Samantha H. Averill, MD

Credit: Riley Children's Health

Anxiety and depression are highly prevalent among pediatric high-risk asthma (HRA) patients, according to recent findings, and positive mental health outcomes for this population can be seen with the use of a clinical psychologist.¹

These results were drawn from a new study conducted to expand upon existing information regarding anxiety and depression in pediatric patients with difficult-to-control (DTC) asthma. While the use of at least a single symptom of anxiety or depression has been linked to lower Asthma Control Test scores, data prior to this study was noted as sparse regarding mental health for DTC pediatric asthma patients.²

The new research conducted to explore this topic was led by Samantha H. Averill, MD, from the Division of Pulmonary Department of Pediatrics at Indiana University School of Medicine.

“We hypothesized that the HRA population would experience a higher prevalence of anxiety/depression symptoms than that previously reported in the general pediatric asthma population,” Averill and colleagues wrote.

Background and Findings

The investigators used a retrospective single-center study design which utilized a prospectively collected database for MH screening, focusing on individuals in the High-Risk Asthma (HRA) clinic found at Indiana University School of Medicine’s Riley Hospital for Children. The HRA clinic maintains enhanced resources for patients’ management of asthma and related issues.

This clinic in particular helps a population which is disproportionately low-income and minority population compared with statewide demographics, with a higher proportion of Black/African American patients and individuals who are Medicaid insured. Those in the HRA clinic are typically given care over an extended time frame.

The investigators’ research spanned 3 distinct periods, with each period being marked by changes in social worker coverage and the patients’ use of a clinical psychologist. The screening for MH’s target population covered all study subjects found in the HRA clinic who were aged 13 years and older, with some younger patients screened at the discretion of the clinical team.

The research team utilized the Patient Health Questionnaire (PHQ-9) as well as the Generalized Anxiety Disorder Screener (GAD-7) to screen the subjects for both depression and anxiety, with specific referral thresholds formulated by the team. The data was prospectively recorded, including subjects’ results of screening, interventions, and characteristics of patients.

The investigators also assessed time to engagement in MH services and any of the delays. Overall, they ended up screening a total of 186 individuals.

The team’s work indicated that there was a substantial prevalence of anxiety and depression symptoms among pediatric patients that had DTC asthma, reaching 60%. This was double the rates that were previously reported in the general pediatric asthma population, around 27% - 33%.

This new data was also consistent with a similar study conducted in a different area of the US, indicating that MH issues faced by subjects with DTC asthma may not be limited to a specific region but are more likely widespread. The investigators noted that their study was reliable due to their significantly high rate of completion for MH screening.

The relationship between anxiety, asthma, and MH was noted as being complex, with the research team suggesting it could be influenced by elements such as housing instability and shared symptoms. That said, they note emerging evidence which indicates a biochemical link between asthma/allergy and disorders which are stress-related, citing oxidative stress and its effects on stress hormone responses.

Additionally, the investigators found that female subjects were shown to be more likely to have positive MH screening scores and to take part in MH services, in line with prior information suggesting sex-based disparities in comorbidities with MH.

They reported in this new study that the use of a clinical psychologist in the healthcare team significantly affected greater engagement in services for MH issues, specifically among new patients. This effectively eliminated delays in subjects’ access to health care.

Nevertheless, barriers to MH care access such as constrictions on time, financial struggles, and navigating the health system, continued to exist even with the help of a dedicated social worker.

“Based on our results, DTC pediatric asthma clinics adopting universal MH screening as routine clinical care will need to prepare for high rates of positive screens, and possible endorsement of suicidality,” they wrote.

References

1. ^{Averill, SH, McQuillan, ME, Slaven, JE, Weist, AD, Kloepfer, KM, Krupp, NL. Assessment and management of anxiety and depression in a pediatric high-risk asthma clinic. Pediatr Pulmonol. 2023; 1-9. doi:10.1002/ppul.26727.}
2. ^{Griffiths D, Giancola LM, Welsh K, et al. Asthma control and psychological health in pediatric severe asthma. Pediatr Pulmonol. 2021; 56(1): 42-48. doi:10.1002/ppul.25120.}