Comorbid Anxiety Disorders in Adolescents with Asthma

描述(调查者提供)：哮喘是儿童和青春期最常见的慢性病，其患病率正在上升。先前的研究结果表明，惊恐障碍和其他焦虑症在患有哮喘的儿童和成人人群中的患病率增加。然而，这些研究一直受到限制，因为这些研究是在患者人数较少的三级护理环境中进行的，而且缺乏关于共存的焦虑和抑郁障碍对哮喘结局的影响的信息。在这项流行病学研究中，我们建议(1)比较患有惊恐障碍和哮喘的青少年与仅患有哮喘的青少年，以衡量惊恐共病对哮喘的个人、家庭和社会影响的影响，如症状负担、功能状态、生活质量、医疗费用和哮喘自我管理的质量；(2)比较患有一种或多种焦虑和抑郁障碍的青少年与仅患有哮喘的青少年，以衡量焦虑/抑郁对目标1相同结果的影响。这些分析将控制哮喘的严重程度，医学上的共病，以及在目标1中，精神上的共病。此外，两个次级目标包括：(3)估计在卫生管理组织登记的1,300名12至17岁哮喘儿童中惊恐障碍和其他焦虑和情感障碍的患病率，以及心理健康诊断的准确性和为这些焦虑和抑郁障碍提供的心理健康护理的质量；以及(4)表明患有哮喘和DSM IV焦虑和/或抑郁障碍的青少年父母和自我对焦虑和抑郁症状的评分更高。我们预计，这项研究的结果将增加对患有哮喘的青少年中共病惊恐障碍和其他重要的焦虑和抑郁障碍的影响的流行病学知识，并将提高对这些精神障碍对青少年哮喘治疗和预后的影响的认识。我们的研究团队拥有十多年设计基于人群的干预研究的经验，以改善初级保健环境中焦虑和抑郁障碍患者以及哮喘患者的预后。这笔赠款的结果将用于开发未来治疗患有哮喘和焦虑的青少年患者的计划。

DESCRIPTION (provided by investigator): Asthma is the most common chronic illness of childhood and adolescence, and the prevalence rate is increasing. Results from prior studies have suggested an increased prevalence of panic disorder and other anxiety disorders in populations of children and adults with asthma. However, these studies have been limited by having been carried out in tertiary-care settings with small numbers of patients and by a lack of information on the effect of comorbid anxiety and depressive disorders on asthma outcomes. In this epidemiologic study, we propose to (1) compare adolescents with panic disorder and asthma to those with asthma alone in order to measure the impact of panic comorbidity on the personal, familial and societal impacts of asthma such as symptom burden, functional status, quality of life, medical costs and on the quality of asthma self-management; (2) compare adolescents with asthma with one or more anxiety and depressive disorders to adolescents with asthma alone in order to measure the impact of anxiety/depression on the same outcomes as Aim #1. By self-management, we refer to both patients' and providers' roles in ongoing care of a recurrent or chronic illness. These analyses will control for severity of asthma, medical comorbidity and, in Aim #1, psychiatric comorbidity. In addition, two secondary aims include (3) estimating the prevalence of panic disorder and other anxiety and affective disorders in a population-based sample of 1,300 12- to 17-year-olds with asthma enrolled in an HMO and the accuracy of mental health diagnoses and quality of the mental health care provided for these anxiety and depressive disorders; and (4) demonstrating that adolescents with asthma and DSM IV anxiety and/or depressive disorders will have higher parental- and self-ratings of anxiety and depressive symptoms. We anticipate that the results of this study will increase epidemiologic knowledge regarding the effects of comorbid panic disorder and other important anxiety and depressive disorders in adolescents with asthma, and will increase awareness of the impact of these psychiatric disorders on asthma management and outcomes in adolescents. Our research team has over a decade of experience designing population-based intervention studies to improve outcomes for both patients with anxiety and depressive disorders as well as asthma within primary care settings. The results of this grant will be used to develop future treatment programs for adolescent patients with comorbid asthma and anxiety.