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Childhood Adversity, Early-Onset Depressive/Anxiety Disorders, and Adult-Onset Asthma

From the Department of Psychological Medicine (K.M.S.), School of Medicine and Health Sciences, Otago University, Wellington, New Zealand; Center for Health Studies (M.V.K.), Group Health Cooperative of Puget Sound, Seattle, Washington; Health Services Research Unit (J.A.), Institut Municipal d'Investigacio Medica (IMIM) and CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain; Center for Public Mental Health (M.C.A.), Gösing am Wagram, Austria; National Institute of Psychiatry (C.B.), Calzada Mexico Xochimilco, Mexico City, Mexico; Department of Neurosciences and Psychiatry (R.B.), University Hospital, Gasthuisberg, Leuven, Belgium; Regional Health Care Agency (G.G.), Emilia-Romagna Region, Bologna, Italy; Sant Joan de Deu-SSM (J.M.H.), RETICS RD06/0011 REM-TAP, Barcelona, Spain; Department of Health Care Policy (R.K.), Harvard Medical School, Boston, Massachusetts; Fondation MGEN pour la Santé Publique (V.K.), Université Paris 5, Paris, France; Health Center (Y.O.), Keio University, Tokyo, Japan; Department of Psychiatry (J.O.), University Medical Center, Groningen, Netherlands; and Colegio Mayor de Cundinamarca University (J.P.-V.), Bogota, Colombia.

Address correspondence and reprint requests to Kate M. Scott, Department of Psychological Medicine, School of Medicine and Health Sciences, Otago University, Wellington, PO Box 7343, Wellington South, New Zealand. E-mail: kate.scott{at}otago.ac.nz

Objectives: To investigate a) whether childhood adversity predicts adult-onset asthma; b) whether early-onset depressive/anxiety disorders predict adult-onset asthma; and c) whether childhood adversity and early-onset depressive/anxiety disorders predict adult-onset asthma independently of each other. Previous research has suggested, but not established, that childhood adversity may predict adult-onset asthma and, moreover, that the association between mental disorders and asthma may be a function of shared risk factors, such as childhood adversity.

Methods: Ten cross-sectional population surveys of household-residing adults (>18 years, n = 18,303) assessed mental disorders with the Composite International Diagnostic Interview (CIDI 3.0) as part of the World Mental Health surveys. Assessment of a range of childhood family adversities was included. Asthma was ascertained by self-report of lifetime diagnosis and age of diagnosis. Survival analyses calculated hazard ratios (HRs) for risk of adult-onset (>age 20 years) asthma as a function of number and type of childhood adversities and early-onset (<age 21 years) depressive and anxiety disorders, adjusting for current age, sex, country, education, and current smoking.

Results: Childhood adversities predicted adult-onset asthma with risk increasing with the number of adversities experienced (HRs = 1.49–1.71). Early-onset depressive and anxiety disorders also predicted adult-onset asthma (HRs = 1.67–2.11). Childhood adversities and early-onset depressive and anxiety disorders both predicted adult-onset asthma after mutual adjustment (HRs = 1.43–1.91).

Conclusions: Childhood adversities and early-onset depressive/anxiety disorders independently predict adult-onset asthma, suggesting that the mental disorder-asthma relationship is not a function of a shared background of childhood adversity.

Key Words: asthma • childhood adversity • comorbidity • depressive disorders • anxiety disorders

Abbreviations: CIDI = Composite International Diagnostic Interview; HR = hazard ratio; WMH = World Mental Health; HPA = hypothalamic-pituitary-adrenal; CI = Confidence Interval.