Psychiatric disorders and asthma outcomes among high-risk inner-city patients.
OBJECTIVE
The purpose of this study was to examine the rate of psychiatric disorders among patients attending an ethnically diverse, inner-city asthma clinic for an initial visit and assess the association between psychiatric disorders and asthma morbidity.


METHODS
A semistructured psychological interview was conducted to assess for psychiatric diagnoses. A pulmonary physician, who was blind to psychiatric disorder, established diagnosis of asthma based on national guidelines.


RESULTS
Sixty-four percent of 85 participants received at least 1 psychiatric diagnosis. The pulmonary physician rated patients with a psychiatric disorder as achieving fewer goals (M = 2.3 +/- 1.3) for asthma control than patients without a psychiatric disorder (M = 3.6 +/- 1.5, p = .0002). Patients with a psychiatric diagnosis more frequently reported an emergency room visit for asthma during the past 6 months (OR = 4.89; 95% CI, 1.76-13.39) and greater use of short-acting beta2-agonist medication (M = 1.5 +/- 0.9 canisters per month) than patients without a psychiatric diagnosis (M = 0.9 +/- 0.8, p = .003). These findings were independent of demographics, health insurance, and asthma severity. No differences emerged between patients with and without a mental disorder on percent predicted FEV1. Patients with a psychiatric disorder reported a higher severity level for asthma symptoms than the severity level indicated by their pulmonary function in comparison to patients without a psychiatric diagnosis (OR = 3.52; 95% CI, 1.23-10.10). Health insurance appeared to be a confounding factor in this relationship.


CONCLUSIONS
A high rate of psychiatric disorders was found among inner-city asthma patients. Psychiatric diagnoses were associated with greater perceived impairment from asthma but not objective measurement of pulmonary function.
Feldman
Jonathan M
JM
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York 10461, USA. JFeldman@aecom.yu.edu
Siddique
Mahmood I
MI
Morales
Enid
E
Kaminski
Beverly
B
Lu
Shou-En
SE
Lehrer
Paul M
PM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012129:Respiratory Function Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*