title: Depression's influence on the Asthma Control Test, Japanese version.
abstract: BACKGROUND
  Depression has been linked to poorer asthma control in asthmatic patients. Although the Japanese version of the Asthma Control Test (ACT-J) is frequently used as a simple, practical evaluation tool in clinical care settings in Japan, knowledge regarding its efficacy for assessing asthma control in asthmatic patients with depression is limited. Thus, we retrospectively investigated cut-off values of the ACT-J for well-controlled asthma, and explored depression's influence on the test with a questionnaire survey.
  
  
  METHODS
  Data were analyzed on 1,962 adult asthmatic patients who had completed both the ACT-J and the Japanese version of the Patient Health Questionnaire-9 (J-PHQ-9) in 2008 questionnaire survey conducted by the Niigata Asthma Treatment Study Group. Patients were classified into low (LD: J-PHQ-9 score of 0-4) or high depression (HD: J-PHQ-9 score of 5-27) groups. In both groups, the efficacy of the ACT-J was confirmed. We then compared the optimal cut-off points for uncontrolled asthma in both groups by performing a receiver operating characteristic (ROC) analysis, using the original classification referred to the GINA classification as the "true" classification.
  
  
  RESULTS
  Cronbach's alpha in the LD and HD group was 0.808 and 0.740 respectively. In both groups, the sub-group with existence of work absenteeism or frequent attacks during the previous 12 months scored lower on the ACT-J. The area under the curve and optimal cut-off point for patients with LD and HD were 0.821 and 0.846, and 23 and 20 respectively.
  
  
  CONCLUSIONS
  The efficacy of the ACT-J was confirmed in depressive patients with asthma. Because asthma control as evaluated with the ACT-J can be worse than actual control under depressive states, physicians should also pay attention to a patient's depressive state at evaluation. Further investigations focus on the association between the ACT-J and depression are required.
authors.affiliation: Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Mio
authors.initials: M
authors.lastname: Toyama
authors.affiliation: Department of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Sakagami
authors.affiliation: Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Koya
authors.affiliation: Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Masachika
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kagamu
authors.affiliation: School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Muramatsu
authors.affiliation: Clinical Course, Graduate School of Niigata Seiryo University, Niigata, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Muramatsu
authors.affiliation: Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Arakawa
authors.affiliation: Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Fumitake
authors.initials: F
authors.lastname: Gejyo
authors.affiliation: Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
authors.affiliation: Department of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D001249:Asthma / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D003863:Depression / Q000150:complications* / Q000175:diagnosis; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome