Effect of depressive symptoms on asthma intervention in urban teens

Abstract

Background: The literature suggests that depression is an important comorbidity in asthma that can significantly influence disease management and quality of life (QOL).

Objective: To study the effect of coexisting depressive symptoms on the effectiveness of self-management interventions in urban teens with asthma.

Methods: We analyzed data from a randomized controlled trial of Puff City, a web-based, tailored asthma management intervention for urban teens, to determine whether depression modulated intervention effectiveness for asthma control and QOL outcomes. Teens and caregivers were classified as depressed based on responses collected from baseline questionnaires.

Result: Using logistic regression analysis, we found that a lower percentage of treatment students had indicators of uncontrolled asthma compared with controls (adjusted odds ratios <1). However, for teens depressed at baseline, QOL scores at follow-up were significantly higher in the treatment group compared with the control group for the emotions domain (adjusted relative risk, 2.08; 95% confidence interval, 1.2-3.63; P = .01; interpreted as emotional QOL for treatment students increased by a factor of 2.08 above controls). Estimates for overall QOL and symptoms QOL were borderline significant (adjusted relative risk, 1.57; 95% confidence interval, 0.93-2.63; P = .09; and adjusted relative risk, 1.72; 95% confidence interval, 0.94-3.15; P = .08; respectively). Among teens not depressed at baseline, no significant differences were observed between treatment and control groups in QOL domains at follow-up.

Conclusion: Our results suggest that depression modified the relationship between the effectiveness of an asthma intervention and emotional QOL in urban teens. Further assessment of self-management behavioral interventions for asthma should explore the mechanism by which depression may alter the intervention effect.

Trial registration: ClinicalTrials.gov NCT00201058.

Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1

CONSORT flow diagram for Puff City randomized controlled trial showing details of enrollment and randomization into treatment and control groups. Of the 9,125 students in English class, 1,233 were not screened because they were either absent or not present in class at the time the questionnaire was administered.