Examining the relationship between depression and asthma exacerbations in a prospective follow-up study.
Examining the relationship between depression and asthma exacerbations in a prospective follow-up study.
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DOI：
10.1097/psy.0b013e3182864ee3
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发表时间：
2013-04
影响因子：
3.3
通讯作者：
Williams LK
中科院分区：
文献类型：
--
作者：
Ahmedani BK;Peterson EL;Wells KE;Williams LK
虽然在许多研究中，抑郁与哮喘有关，但它与哮喘恶化的关系，包括急诊室(ER)就诊和口服类固醇(OS)的使用，还没有很好的记录。主要目的是调查合并抑郁是否会增加哮喘患者的病情恶化。这项研究包括568名哮喘患者，他们年龄在18-56岁之间，正在服用吸入皮质类固醇，并参与了基线和随访调查。从一个大型综合卫生系统收集的调查和医疗记录作为改善呼吸系统用药试验(ClinicalTrials.gov：NCT00459368)依从性反馈的一部分。在随访调查之前和之后的12个月期间，计算急诊室就诊次数和哮喘的OS处方填充量。在这两项调查中，抑郁都是使用标准化的两项工具进行测量的。采用负二项回归和修正比例风险模型进行分析。在哮喘患者中，有抑郁症的患者(n=187；32.9%)接受哮喘相关急诊的风险增加(调整后的相对风险(ARR)：1.96，95%可信区间(CI)：1.02-3.75)，但不存在OS填充(ARR：0.98；95%CI：0.72-1.32)。同时接受抗抑郁药物治疗(n=126；22.2%)或心理治疗(n=39；6.9%)的抑郁症和哮喘患者更有可能去急诊室就诊(药物风险比(HR)：2.09，95%CI：1.35-3.25；心理治疗HR：2.07，95%CI：1.38-3.22)。这项研究表明抑郁和哮喘相关急诊室就诊之间存在时间关系。研究和实践必须进一步考虑这些并存条件的重要性。
While depression has been linked with asthma in numerous studies, its relationship with asthma exacerbations, including emergency room (ER) visits and oral steroid (OS) use has not been well documented. The main aim is to investigate whether comorbid depression increases exacerbations among patients with asthma. The study included 568 participants with asthma, who were between 18-56 years old, were taking an inhaled corticosteroid, and participated in both baseline and follow-up surveys. Surveys and medical records from a large, integrated health system were collected as part of the Adherence Feedback for Improving Respiratory Medication Use trial (ClinicalTrials.gov: NCT00459368). Number of ER visits and OS prescription fills for asthma were calculated for 12-month periods before and after the follow-up survey. Depression was measured using a standardized two-item instrument on both surveys. Negative binomial regression and modified proportional hazards models were used in the analyses. Among patients with asthma, those who had depression (n=187; 32.9%) were at increased risk of having an asthma-related ER visit (adjusted relative risk (aRR): 1.96, 95% confidence interval (CI): 1.02 - 3.75), but not an OS fill (aRR: 0.98; 95%CI: 0.72-1.32). Participants with depression and asthma, who also received psychiatric treatment via antidepressant medication (n=126; 22.2%) or psychotherapy (n=39; 6.9%), were more likely to have an ER visit (medication hazard ratio (HR): 2.09, 95%CI: 1.35-3.25; psychotherapy HR: 2.07, 95%CI: 1.38-3.22). This study suggests a temporal relationship between depression and asthma-related ER visits. Research and practice must further consider the importance of these comorbid conditions.