The asthma-anxiety connection.
The literature reports a significant association between various mental disorders and asthma, in particular depression and/or anxiety, with some more robust data regarding anxiety disorders. However, the nature of this association remains largely unclear.



(1) To test the hypothesis of a specific association of anxiety and depressive disorder (according to the DSM-IV) with asthma and (2) to test the bidirectional hypothesis of causality between asthma and psychiatric disorders.



Ninety-six adults were compared with 96 control subjects matched according to main socio-demographic variables (i.e., gender, age, marital status, cohabiting/non-cohabiting, and BMI). Subjects with asthma were divided according to GINA and ACT classifications. All subjects underwent Structured Clinical Interviews for DSM-IV Axis I (SCID-I) diagnosis.



Significant association between asthma and lifetime anxiety disorders emerged (OR 3.03; p = 0.003); no significant association with other psychiatric diagnosis emerged. Moreover, lifetime and current anxiety were associated with asthma severity levels (p < 0.01 and p = 0.001 based on age). Asthma preceded anxiety in 48% of cases; in 52% of cases, anxiety preceded asthma, without significant group differences. The risk of asthma, particularly of severe, uncontrolled forms (p < 0.01), resulted higher in lifetime anxiety disorder patients (p = 0.003 and p = 0.001 based on age at onset). Current anxiety increased the risk of asthma, and that of an uncontrolled form (p < 0.05). Asthma increased the risk of lifetime anxiety disorders (p = 0.002 and p = 0.018 using ages). Intermittent asthma increased the risk of lifetime and current anxiety disorders (p < 0.01).



Anxiety disorders, in particular Lifetime Anxiety Disorders, represent the only psychiatric disorder significantly associated with asthma, with a possible bidirectional, anxiety-asthma relationship, each of which can be caused or result from the other.
Department of Medical Sciences "M. Aresu", Allergy and Clinical Immunology Unit, University of Cagliari, Cagliari, Italy. Electronic address: stedg@medicina.unica.it.
Stefano R
SR
Del Giacco
South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Alessandra
A
Cappai
Department of Medical Sciences "M. Aresu", Allergy and Clinical Immunology Unit, University of Cagliari, Cagliari, Italy.
Luisanna
L
Gambula
Department of Mathematics and Informatics, University of Cagliari, Cagliari, Italy; Department of Statistics, Carlos III University of Madrid, Madrid, Spain.
Stefano
S
Cabras
Department of Mathematics and Informatics, University of Cagliari, Cagliari, Italy.
Silvia
S
Perra
Department of Medical Sciences "M. Aresu", Allergy and Clinical Immunology Unit, University of Cagliari, Cagliari, Italy.
Paolo Emilio
PE
Manconi
Department of Public Health, Psychiatry Unit, University of Cagliari, Cagliari, Italy.
Bernardo
B
Carpiniello
Department of Public Health, Psychiatry Unit, University of Cagliari, Cagliari, Italy.
Federica
F
Pinna
D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D001249:Asthma / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D015992:Body Mass Index; D016022:Case-Control Studies; D015897:Comorbidity; D017281:Cost of Illness; D003866:Depressive Disorder / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D012720:Severity of Illness Index; D055815:Young Adult
Anxiety; Asthma; DSM-IV; Depression; Psychiatric disorders; SCID