Skip to main content

Advertisement

SpringerLink
Log in

Effects of depressive symptoms on health-related quality of life in asthma patients

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

OBJECTIVE: To assess the effects of depressive symptoms on asthma patients’ reports of functional status and health-related quality of life.

DESIGN: Cross-sectional study.

SETTING: Primary care internal medicine practice at a tertiary care center in New York City.

PATIENTS: We studied 230 outpatients between the ages of 18 and 62 years with moderate asthma.

MEASUREMENTS AND MAIN RESULTS: Patients were interviewed in person in English or Spanish with two health-related quality-of-life measures, the disease-specific Asthma Quality of Life Questionnaire (AQLQ) (possible score range, 1 to 7; higher scores reflect better function) and the generic Medical Outcomes Study SF-36 (general population mean is 50 for both the Physical Component Summary [PCS] score and Mental Component Summary [MCS] score). Patients also completed a screen for depressive symptoms, the Geriatric Depression Scale (GDS), and a global question regarding current disease activity. Stepwise multivariate analyses were conducted with the AQLQ and SF-36 scores as the dependent variables and depressive symptoms, comorbidity, asthma, and demographic characteristics as independent variables. The mean age of patients was 41 ± SD 11 years and 83% were women. The mean GDS score was 11 ± SD 8 (possible range, 0 to 30; higher scores reflect more depressive symptoms), and a large percentage of patients, 45%, scored above the threshold considered positive for depression screening. Compared with patients with a negative screen for depressive symptoms, patients with a positive screen had worse composite AQLQ scores (3.9±SD 1.3 vs 2.8±SD 0.8, P<.0001) and worse PCS scores (40±SD 11 vs 34±SD 8, P<.0001) and worse MCS scores (48±SD 11 vs 32±SD 10, P<.0001) scores. In stepwise analyses, current asthma activity and GDS scores had the greatest effects on patient-reported health-related quality of life, accounting for 36% and 11% of the variance, respectively, for the composite AQLQ, and 11% and 38% of the variance, respectively, for the MCS in multivariate analyses.

CONCLUSIONS: Nearly half of asthma patients in this study had a positive screen for depressive symptoms. Asthma patients with more depressive symptoms reported worse health-related quality of life than asthma patients with similar disease activity but fewer depressive symptoms. Given the new emphasis on functional status and health-related quality of life measured by disease-specific and general health scales, we conclude that psychological status indicators should also be considered when patient-derived measures are used to assess outcomes in asthma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yellowlees PM, Ruffin RE. Psychological defenses and coping styles in patients following a life-threatening attack of asthma. Chest. 1989;95:1298–303.

    PubMed  CAS  Google Scholar 

  2. Thompson WL, Thompson TL. Treating depression in asthmatic patients. Psychosomatics. 1984;25:809–12.

    PubMed  CAS  Google Scholar 

  3. Miller BD. Depression and asthma: a potentially lethal mixture. J Allergy Clin Immunol. 1987;80:481–6.

    Article  PubMed  CAS  Google Scholar 

  4. Rubin NJ. Severe asthma and depression. Arch Fam Med. 1993;2:433–40.

    Article  PubMed  CAS  Google Scholar 

  5. Struck RC, Mrazek DA, Fuhrmann GSW, LaBrecque JF. Physiologic and psychological characteristics associated with deaths due to asthma in childhood. JAMA. 1985;254:1193–8.

    Article  Google Scholar 

  6. Allen GM, Hickie I, Gandevia SC, McKenzie DK. Impaired voluntary drive to breathe: a possible link between depression and unexplained ventilatory failure in asthmatic patients. Thorax. 1994;49:881–4.

    PubMed  CAS  Google Scholar 

  7. Alt HL. Psychiatric aspects of asthma. Chest. 1992;101:S415-S417.

    Google Scholar 

  8. Belloch A, Perpina M, Paredes T, Gimenez A, Compte L, Banos R. Bronchial asthma and personality dimensions: a multifaceted association. J Asthma. 1994;31:161–70.

    PubMed  CAS  Google Scholar 

  9. Rushford N, Tiller JWG, Pain MCF. Perception of natural fluctuations in peak flow in asthma: clinical severity and psychological correlates. J Asthma. 1998;35:251–9.

    PubMed  CAS  Google Scholar 

  10. Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA. 1989;262:914–9.

    Article  PubMed  CAS  Google Scholar 

  11. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA. 1989;262:907–13.

    Article  PubMed  CAS  Google Scholar 

  12. Janson C, Bjornsson E, Jerker H, Boman G. Anxiety and depression in relation to respiratory symptoms and asthma. Am J Respir Crit Care Med. 1994;149:930–4.

    PubMed  CAS  Google Scholar 

  13. Yellowlees PM, Kalucy RS. Psychobiological aspects of asthma and the consequent research implications. Chest. 1990;97:628–34.

    PubMed  CAS  Google Scholar 

  14. Lyketsos GC, Karabetsos A, Jordanoglou J, Liokis T, Armagianidis A, Lyketsos CG. Personality characteristics and dysthymic states in bronchial asthma. Psychother Psychosom. 1984;41:177–85.

    Article  PubMed  CAS  Google Scholar 

  15. Bukstein DA. Practical approach to the use of outcomes in asthma. Immun Allergy Clin North Am. 1996;16:859–91.

    Article  Google Scholar 

  16. Rose R, Weiss KB. An overview of outcomes measurement in asthma care. Immun Allergy Clin North Am. 1996;16:841–58.

    Article  Google Scholar 

  17. Richards JM, Hemstreet MP. Measures of life quality, role performance and functional status in asthma research. Am J Respir Crit Care Med. 1994;149:S31-S39.

    PubMed  Google Scholar 

  18. Player R, Richards J, Kohler CL, Woodby LL, Brooks CM, Bailey WC. Scale for assessing functional impairment in adults with asthma. J Asthma. 1994;31:437–44.

    PubMed  CAS  Google Scholar 

  19. Blaiss MS. Outcomes analysis in asthma. JAMA. 1997;278:1874–80.

    Article  PubMed  CAS  Google Scholar 

  20. Van der Molen T, Postma DS, Schreurs JM, Bosveid HEP, Sears MR, Meyboom de Jong B. Discriminative aspects of two generic and two asthma-specific instruments: relation with symptoms, bronchodilator use and lung function in patients with mild asthma. Qual Life Res. 1997;6:353–61.

    Article  PubMed  Google Scholar 

  21. Guidelines for the Diagnosis and the Management of Asthma Expert Panel Report II. Bethesda, Md: National Asthma Education and Prevention Program; April 1997. NIH publication no 97-4051.

  22. Dales RE, Spitzer WO, Schechter MT, Suissa S. The influence of psychological status on respiratory symptom reporting. Am Rev Respir Dis. 1989;139:1459–63.

    PubMed  CAS  Google Scholar 

  23. National Heart, Lung and Blood Institute. Guidelines for the Diagnosis and Management of Asthma. J Aller Clin Immunol. 1991;88:435.

    Google Scholar 

  24. Guyatt GH, King DR, Feeny DH, Stubbing D, Goldstein RS. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol. 1999;52:187–92.

    Article  PubMed  CAS  Google Scholar 

  25. Gill TM, Feinstein AR. A critical appraisal of the quality of quality-of-life measurements. JAMA. 1994;272:619–26.

    Article  PubMed  CAS  Google Scholar 

  26. Kucera CM, Greenberger PA, Yarnold PR, Choy AC, Levenson T. An attempted prospective testing of an asthma severity index and a quality of life survey for 1 year in ambulatory patients with asthma. Allergy Asthma Proc. 1999;20:29–38.

    Article  PubMed  CAS  Google Scholar 

  27. Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health-related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax. 1992;47:76–83.

    PubMed  CAS  Google Scholar 

  28. Malo JL, Boulet LP, Dewitte JD, et al. Quality of life of subjects with occupational asthma. J Allergy Clin Immunol. 1993;91:1121–7.

    Article  PubMed  CAS  Google Scholar 

  29. Juniper EF, Johnston PR, Borkhoff CM, Guyatt GH, Boulet LP, Haukioja A. Quality of life in asthma clinical trials: comparison of salmeterol and salbutamol. Am J Respir Crit Care Med. 1995;151:66–70.

    PubMed  CAS  Google Scholar 

  30. Rowe BH, Oxman AD. Performance of an asthma quality of life questionnaire in an outpatient setting. Am Rev Respir Dis. 1993;148:675–81.

    PubMed  CAS  Google Scholar 

  31. Rutten-van Molken MPMH, Custers F, van Doorslaer EKA, et al. Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life. Eur Respir J. 1995;8:888–98.

    PubMed  CAS  Google Scholar 

  32. Malmstrom K, Rodriguez-Gomez G, Guerra J, et al. Oral montelukast, inhaled beclomethasone, and placebo for chronic asthma: a randomized, controlled trial. Ann Intern Med. 1999;130:487–95.

    PubMed  CAS  Google Scholar 

  33. Stewart AL, Hays RD, Ware JE. The MOS Short-form General Health Survey: reliability and validity in a patient population. Med Care. 1988;26:724–32.

    Article  PubMed  CAS  Google Scholar 

  34. Ware JE, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995;33:AS264-AS2779.

    Article  PubMed  Google Scholar 

  35. Bousquet J, Knani J, Dhivert H, et al. Quality of life in asthma: internal consistency and validity of the SF-36 questionnaire. Am J Respir Crit Care Med. 1994;149:371–5.

    PubMed  CAS  Google Scholar 

  36. Mahajan P, Okamoto LJ, Schaberg A, Kellerman D, Schoenwetter WF. Impact of fluticasone propionate powder on health-related quality of life in patients with moderate asthma. J Asthma. 1997;34:227–34.

    PubMed  CAS  Google Scholar 

  37. Noonan M, Chervinsky P, Busse WW, et al. Fluticasone propionate reduces oral prednisone use while it improves asthma control and quality of life. Am J Respir Crit Care Med. 1995;152:1467–73.

    PubMed  CAS  Google Scholar 

  38. Yesavage JA, Brink TL. Development and validation of a geriatric depression screening scale: a preliminary report. Psychiatr Res. 1983;17:37–49.

    Article  CAS  Google Scholar 

  39. Yellowlees PM, Haynes S, Potts N, Ruffin RE. Psychiatric morbidity in patients with life threatening asthma: initial report of a controlled study. Med J Aust. 1988;149:246–9.

    PubMed  CAS  Google Scholar 

  40. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.

    PubMed  CAS  Google Scholar 

  41. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. J Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  42. Callahan LF, Kaplan MR, Pincus T. The Beck Depression Inventory, Center for Epidemiological Studies Depression Scale (CES-D), and General Well-Being Schedule Depression subscale in rheumatoid arthritis. Arthritis Care Res. 1991;4:3–11.

    Article  PubMed  CAS  Google Scholar 

  43. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–73.

    Article  Google Scholar 

  44. Charlson ME, Pompei P, Ales KI, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  45. Aaronson NK, Acquadro C, Alonso J, et al. International quality of life assessment (IQOLA) project. Qual Life Res. 1992;1:349–51.

    Article  PubMed  CAS  Google Scholar 

  46. Lang TA, Secic M. How to Report Statistics in Medicine. Philadelphia, Pa: American College of Physicians/BMJ Publishing Group; 1997.

    Google Scholar 

  47. Armitage P, Berry G. Statistical Methods in Medical Research, 3rd ed. Oxford, UK: Blackwell Science Ltd; 1994.

    Google Scholar 

  48. Tukey JW. Exploratory Data Analysis. Reading, Mass: Addison-Wesley; 1977.

    Google Scholar 

  49. Draper NR, Smith H. Applied Regression Analysis. 2nd ed. New York, NY: Wiley; 1981.

    Google Scholar 

  50. Coulehan JL, Schulberg HC, Block MA, Janosky JE, Arena VC. Depressive symptomatology and medical co-morbidity in a primary care clinic. Int J Psychiatry Med. 1990;20:335–47.

    Article  PubMed  CAS  Google Scholar 

  51. Coyne JC, Fechner-Bates S, Schwenk TL. Prevalence, nature, and comorbidity of depressive disorders in primary care. Gen Hosp Psychiatry. 1994;16:267–76.

    Article  PubMed  CAS  Google Scholar 

  52. Katon W, von Korff M, Lin E, Bush T, Ormel J. Adequacy and duration of antidepressant treatment in primary care. Med Care. 1992;30:67–76.

    Article  PubMed  CAS  Google Scholar 

  53. Bell JR. Underdiagnosis of depression in primary care: by accident or design? JAMA. 1997;277:1433.

    Article  PubMed  CAS  Google Scholar 

  54. Simon GE, Goldberg D, Tiemens BG, Ustun TB. Outcomes of recognized and unrecognized depression in an international primary care study. Gen Hosp Psychiatry. 1999;21:97–105.

    Article  PubMed  CAS  Google Scholar 

  55. Goldman LS, Nielsen NH, Champion HC. Awareness, diagnosis, and treatment of depression. J Gen Intern Med. 1999;14:569–80.

    Article  PubMed  CAS  Google Scholar 

  56. Hirschfeld RM, Keller MB, Panico S, et al. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA. 1997;277:333–40.

    Article  PubMed  CAS  Google Scholar 

  57. Fitzpatrick MF, Engleman H, Whyte KF, Deary IJ, Shapiro CM, Douglas NJ. Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance. Thorax. 1991;46:569–73.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Weil Medical College of Cornell University, New York, NY

    Carol A. Mancuso MD, Margaret G. E. Peterson PhD & Mary E. Charlson MD

  2. Hospital for Special Surgery, New York, NY

    Carol A. Mancuso MD & Margaret G. E. Peterson PhD

  3. New York Presbyterian Hospital, 525 East 68th St., Box 46, 10021, New York, NY

    Carol A. Mancuso MD & Mary E. Charlson MD

Authors
  1. Carol A. Mancuso MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margaret G. E. Peterson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mary E. Charlson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carol A. Mancuso MD.

Additional information

This project was supported by a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar’s Award to Dr. Mancuso.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mancuso, C.A., Peterson, M.G.E. & Charlson, M.E. Effects of depressive symptoms on health-related quality of life in asthma patients. J GEN INTERN MED 15, 301–310 (2000). https://doi.org/10.1046/j.1525-1497.2000.07006.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.2000.07006.x

Key words

Search

Navigation