Depression, Asthma and Suicide

Chronic illness lends itself to depression. Asthma is a chronic illness and it is estimated that two out of three patients with asthma may suffer from depression. Depression may exacerbate asthma and asthma in turn can exacerbate depression. Depression, particularly in adolescents with asthma, can result in potentially fatal asthma. Researchers have now linked depression with increased severity of asthma.(1)

Patients often report symptoms of depression. Living with the disease, they truly understand how difficult it is to monitor and control their asthma. Physicians and health care providers see asthma patients infrequently and these encounters may not provide a clue as to the degree of depression and how it affects the life of the patient with asthma. So there may be two calculated levels of depression - patient perceived and provider estimated for any individual patient.

To test this hypothesis and to determine the link between depression and asthma control and severity, 257 adult patients, 75% of them women, with mild to moderate-persistent asthma were evaluated using the Geriatric Depression scale to measure depression. 34% were reported to have a depressive disorder by their physicians. The patients were also asked to evaluate their level of asthma control and asthma severity using a Severity of Asthma Scale (SOA) and the Asthma Control Questionnaire (ACQ). In all cases, a higher score indicated more depression, increased severity and reduced asthma control. Patients with depressive disorders had higher SOA scores that corresponded with more unscheduled physician visits, more emergency room visits and more days of restricted activity due to asthma.

All the results were adjusted for confounders such as age, gender, race, ethnicity, body mass index, education, medication adherence and smoking status. The researchers found that patient-reported depressive symptoms were associated with asthma severity and with asthma control while physician-reported depressive disorders were associated with asthma severity but not with asthma control.

Underestimated, the level of depression can result in under treatment of asthma leading to reduced levels of control and increased levels of severity. Short-term depressive symptoms appear to be crucial for asthma control. Hence, educators and health care professionals should work with patients to identify associations between depression and asthma in order to increase control and reduce severity of asthma.

Studies have reported a high rate of psychiatric disorder among asthma patients. A study of 406 adults with asthma evaluated data with respect to links between psychiatric status, level of asthma control and asthma-related quality of life. Results showed that

  • 34% of patients had one or more psychiatric diagnosis of whom
  • 15% had major depression
  • 5% had minor depression
  • 4% had dysthymia (persistent mild depression)
  • 12% had panic disorder
  • 5% had generalized anxiety disorder, and
  • 4% had social phobia.

 
The results showed that psychiatric disorders are prevalent among individuals with asthma and are linked with poorer asthma control and reduced quality of life.
 
Another study by Clarke and colleagues found that there is a link between chronic respiratory diseases, suicide ideation and suicide attempts. A multivariate logistic regression analyses of data from 5692 adults found that while 4.2% of adults attempt suicide, the ratio for adults with asthma who attempt suicide is 12%. The difference between non-asthma and asthma patients remained significant even after adjustment for confounders such as smoking, nicotine dependence, age, sex, and race/ethnicity, depression, panic disorder, and alcohol abuse.
 

The factors that were associated with an increased likelihood of suicide attempts included:

  • female sex
  • current smoke
  • nicotine dependent
  • depression
  • anxiety, and
  • alcohol abuse

 There is a link between respiratory disease and suicide ideation and suicide attempts. Cigarette smoking and coexisting mental conditions may have an impact on the association between asthma and attempted suicide. Hence any treatment modality for asthma, in order to minimize the possibility of suicide, must incorporate

  • asthma treatment
  • smoking cessation
  • alcohol surcease
  • behaviour modification, and
  • treatment for depressive disorders

 More research is required in the field of mental health and asthma but the indicators are clear that there is a significant association between asthma, depressive mental disorders and suicide.
 
 
References
Mancuso CA, Wenderoth S, Westermann H, Choi TN, Briggs WM, Charlson ME. Patient-reported and physician-reported depressive conditions in relation to asthma severity and control.Chest. 2008; 133(5): 1142–8.

Lavoie KL, Cartier A et al. Are psychiatric disorders associated with worse asthma control and quality of life in asthma patients? Respir Med 2005; 99 (10): 1249–57

Clarke DE, Goodwin RD, Messias EL, Eaton WW. Asthma and suicidal ideation with and without suicide attempts among adults in the United States: what is the role of cigarette smoking and mental disorders? Ann Allergy Asthma Immunol. 2008;100(5):439–46