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From the Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York (J.M.F.); Department of Medicine, Division of Pulmonary and Critical Care Medicine (M.I.S.), Eric B. Chandler Health Center (B.K.), Department of Biostatistics, School of Public Health (S.-E.L.), Department of Psychiatry (P.M.L.), University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, New Jersey; Robert Wood Johnson University Hospital at Hamilton, Hamilton, New Jersey (M.I.S.); Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, New Jersey (E.M.).
Address correspondence and reprint requests to Jonathan M. Feldman, PhD, Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1300 Morris Park Avenue, Bronx, NY 10461. E-mail: JFeldman{at}aecom.yu.edu
Objective: The purpose of this study was to examine the rate of psychiatric disorders among patients attending an ethnically diverse, inner-city asthma clinic for an initial visit and assess the association between psychiatric disorders and asthma morbidity.
Methods: A semistructured psychological interview was conducted to assess for psychiatric diagnoses. A pulmonary physician, who was blind to psychiatric disorder, established diagnosis of asthma based on national guidelines.
Results: Sixty-four percent of 85 participants received at least 1 psychiatric diagnosis. The pulmonary physician rated patients with a psychiatric disorder as achieving fewer goals (M = 2.3 ± 1.3) for asthma control than patients without a psychiatric disorder (M = 3.6 ± 1.5, p = .0002). Patients with a psychiatric diagnosis more frequently reported an emergency room visit for asthma during the past 6 months (OR = 4.89; 95% CI, 1.76–13.39) and greater use of short-acting ß2-agonist medication (M = 1.5 ± 0.9 canisters per month) than patients without a psychiatric diagnosis (M = 0.9 ± 0.8, p = .003). These findings were independent of demographics, health insurance, and asthma severity. No differences emerged between patients with and without a mental disorder on percent predicted FEV1. Patients with a psychiatric disorder reported a higher severity level for asthma symptoms than the severity level indicated by their pulmonary function in comparison to patients without a psychiatric diagnosis (OR = 3.52; 95% CI, 1.23–10.10). Health insurance appeared to be a confounding factor in this relationship.
Conclusion: A high rate of psychiatric disorders was found among inner-city asthma patients. Psychiatric diagnoses were associated with greater perceived impairment from asthma but not objective measurement of pulmonary function.
Key Words: asthma • mental disorders • quality of life • health-care-seeking behavior
Abbreviations: ER = emergency room; MDI = metered-dose inhaler; NHLBI = National Heart Lung and Blood Institute; PHQ = Patient Health Questionnaire; SCID-IV = Structured Clinical Interview for DSM-IV; SES = socioeconomic status.
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