Depressive Symptoms Among Urban Adolescents with Asthma: A Focus for Providers

Published:December 19, 2018DOI:



      Asthma is the most common chronic disease of childhood in the United States, disproportionately affecting urban, poor, and minority children. Adolescents are at high risk for poor asthma outcomes and for depressive symptoms. The purpose of this study is to investigate associations between depressive symptoms and asthma-related clinical and functional outcomes among urban teens.


      We used baseline data from a 3-arm randomized trial, School-Based Asthma Care for Teens, in Rochester, NY. We used the Center for Epidemiological Studies Depression Scale with a standard cutoff score of 16 to identify subjects at risk for clinical depression. We used structured in-home surveys and validated scales to assess clinical and functional outcomes and conducted bivariate and multivariate analyses to evaluate differences between groups.


      We identified 277 eligible teens (ages 12 to 16, 80% participation, 54% black, 34% Hispanic, 45% female, 84% on Medicaid). Overall, 28% reported depressive symptoms. Teens with depressive symptoms experienced greater asthma symptom severity and more acute health care utilization for asthma (all P < .001); however, there was no difference in preventive care use between groups. Teens with depressive symptoms also reported lower asthma-related quality of life (P < .001), less sleep (P < .001), and more limitation in mild (adjusted odds ratio [aOR], 2.60; 95% confidence interval [CI], 1.34–5.02) and moderate (aOR, 2.56; 95% CI, 1.41–4.61) activity and in gym (aOR, 2.33; 95% CI, 1.30–4.17).


      Depressive symptoms are prevalent among urban teens with asthma and are associated with worse asthma-related clinical outcomes, functional limitation, and quality of life. Providers should consider depression as a significant comorbidity that may impact multiple aspects of daily life for this population.


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        • Akinbami LJ
        • Moorman JE
        • Liu X
        Asthma prevalence, health care use, and mortality: United States 2005-2009.
        Natl Health Stat Report. 2011; : 1-14
        • Centers for Disease Control and Prevention
        CDC surveillance summaries, October 13, 2000.
        MMWR. 2000; 49: 908-911
        • Smith LA
        • Hatcher-Ross JL
        • Wertheimer R
        • et al.
        Rethinking race/ethnicity, income, and childhood asthma: racial/ethnic disparities concentrated among the very poor.
        Public Health Rep. 2005; 120: 109-116
        • Aligne CA
        • Auinger P
        • Byrd RS
        • et al.
        Risk factors for pediatric asthma. Contributions of poverty, race, and urban residence.
        Am J Respir Crit Care Med. 2000; 162: 873-877
        • Lozier MJ
        • Zahran HS
        • Bailey CM
        Assessing health outcomes, quality of life, and healthcare use among school-age children with asthma.
        J Asthma. 2018;
        • Calmes D
        • Leake BD
        • Carlisle DM
        Adverse asthma outcomes among children hospitalized with asthma in California.
        Pediatrics. 1998; 101: 845-850
        • Katon W
        • Lozano P
        • Russo J
        • et al.
        The prevalence of DSM-IV anxiety and depressive disorders in youth with asthma compared with controls.
        J Adolesc Health. 2007; 41: 455-463
        • Brady AM
        • Deighton J
        • Stansfeld S
        Psychiatric outcomes associated with chronic illness in adolescence: a systematic review.
        J Adolesc. 2017; 59: 112-123
        • Lu Y
        • Mak KK
        • van Bever HP
        • et al.
        Prevalence of anxiety and depressive symptoms in adolescents with asthma: a meta-analysis and meta-regression.
        Pediatr Allergy Immunol. 2012; 23: 707-715
        • Strine TW
        • Mokdad AH
        • Balluz LS
        • et al.
        Impact of depression and anxiety on quality of life, health behaviors, and asthma control among adults in the United States with asthma, 2006.
        J Asthma. 2008; 45: 123-133
        • Yonas MA
        • Marsland AL
        • Emeremni CA
        • et al.
        Depressive symptomatology, quality of life and disease control among individuals with well-characterized severe asthma.
        J Asthma. 2013; 50: 884-890
        • Ferro MA
        • Van Lieshout RJ
        • Scott JG
        • et al.
        Condition-specific associations of symptoms of depression and anxiety in adolescents and young adults with asthma and food allergy.
        J Asthma. 2016; 53: 282-288
        • Steinberg L
        • Aldea I
        • Messias E
        Asthma, depression, and suicidality: results from the 2007, 2009, and 2011 youth risk behavior surveys.
        J Nerv Ment Dis. 2015; 203: 664-669
        • Bender BG.
        Depression symptoms and substance abuse in adolescents with asthma.
        Ann Allergy Asthma Immunol. 2007; 99: 319-324
        • Walters P
        • Schofield P
        • Howard L
        • et al.
        The relationship between asthma and depression in primary care patients: a historical cohort and nested case control study.
        PLoS ONE. 2011; 6: e20750
        • Chen MH
        • Su TP
        • Chen YS
        • et al.
        Higher risk of developing major depression and bipolar disorder in later life among adolescents with asthma: a nationwide prospective study.
        J Psychiatr Res. 2014; 49: 25-30
        • Waxmonsky J
        • Wood BL
        • Stern T
        • et al.
        Association of depressive symptoms and disease activity in children with asthma: methodological and clinical implications.
        J Am Acad Child Adolesc Psychiatry. 2006; 45: 945-954
        • Goethe JW
        • Maljanian R
        • Wolf S
        • et al.
        The impact of depressive symptoms on the functional status of inner-city patients with asthma.
        Ann Allergy Asthma Immunol. 2001; 87 (erratum in Ann Allergy Asthma Immunol. 2003;91:99): 205-210
        • McCauley E
        • Katon W
        • Russo J
        • et al.
        Impact of anxiety and depression on functional impairment in adolescents with asthma.
        Gen Hosp Psychiatry. 2007; 29: 214-222
        • Delmas MC
        • Guignon N
        • Chee CC
        • et al.
        Asthma and major depressive episode in adolescents in France.
        J Asthma. 2011; 48: 640-646
        • Urrutia I
        • Aguirre U
        • Pascual S
        • et al.
        Impact of anxiety and depression on disease control and quality of life in asthma patients.
        J Asthma. 2012; 49: 201-208
        • National Asthma Education and Prevention Program
        Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007.
        J Allergy Clin Immunol. 2007; 120 (erratum in J Allergy Clin Immunol. 2008;121:1330): S94-S138
        • Nathan RA
        • Sorkness CA
        • Kosinski M
        • et al.
        Development of the asthma control test: a survey for assessing asthma control.
        J Allergy Clin Immunol. 2004; 113: 59-65
        • Radloff LS.
        The CES-D scale: a self-report depression scale for research in the general population.
        Appl Psychol Measure. 1977; 1: 385-401
        • Radloff LS.
        The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults.
        J Youth Adolesc. 1991; 20: 149-166
        • Stockings E
        • Degenhardt L
        • Lee YY
        • et al.
        Symptom screening scales for detecting major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity and diagnostic utility.
        J Affect Disord. 2015; 174: 447-463
        • Weissman MM
        • Sholomskas D
        • Pottenger M
        • et al.
        Assessing depressive symptoms in five psychiatric populations: a validation study.
        Am J Epidemiol. 1977; 106: 203-214
        • Riekert KA
        • Borrelli B
        • Bilderback A
        • et al.
        The development of a motivational interviewing intervention to promote medication adherence among inner-city, African-American adolescents with asthma.
        Patient Educ Couns. 2011; 82: 117-122
        • Juniper EF
        • Guyatt GH
        • Feeny DH
        • et al.
        Measuring quality of life in children with asthma.
        Qual Life Res. 1996; 5: 35-46
      1. Centers for Disease Control and Prevention. State and Local Area Integrated Telephone Survey: National Survey of Children's Health. Available at: Accessed December 24, 2018.

        • Asmussen L
        • Olson LM
        • Grant EN
        • et al.
        Reliability and validity of the Children's Health Survey for Asthma.
        Pediatrics. 1999; 104: e71
        • Bitsko MJ
        • Everhart RS
        • Rubin BK
        The adolescent with asthma.
        Paediatr Respir Rev. 2014; 15: 146-153
        • Naimi DR
        • Apter AJ
        Adolescents and asthma.
        in: Harvey A Kostes H Asthma Health, and Society: A Public Health Perspective. Springer, Charlotte, NC2010: 201-207
        • Lu Y
        • Mak KK
        • van Bever HP
        • et al.
        Prevalence of anxiety and depressive symptoms in adolescents with asthma: a meta-analysis and meta-regression.
        Pediatr Allergy Immunol. 2012; 23: 707-715
        • Lewinsohn PM
        • Rohde P
        • Seeley JR
        Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications.
        Clin Psychol Rev. 1998; 18: 765-794
        • Schoenbach VJ
        • Kaplan BH
        • Wagner EH
        • et al.
        Prevalence of self-reported depressive symptoms in young adolescents.
        Am J Public Health. 1983; 73: 1281-1287
        • Blazer DG
        • Kessler RC
        • McGonagle KA
        • et al.
        The prevalence and distribution of major depression in a national community sample: the national comorbidity survey.
        Am J Psychiatry. 1994; 151: 979-986
        • Opolski M
        • Wilson I
        Asthma and depression: a pragmatic review of the literature and recommendations for future research.
        Clin Pract Epidemiol Ment Health. 2005; 1: 18
        • Bender BG
        Risk taking, depression, adherence, and symptom control in adolescents and young adults with asthma.
        Am J Respir Crit Care Med. 2006; 173: 953-957
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        5th ed. American Psychiatric Association, Washington, DC2013
        • Zuckerbrot RA
        • Cheung A
        • Jensen PS
        • et al.
        Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management.
        Pediatrics. 2018; 141 (pii: e20174081)
        • Cheung AH
        • Zuckerbrot RA
        • Jensen PS
        • et al.
        Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and ongoing management.
        Pediatrics. 2018; 141 (pii: e20174082)