Asthma and anxiety development in Australian children and adolescents

Abstract

Background Evidence has suggested a bidirectional association between both the effects and onset of asthma and anxiety. The direction of this association in children and adolescents is less clear. The study evaluates whether anxiety in children is associated with the development of later asthma or, by contrast, whether asthma in children precedes anxiety. Methods Parental reports from 9369 children at two age points (4–5 and 14–15 years old) and from baby (B) (recruited at birth in 2004) and kindergarten (K) (recruited at 4–5 years of age in 2004) cohorts of the Longitudinal Study of Australian Children (LSAC) were analyzed. Asthma cases were defined as reports of doctor‐diagnosed asthma and the use of asthma medication or/and wheezing. Scores of the Strengths and Difficulties Questionnaire (SDQ) defined anxiety. Results We found a unidirectional association between asthma in children aged 4–5 years and future anxiety development in weighted generalized linear adjusted models (B cohort OR (CI 95%) = 1.54 (1.14–2.08); K cohort OR (CI 95%) = 1.87 (1.40–2.49)). Children with asthma (no anxiety at 4 years) had a higher prevalence of anxiety in adolescence compared with nonasthmatics (B cohort = 26.8% vs 17.6%: K cohort = 27.7% vs 14.3%). Anxiety in childhood was not associated with the development of asthma from 6 years old to adolescence. Conclusion Australian children with asthma have a greater risk of developing anxiety from 6 to 15 years old. This suggests that early multidisciplinary intervention may be required to support children with asthma to either prevent the increased risk of anxiety and/or promote optimal anxiety management.

Dissecting the causal relationships between childhood-onset asthma and major mental disorders: a univariable and multivariable Mendelian randomization study

“…In particular, accumulating studies have indicated that asthma with a childhood-onset is associated with increased risk of severe mental illnesses in later life. Meta-analyses of observational studies have reported children with asthma had higher risk of developing subsequent major depressive disorder (MDD) [3,4], bipolar disorder [4,5], schizophrenia [5], anxiety [6], autism [7]and attention deficit hyperreactivity disorder (ADHD) [8,9]. While various covariates have been controlled in these studies, the remaining uncontrolled confounding factors and reverse causation bias still limit the ability of elucidating the causal relationships from observational studies [10].…”

Editorial comments on “Asthma and anxiety development in Australian children and adolescents”

“…The results of Garcia‐Sanchez et al's study 5 could raise health professionals' awareness of the increased risk of developing anxiety among children and adolescents with asthma. Clinicians should formulate strategies to assess anxiety in young patients with asthma and offer psychological support to either prevent the increased risk of and/or reduce the burden of anxiety symptoms.…”

“…The study of Garcia‐Sanchez et al 5 is therefore particularly relevant, since it used a longitudinal and representative sample from two cohorts of Australian children to assess whether anxiety in adolescents was associated with the occurrence of asthma in childhood or, conversely, if anxiety in children precedes asthma in adolescence.…”

The impact of perinatal and at birth risk factors on the progression from preschool wheezing to adolescent asthma

“…Consequently, asthma is regarded as one of the leading causes of school absenteeism and is associated with poorer academic performance and reduced quality of life. 3,4 If not appropriately managed, pediatric asthma can result in reduced lung function and greater respiratory events throughout adulthood, 5 which subsequently increases the risk of early-onset comorbidities and premature mortality. 6 As such, the prevention and management of pediatric asthma has become a global priority, with increased interest in understanding and characterizing the natural disease progression.Wheezing is the primary clinical manifestation of asthma and often originates in early life, with up to 50% of children wheezing during their preschool years (before age 6).…”