Anxiety disorders and asthma among adolescents in urban Uganda: the role of early life exposures

Abstract

Background: The reasons for the association between anxiety disorders and asthma are not fully established, and data from Africa is sparse. We investigated whether the association between anxiety disorders and asthma among adolescents may be partly related to shared exposures in early life. Methods: We conducted a case-control study among adolescents (12-17 years) with and without asthma in Wakiso District, an urban area in Uganda. Anxiety disorders were diagnosed by the Youth Inventory-4R (YI-4R), a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) referenced instrument. For this report, we focus on generalized anxiety disorder (GAD), panic disorder and social anxiety disorder. Asthma was doctor-diagnosed by study clinicians. We used questionnaires to collect data on early life exposures. The data were analysed using multiple logistic regression models. Results: We enrolled 162 adolescents. Adolescents with asthma were more likely to have any of three anxiety disorders (44.6%) than adolescents without asthma (21.4%) (adjusted odds ratio (AOR) 2.68, 95% confidence interval (CI) 1.30-5.53, p-value=0.007). The association was strong for GAD (AOR 4.49, 95% CI 1.48-13.56) and panic disorder (AOR 5.43, 95% CI 2.11-14.02), but not for social anxiety disorder (1.46, 95% CI 0.63-3.37). The early life risk factors associated with anxiety disorders among adolescents were similar to asthma risk factors previously published, including urban residence at birth (AOR 3.42 (1.29-9.09)) and during most of the first five years of life (AOR 2.87 (1.07-7.66)), fathers tertiary education (AOR 2.09 (1.00-4.37)), and adolescents history of other allergy-related diseases (AOR 4.64 (1.66-13.00)). Conclusion: We confirm a positive association between anxiety disorders and asthma among adolescents in urban Uganda. The early life risk factors associated with anxiety disorders among adolescents were similar to those for asthma in the same age-group, suggesting shared underlying causes.