title: Impact of depressive symptoms on adult asthma outcomes.
abstract: BACKGROUND
  Psychological disorders, including depression, are common in adults with asthma. Although depression is treatable, its impact on longitudinal asthma outcomes is not clear.
  
  
  OBJECTIVE
  To elucidate the impact of depressive symptoms on patient-centered outcomes and emergency health care use in adults with asthma.
  
  
  METHODS
  We conducted a prospective cohort study of 743 adults with asthma who were recruited after hospitalization for asthma. Depressive symptoms were defined as having a score of 16 or more on the Center for Epidemiologic Studies Depression Scale. We examined the impact of depressive symptoms on patient-centered outcomes (validated severity-of-asthma score, Marks Asthma Quality of Life Questionnaire, and 12-Item Short-Form Health Survey physical component summary score) and on future emergency health care use for asthma ascertained from computerized databases.
  
  
  RESULTS
  The prevalence of depressive symptoms was 18% (95% confidence interval [CI], 15%-21%) among adults with asthma. Depressive symptoms were associated with greater severity-of-asthma scores after controlling for age, sex, race/ ethnicity, educational attainment, and cigarette smoking (mean score increment, 2.6 points; 95% CI, 1.8-3.4 points). Furthermore, depressive symptoms were associated with poorer asthma-specific quality of life (mean score increment, 19.9 points; 95% CI, 17.7-22.1 points) and poorer physical health status (mean score decrement, 3.7 points; 95% CI, 1.5-5.8 points). Depressive symptoms were associated with a greater longitudinal risk of hospitalization for asthma (hazard ratio, 1.34; 95% CI, 0.98-1.84). After controlling for differences in preventive care for asthma, the relationship was stronger (hazard ratio, 1.45; 95% CI, 1.05-2.0).
  
  
  CONCLUSIONS
  Depressive symptoms are common in adults with asthma and are associated with poorer health outcomes, including greater asthma severity and risk of hospitalization for asthma.
authors.affiliation: Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California 94117, USA. eisner@itsa.ucsf.edu
authors.forename: Mark D
authors.initials: MD
authors.lastname: Eisner
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.forename: Gretchen
authors.initials: G
authors.lastname: Lactao
authors.forename: Carlos
authors.initials: C
authors.lastname: Iribarren
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications*; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires