title: Impact of anxiety and depression on respiratory symptoms.
abstract: Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20-44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33-1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.
authors.affiliation: Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden. Electronic address: mai.leander@rkh.se.
authors.forename: Mai
authors.initials: M
authors.lastname: Leander
authors.affiliation: Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Lampa
authors.affiliation: Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Rask-Andersen
authors.affiliation: Surgical and Perioperative Sciences, Department of Surgery, Umeå University,Umeå Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Franklin
authors.affiliation: Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Thorarinn
authors.initials: T
authors.lastname: Gislason
authors.affiliation: Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Oudin
authors.affiliation: Bergen Respiratory Research Group, Institute of Medicine, University of Bergen and Department of Occupational Medicine, Haukeland University Hospital Bergen, Bergen, Norway.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Svanes
authors.affiliation: Section of Occupational and Environmental Medicine University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Torén
authors.affiliation: Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D001249:Asthma / Q000453:epidemiology / Q000523:psychology; D001985:Bronchial Provocation Tests / Q000379:methods; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D009664:Norway / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D011603:Psychophysiology; D012120:Respiration Disorders / Q000453:epidemiology / Q000523:psychology*; D013147:Spirometry / Q000379:methods; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Anxiety; Asthma; Depression