Asthmatic children with anxiety, depression likely to visit ER more

Children with asthma are more likely to be affected by anxiety and depression and those with all the three conditions are twice as likely to seek Emergency Room care, than patients only with the respiratory condition, finds a new study.

In a study published in the journal Pediatrics, researchers incorporated more than 65,000 children and youth with asthma, aged between 6 to 21, and found that 7.7 per cent of participants with both depression and anxiety had a rate of 28 ER visits per 100 child years, controlling for age, gender, insurance type and other chronic illnesses.

This is almost twice the rate of those without depression and anxiety -- 16 ER visits per 100 child years.

For asthma patients who just had depression, the rate was lower, with 22 visits per 100 child years, and for those asthma patients who just had anxiety, the rate was 19 visits per 100 child years.

"Asthma self-management is complex, requiring recognition of symptoms, adherence to medication and avoidance of triggers," said first author Naomi Bardach, MD, MAS, of the University of California, San Francisco, Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies.

"The symptoms of anxiety and depression can make it more challenging to follow treatment, leading to more ER visits," she added.

The authors noted that anxiety and depression are more common in children with asthma.

In their study, among those with asthma, 11.2 per cent had anxiety and 5.8 per cent had depression, versus 7.1 per cent and 3.2 per cent in those without. Children were aged between 3 to 17, according to data from the Centers for Disease Control and Prevention.

To qualify for the study, the 65,342 participants had to have had asthma-related doctor visits or hospitalizations, or prior use of preventive medications with an asthma-related doctor visit. They were identified with anxiety and depression if they had at least one inpatient, outpatient or ER visit for either condition.

In some children with asthma, depression and anxiety, it can be difficult to tease out which symptom is attributed to which condition, said senior author Michael Cabana, MD, MPH, formerly of UCSF and currently with Children's Hospital at Montefiore.

The research results confirm studies in adults with asthma who also had depression and anxiety. This group of patients was also found to have a higher likelihood of visits to the ER, urgent care clinics and unscheduled visits with their providers, compared to adults with asthma alone.