title: Mental Health Services Claims and Adult Onset Asthma in Ontario, Canada.
abstract: BACKGROUND
  Living with asthma is associated with a decrease in quality of life due to reductions in activities of daily living and increased psychological stress, both of which are associated with poor mental health outcomes.
  
  
  OBJECTIVE
  The objective of this study was to quantify the burden of mental disorders on the adult asthma population and compare the risk of mental health services claims (MHSCs) in the 1 year before and 1 year after asthma diagnosis.
  
  
  METHODS
  Ontario residents aged 25 to 65 years with incident physician-diagnosed asthma between April 1, 2005, and March 31, 2012, were included. MHSCs, which consisted of hospitalizations, emergency department (ED), and outpatient physician visits, were identified from universal health administrative data. Poisson regression models with repeated measures were used to estimate the relative risk (RR) of MHSCs for 2 time periods: 1 year after asthma diagnosis compared with the 1 year before and 2 years after compared with 2 years before.
  
  
  RESULTS
  A total of 145,881 adults had incident asthma. In the 1 year after asthma diagnosis, 27% had an MHSC. The risk of ED visits for any mental disorders increased by 13% in the 1 year after asthma diagnosis compared with the 1 year before (adjusted RR [aRR], 1.13; 95% confidence interval [CI], 1.06-1.21). This increased risk of ED visits was not found when comparing 2 years after asthma diagnosis with 2 years before. The risk for outpatient physician visits for substance-related disorders increased by 21% at 1 year (aRR, 1.21; 95% CI, 1.14-1.28) and 37% at 2 years (aRR, 1.37; 95% CI, 1.28-1.46).
  
  
  CONCLUSIONS
  The significant comorbid burden of mental disorders in adults with newly diagnosed asthma highlights the need for primary care physicians to assess mental health needs and provide appropriate care.
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Chronic Disease and Pharmacotherapy Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: teresa.to@sickkids.ca.
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kandace
authors.initials: K
authors.lastname: Ryckman
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Chronic Disease and Pharmacotherapy Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Jingqin
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Devon
authors.initials: D
authors.lastname: Williams
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Laura Y
authors.initials: LY
authors.lastname: Feldman
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Kristian
authors.initials: K
authors.lastname: Larsen
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Chronic Disease and Pharmacotherapy Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gershon
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011788:Quality of Life; D012306:Risk
keywords: Asthma; Comorbidity; Epidemiology; Mental disorders; Mental health