Chest
Volume 130, Issue 4, October 2006, Pages 1034-1038
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Original Research
Depressive Symptoms and Adherence to Asthma Therapy After Hospital Discharge

https://doi.org/10.1378/chest.130.4.1034Get rights and content

Study objectives

To evaluate the effect of depressive symptoms on adherence to therapy after discharge in patients hospitalized for asthma exacerbations.

Design

Prospective cohort study in which depressive symptoms were assessed during hospitalization and use of asthma medications was electronically monitored for 2 weeks after discharge.

Setting

Inner-city academic hospital in Baltimore, MD.

Patients

Patients were 59 adults with a mean age of 43.2 ± 10.9 years (± SD), who were mostly female (64%), African American (80%), and were hospitalized for an asthma exacerbation.

Measurement and results

Depressive symptoms were assessed with the Center for Epidemiological Studies-Depression scale. Electronic monitors were used to evaluate inhaled corticosteroid and oral corticosteroid use for up to 2 weeks after discharge. Forty-one percent of patients had high levels of depressive symptoms. Mean adherence to therapy was significantly lower in patients with (vs without) high levels of depressive symptoms (60 ± 26% vs 74 ± 21%, p + 0.02). Even after controlling for age, gender, and education, depressive symptoms were a significant and independent predictor of poorer adherence. High levels of depressive symptoms were associated with a 11.4-fold increase (95% confidence interval, 2.2 to 58.2) in the odds of poor adherence to therapy after adjustment for potential confounders.

Conclusions

Depressive symptoms are common in inner-city adults hospitalized for asthma exacerbations and identify a subset of patients at high risk for poor adherence to asthma therapy after discharge. Further research is needed to determine if screening for and treating depression improves adherence and asthma outcomes in this population.

Section snippets

Materials and Methods

This study was approved by the Johns Hopkins Internal Review Board. Data were collected as part of a prospective cohort study conducted from April 2001 through October 2002, which has been previously described.3 Participants were men and women ≥ 18 years old who had been admitted to an inner-city hospital with a physician diagnosis of asthma exacerbation. Participants did not have other respiratory disorders or contraindications to inhaled corticosteroids (ICS) and/or oral corticosteroids (OCS).

Participants

Of 111 eligible patients, 82 patients (74%) agreed to participate in the study. Fifty-nine patients (72%) completed the 2-week follow-up visit and had complete data on adherence to ICS and OCS (hereby referred to as “participants”). As compared with participants, patients without adherence data were younger (43.2 ± 10.9 years vs 35.8 ± 9.3 years, p = 0.005), but they did not differ on the other measured sociodemographic or asthma-related characteristics. Participants were most often unmarried

Discussion

The main findings of this study are as follows: (1) high levels of depressive symptoms are common (ie, 41%) in inner-city patients hospitalized with asthma exacerbations, and (2) the presence of a high level of depressive symptoms is associated with an increased risk of poor adherence to asthma therapy after discharge home. Compared to patients with low levels of depressive symptoms, those with high levels of depressive symptoms had more than five times the odds of using less than half of their

Conclusions

Our results suggest that depressive symptoms are common among minority adults hospitalized for asthma and serve as an important predictor of poor adherence to asthma therapy after discharge home. Our findings add to a growing body of evidence across several chronic health conditions and suggest that screening and treating depression, and providing additional forms of psychosocial support may improve the health outcomes of asthma patients, both in terms of symptom remission and of improved

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  • Cited by (0)

    This work was performed at Johns Hopkins University.

    Financial support was provided by a Parker B. Francis Fellowship Award, National Institutes of Health (HL67850 and AR02160).

    The authors have no conflicts of interest to disclose.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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