full Text]

2. Ortega AN, Calderon JG: Pediatric asthma among minority populations. Curr Opin Pediatr 2000; 12:579–583[CrossRef][Medline]

3. Roberts EM: Racial and ethnic disparities in childhood asthma diagnosis: the role of clinical findings. J Natl Med Assoc 2002; 94:215–223[Medline]

4. Ortega AN, Huertas SE, Canino G, Ramirez R, Rubio-Stipec M: Childhood asthma, chronic illness, and psychiatric disorders. J Nerv Ment Dis 2002; 190:275–281[CrossRef][Medline]

5. Ortega AN, McQuaid EL, Canino G, Ramirez R, Fritz GK, Klein RB: Association of psychiatric disorders and different indicators of asthma in island Puerto Rican children. Soc Psychiatry Psychiatr Epidemiol 2003; 38:220–226[CrossRef][Medline]

6. Beckett WS, Belanger K, Gent JF, Holford TR, Leaderer BP: Asthma among Puerto Rican Hispanics: a multi-ethnic comparison study of risk factors. Am J Respir Crit Care Med 1996; 154:894–899[Abstract]

7. Carter-Pokras OD, Gergen PJ: Reported asthma among Puerto Rican, Mexican-American, and Cuban children, 1982 through 1984. Am J Public Health 1993; 83:580–582[Abstract]

8. Lieu TA, Lozano P, Finkelstein JA, Chi FW, Jensvold NG, Capra AM, Quesenberry CP, Selby JV, Farber HJ: Racial/ethnic variation in asthma status and management practices among children in managed Medicaid. Pediatrics 2002; 109:857–865[Abstract/Free Full Text]

9. Mrazek DA: Psychological aspects in children and adolescents, in Asthma. Edited by Barnes PJ, Grunstein MM, Leff AR, Woolcock AJ. Philadelphia, Lippincott-Raven, 1997, pp 2177–2183

10. Bennett DS: Depression among children with chronic medical problems: a meta analysis. J Pediatr Psychol 1994; 19:149–169[Abstract/Free Full Text]

11. Gillaspy SR, Hoff AL, Mullins LL, Van Pelt JC, Chaney JM: Psychological distress in high-risk youth with asthma. J Pediatr Psychol 2002; 27:363–371[Abstract/Free Full Text]

12. Hamlett KW, Pellegrini DS, Katz KS: Childhood chronic illness as a family stressor. J Pediatr Psychol 1992; 17:33–47[Abstract/Free Full Text]

13. Miller B: Depression and asthma: a potentially lethal mixture. J Allergy Clin Immunol 1987; 80:481–486[CrossRef][Medline]

14. Wamboldt MZ, Fritz G, Mansell A, McQuaid EL, Klein RB: Relationship of asthma severity and psychological problems in children. J Am Acad Child Adolesc Psychiatry 1998; 37:943–950[CrossRef][Medline]

15. McQuaid EL, Kopel SJ, Nassau JH: Behavioral adjustment in children with asthma: a meta-analysis. J Dev Behav Pediatr 2001; 22:430–490[Medline]

16. Vila G, Nollet-Clemencon C, de Blic J, Mouren-Simeoni MC, Scheinmann P: Prevalence of DSM-IV anxiety and affective disorders in a pediatric population of asthmatic children and adolescents. J Affect Disord 2000; 58:223–231[CrossRef][Medline]

17. Bender BG, Annett RD, Ikle D, DuHamel TR, Rand C, Strunk RC (CAMP Research Group): Relationship between disease and psychological adaptation in children in the Childhood Asthma Management Program and their families. Arch Pediatr Adolesc Med 2000; 154:706–713[Abstract/Free Full Text]

18. Wamboldt MZ, Weintraub P, Krafchick D, Wamboldt FS: Psychiatric family history in adolescents with severe asthma. J Am Acad Child Adolesc Psychiatry 1996; 35:1042–1049[CrossRef][Medline]

19. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV). Washington, DC, APA, 1994

20. Bravo M, Ribera J, Rubio-Stipec M, Canino G, Shrout P, Ramirez R, Fabregas L, Chavez L, Alegria M, Bauermeister JJ, Martinez Taboas A: Test-retest reliability of the Spanish version of the Diagnostic Interview Schedule for Children (DISC-IV). J Abnorm Child Psychol 2001; 29:433–444[CrossRef][Medline]

21. Shaffer D, Fisher P, Dulcan MK, Davies M, Piacentini J, Schwab-Stone ME, Lahey BB, Bourdon K, Jensen PS, Bird HR, Canino G, Regier DA: The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study (Methods for the Epidemiology of Child and Adolescent Mental Disorders Study). J Am Acad Child Adolesc Psychiatry 1996; 35:865–877[CrossRef][Medline]

22. Bravo M, Woodbury-Farina M, Canino GJ, Rubio-Stipec M: The Spanish translation and cultural adaptation of the Diagnostic Interview Schedule for Children (DISC) in Puerto Rico. Cult Med Psychiatry 1993; 17:329–344[CrossRef][Medline]

23. SUDAAN Software for the Statistical Analysis of Correlated Data. Research Triangle Park, NC, Research Triangle Institute, 2002.

24. von Mutius E: Environmental factors influencing the development and progression of pediatric asthma. J Allergy Clin Immunol 2002; 109:S525-S532

25. Braun-Fahrlander C, Gassner M, Grize L, Neu U, Sennhauser FH, Varonier HS, Vuille JC, Wuthrich B (SCARPOL [Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution] team): Prevalence of hay fever and allergic sensitization in farmers' children and their peers living in the same rural community. Clin Exp Allergy 1999; 29:28–34[CrossRef][Medline]

26. Slattery MJ, Klein DF, Mannuzza S, Moulton JL III, Pine DS, Klein RG: Relationship between separation anxiety disorder, parental panic disorder, and atopic disorders in children: a controlled high-risk study. J Am Acad Child Adolesc Psychiatry 2002; 41:947–954[CrossRef][Medline]

27. Kagan J, Snidman N, Julia-Sellers M, Johnson MO: Temperament and allergic symptoms. Psychosom Med 1991; 53:332–340[Abstract/Free Full Text]

28. Bell IR, Jasnoski ML, Kagan J, King DS: Is allergic rhinitis more frequent in young adults with extreme shyness? a preliminary survey. Psychosom Med 1990; 52:517–525[Abstract/Free Full Text]

29. Goodwin RD, Pine DS, Hoven CW: Asthma and panic attacks among youth in the community. J Asthma 2003; 40:139–145[CrossRef][Medline]

30. Parker G, Lipscombe P: Parental overprotection and asthma. J Psychosom Res 1979; 23:295–299[CrossRef][Medline]

31. Pine DS, Klein RG, Coplan JD, Papp LA, Hoven CW, Martinez J, Kovalenko P, Mandell DJ, Moreau D, Klein DF, Gorman JM: Differential carbon dioxide sensitivity in childhood anxiety disorders and nonill comparison group. Arch Gen Psychiatry 2000; 57:960–967[Abstract/Free Full Text]

32. Wood BL, Klebba KB, Miller BD: Evolving the biobehavioral family model: the fit of attachment. Fam Process 2000; 39:319–344[CrossRef][Medline]

33. Koltek M, Wilkes TC, Atkinson M: The prevalence of posttraumatic stress disorder in an adolescent inpatient unit. Can J Psychol 1998; 43:64–68

34. Goodwin RD, Wamboldt MZ, Pine DS: Lung disease and internalizing disorders: is child abuse a shared etiologic factor? J Psychosom Res 2003; 55:215–219[CrossRef][Medline]

35. Cunningham J, Dockery DW, Speizer FE: Race, asthma, and persistent wheeze in Philadelphia schoolchildren. Am J Public Health 1996; 86:1406–1409[Abstract]

36. Gergen PJ: Social class and asthma—distinguishing between the disease and the diagnosis. Am J Public Health 1996; 86:1361–1362[Medline]

37. Jessop DJ, Riessman CK, Stein RE: Chronic childhood illness and maternal mental health. J Dev Behav Pediatr 1988; 9:147–156[Medline]

38. Brown ES, Khan DA, Mahadi S: Psychiatric diagnoses in inner-city outpatients with moderate to severe asthma. Int J Psychiatry Med 2000; 30:319–327[CrossRef][Medline]

39. Bussing R, Halfon N, Benjamin B: Prevalence of behavior problems in US children with asthma. Arch Pediatr Adolesc Med 1995; 149:565–572[Abstract]

40. Nejtek VA, Brown ES, Khan DA, Moore JJ, Van Wagner J, Perantie DC: Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic. Ann Allergy Asthma Immunol 2001; 87:129–133[Medline]

41. Lewis-Fernandez R, Guarnaccia PJ, Martinez IE, Martinez IE, Salman E, Schmidt A, Liebowitz M: Comparative phenomenology of ataques de nervios, panic attacks, and panic disorder. Cult Med Psychiatry 2002; 26:199–223[CrossRef][Medline]

42. Guarnaccia PJ, Canino G, Rubio-Stipec M, Bravo M: The prevalence of ataques de nervios in the Puerto Rico disaster study: the role of culture in psychiatric epidemiology. J Nerv Ment Dis 1993; 181:157–165[CrossRef][Medline]

43. Guarnaccia PJ, Guevara LM, González G, Canino G, Bird HR: Cross cultural aspects of psychotic symptoms in Puerto Rico. Res Community Ment Health 1992; 7:99–110

44. Guarnaccia PJ, Rivera M, Franco F, Neighbors C: The experiences of ataques de nervios: towards an anthropology of emotions in Puerto Rico. Cult Med Psychiatry 1996; 20:343–367[CrossRef][Medline]

45. Guarnaccia PJ, Rubio-Stipec M, Canino G: Ataques de nervios in the Puerto Rican Diagnostic Interview Schedule: the impact of cultural categories on psychiatric epidemiology. Cult Med Psychiatry 1989; 13:275–295[CrossRef][Medline]

46. Wamboldt MZ, Hewitt JK, Schmitz S, Wamboldt FS, Rasanen M, Koskenvuo M, Romanov K, Varjonen J, Kaprio J: Familial association between allergic disorders and depression in adult Finnish twins. Am J Med Genet 2000; 96:146–153[CrossRef][Medline]