Quality of mental health care for youth with asthma and comorbid anxiety and depression.
OBJECTIVE
Youth with asthma have a high rate of anxiety and depressive disorders, and these comorbid disorders are associated with increased asthma symptom burden and functional impairment. This study examined the rates and predictors of recognition of anxiety and depressive disorders among youth (ages 11 to 17) with asthma who are seen in primary care settings as well as the quality of mental health care provided to those with comorbid anxiety and depression over a 12-month period.


METHODS
This study used automated utilization and pharmacy data from a health maintenance organization to describe the rate of recognition of Diagnostic and Statistical Manual of Mental Disorders, edition IV, anxiety and depressive disorders and the quality of mental health care provided for the 17% of youth with asthma and comorbid anxiety and/or depression during the 12-month period prior to diagnosis. Psychiatric diagnoses were based on a telephone version of the Computerized Diagnostic Interview Schedule for Children (Version 4.0).


RESULTS
Approximately 35% of youth with 1 or more anxiety and depressive disorders and 43% of those with major depression were recognized by the medical system during a 12-month period. Greater functional impairment (odds ratio [OR] 3.32, 95% confidence interval [CI] 1.25-8.79), higher severity on parent-rated anxiety and depressive symptoms (OR 2.49, 95% CI 1.04-6.00), and a greater number of primary care visits (OR 1.26, 95% CI 1.10-1.44) were associated with significantly higher recognition rates while having Medicaid or Washington state medical insurance was associated with lower rates of recognition (OR 0.27, 95% CI 0.08-0.92). Only approximately 1 in 5 youths with comorbid major depression received an adequate dosage and duration of antidepressant medication, and only 1 in 6 received a minimally adequate number of psychotherapy sessions (> or =4 visits).


CONCLUSIONS
Rates of recognition of comorbid anxiety and depressive disorders are low in youth with asthma and few youth with asthma and comorbid anxiety and depression receive guideline-level mental health treatment.
Katon
Wayne J
WJ
Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA. wkaton@u.washington.edu
Richardson
Laura
L
Russo
Joan
J
Lozano
Paula
P
McCauley
Elizabeth
E
D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008483:Medical Assistance / Q000458:organization & administration; D016347:Medical Records Systems, Computerized; D008605:Mental Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D011787:Quality of Health Care; D012720:Severity of Illness Index; D012959:Socioeconomic Factors