title: Effect of depressive symptoms on asthma intervention in urban teens.
abstract: BACKGROUND
  The literature suggests that depression is an important comorbidity in asthma that can significantly influence disease management and quality of life (QOL).
  
  
  OBJECTIVE
  To study the effect of coexisting depressive symptoms on the effectiveness of self-management interventions in urban teens with asthma.
  
  
  METHODS
  We analyzed data from a randomized controlled trial of Puff City, a web-based, tailored asthma management intervention for urban teens, to determine whether depression modulated intervention effectiveness for asthma control and QOL outcomes. Teens and caregivers were classified as depressed based on responses collected from baseline questionnaires.
  
  
  RESULTS
  Using logistic regression analysis, we found that a lower percentage of treatment students had indicators of uncontrolled asthma compared with controls (adjusted odds ratios <1). However, for teens depressed at baseline, QOL scores at follow-up were significantly higher in the treatment group compared with the control group for the emotions domain (adjusted relative risk, 2.08; 95% confidence interval, 1.2-3.63; P = .01; interpreted as emotional QOL for treatment students increased by a factor of 2.08 above controls). Estimates for overall QOL and symptoms QOL were borderline significant (adjusted relative risk, 1.57; 95% confidence interval, 0.93-2.63; P = .09; and adjusted relative risk, 1.72; 95% confidence interval, 0.94-3.15; P = .08; respectively). Among teens not depressed at baseline, no significant differences were observed between treatment and control groups in QOL domains at follow-up.
  
  
  CONCLUSIONS
  Our results suggest that depression modified the relationship between the effectiveness of an asthma intervention and emotional QOL in urban teens. Further assessment of self-management behavioral interventions for asthma should explore the mechanism by which depression may alter the intervention effect.
authors.affiliation: Pediatric Pulmonary Division, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI 48201, USA. lguglani@med.wayne.edu
authors.forename: Lokesh
authors.initials: L
authors.lastname: Guglani
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Havstad
authors.forename: Christine Cole
authors.initials: CC
authors.lastname: Johnson
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Ownby
authors.forename: Christine L M
authors.initials: CL
authors.lastname: Joseph
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001741:Black or African American; D001249:Asthma / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D017028:Caregivers; D002648:Child; D003863:Depression / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D011795:Surveys and Questionnaires; D014504:Urban Health; D014505:Urban Population