Depression, Anxiety, and Emergency Department Use for Asthma

Bardach, Naomi S.; Neel, Caroline; Kleinman, Lawrence C.; McCulloch, Charles E.; Thombley, Robert; Zima, Bonnie T.; Grupp‐Phelan, Jacqueline; Coker, Tumaini R.; Cabana, Michael D.

doi:10.1542/peds.2019-0856

Cited by 52 publications

(42 citation statements)

References 35 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We believe this most likely highlights the influence of anxiety and depression on the perception of asthma control. Asthmatic patients with anxiety and depression are known to have higher rates of emergency department visits and care utilization 35 . In addition, children and adults with anxiety are known to have altered perception of shortness of breath and a higher degree of symptom reporting 36 .…”

Section: Discussionmentioning

confidence: 99%

Asthma control and psychological health in pediatric severe asthma

Griffiths

Giancola

Welsh

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

Objectives Psychological comorbidities have been associated with asthma in adults and children, but have not been studied in a population of children with severe asthma. The aim of this study was to test the hypothesis that symptoms of anxiety or depression are highly prevalent in pediatric severe asthma and negatively effects asthma control. Methods Longitudinal assessments of anxiety or depression symptoms (Patient Health Questionnaire‐4 [PHQ‐4]), asthma control (Asthma Control Test [ACT]), and lung function were performed in a single‐center pediatric severe asthma clinic. Participant data were collected during routine clinical care. Primary outcomes were ACT and forced expiratory volume in 1 s per forced vital capacity (FEV1/FVC). Results Among 43 subjects (with total 93 observations), 58.1% reported at least one anxious or depressive symptom and 18.6% had a PHQ‐4 more than 2, the threshold for an abnormal test result. After adjusting for age, sex, race, and asthma medication step, there was a significant reduction in ACT for girls with PHQ‐4 more than 2 (adjusted mean [SE] ACT for PHQ‐4 > 2: 13.64 [0.59], ACT for PHQ‐4 ≤ 2: 20.64 [1.25], p = .02) but not boys. Moreover, there was a significant differential effect of mental health impairment for girls than boys. ACT for girls with PHQ more than 2: 13.64 (0.59) compared with boys with PHQ‐4 more than 2: 17.82 (0.95), adjusted mean difference ACT by sex = 4.18 points; 95% confidence interval, 0.63–7.73; p = .033. In adjusted models, there was no association between PHQ‐4 more than 2 and FEV1/FVC. Conclusions Symptoms of anxiety and depression are common. In children with severe asthma, a PHQ‐4 score more than 2 is associated with worse asthma symptom control in girls, but not boys.

show abstract

Section: Discussionmentioning

confidence: 99%

Asthma control and psychological health in pediatric severe asthma

Griffiths

Giancola

Welsh

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…department visits and hospitalizations for asthma 10,11,14,14,20 and children and adolescents with anxiety have demonstrated higher emergency room utilization for asthma. 13,21 Adults with these comorbid conditions are also prescribed more courses of prednisone and have a significantly increased risk of ICU admission and mechanical ventilation for asthma. 15 Asthma is a costly condition and it has been estimated that $100.98 million are spent per year for asthma care for school-age children in the United States.…”

Section: Discussionmentioning

confidence: 99%

“…Comorbid psychiatric illnesses have been associated with significantly increased outpatient healthcare utilization and costs for patients with asthma compared to those without comorbid psychiatric illnesses. Adult patients with comorbid depression and anxiety have been shown to have an increased frequency of primary care provider visits, urgent care visits, emergency department visits and hospitalizations for asthma 10,11,14,14,20 and children and adolescents with anxiety have demonstrated higher emergency room utilization for asthma 13,21 . Adults with these comorbid conditions are also prescribed more courses of prednisone and have a significantly increased risk of ICU admission and mechanical ventilation for asthma 15 .…”

Section: Discussionmentioning

confidence: 99%

Greater length of stay and hospital charges for severe asthma in children with depression or anxiety

Munoz

Benton

Kops

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

Rationale: Asthma is one of the most common chronic disorders of childhood and is associated with significant healthcare utilization and costs. Comorbid psychiatric illnesses, specifically depression and anxiety, are more prevalent in patients with asthma and associated with worse asthma control, more emergency department visits, and increased hospitalization rates. Objectives: We aimed to compare hospital outcomes and charges for children with severe asthma with and without comorbid depression and anxiety, hypothesizing that those with depression and anxiety would have longer hospitalizations and higher charges. Methods: Retrospective review of the 2000-2012 Healthcare Cost and Utilization Project's Kids' Inpatient Databases for admissions of patients aged 10-21 years with an ICD-9 code severe asthma (status asthmaticus or any asthma diagnosis with a procedure code for endotracheal intubation). Depression and Anxiety subgroups were created based on ICD-9 codes. Data collected included demographics, hospital outcomes and charges and comparisons made between groups. Results: There were 52,485 admissions for severe asthma: 45,094 (86%) with No Comorbid Psychiatric Illnesses, 1284 (2.4%) with depression, and 1297 (2.5%) with anxiety. Patients with depression or anxiety were older, had longer hospitalizations, and higher hospital charges (p < .001 for all). Conclusions: Comorbid depression or anxiety is associated with significantly longer hospitalizations and higher charges for children with severe asthma. These findings add to prior reports of worse outcomes for children with asthma and comorbid depression or anxiety and suggest that improved screening for and management of these conditions in children with asthma could improve hospital outcomes and reduce costs.

show abstract

“…Patients ages 3 to 21 years, who met criteria for identifiable asthma (Supplemental Table 5) 24,25 and who were attributed to primary care practices (see below), were included. In 2014, the data set included 9883 patients 3 to 21 years old with identifiable asthma, of whom we attributed 4589 patients to CHAMP network practices: 2376 at participating, 1282 at control, and 931 at partially participating practices.…”

Section: Patient Populationmentioning

confidence: 99%

“…The denominator and numerator definitions followed the asthmarelated ED visit rate measure specifications developed 28 and refined through the PQMP. 24,25,27,29 Eligibility was assessed for each month of data. The criteria for the measure were (1) having $3 months of consecutive enrollment in the same insurance plan (the measurement month and the 2 months before) and…”

Section: Attribution Of Children To Practicesmentioning

confidence: 99%

Statewide Asthma Learning Collaborative Participation and Asthma-Related Emergency Department Use

Harder¹,

Shaw²,

McCulloch³

et al. 2020

Pediatrics

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Quality improvement (QI) efforts can improve guideline-recommended asthma care processes in the pediatric office setting. We sought to assess whether practice participation in an asthma QI collaborative was associated with decreased asthma-related emergency department (ED) visits. METHODS: A statewide network of practices participated in a pediatric asthma QI collaborative from 2015 to 2016. We evaluated asthma-related ED visit rates per 100 child-years for children ages 3 to 21 years with asthma, using the state's all-payer claims database. We used a difference-indifferences approach, with mixed-effects negative binomial regression models to control for practice and patient covariates. Our main analysis measured the outcome before (2014) and after (2017) the QI collaborative at fully participating and control practices. Additional analyses assessed (1) associations during the intervention period (2016) and (2) associations including practices partially participating in QI collaborative activities. RESULTS: In the postintervention year (2017), participating practices' (n = 20) asthma-related ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years for control practices (n = 15; difference in differences = 27.3; P = .002). Within the intervention year (2016), we found no statistically significant differences in asthma-related ED visit rates compared to controls (difference in differences = 24.3; P = .17). The analysis including partially participating practices yielded similar results and inferences to our main analysis. CONCLUSIONS: Participation in an asthma-focused QI collaborative was associated with decreased asthma-related ED visit rates. For those considering implementing this type of QI collaborative, our findings indicate that it takes time to see measurable improvements in ED visit rates. Further study is warranted regarding QI elements contributing to success for partial participants. WHAT'S KNOWN ON THIS SUBJECT: Participation in an asthma quality improvement learning collaborative in primary care is associated with improved processes of care in the office setting for children with asthma. WHAT THIS STUDY ADDS: Participation in an asthma quality improvement learning collaborative in primary care is associated with a substantial decrease in asthmarelated emergency department visits .1 year after the end of the collaborative.

show abstract

Depression, Anxiety, and Emergency Department Use for Asthma

Cited by 52 publications

References 35 publications

Asthma control and psychological health in pediatric severe asthma

Asthma control and psychological health in pediatric severe asthma

Greater length of stay and hospital charges for severe asthma in children with depression or anxiety

Statewide Asthma Learning Collaborative Participation and Asthma-Related Emergency Department Use

Contact Info

Product

Resources

About