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Depressive Symptoms among Urban Adolescents with Asthma: A Focus for Providers.

Academic Pediatrics 2018 December 20
OBJECTIVES: Asthma is the most common chronic disease of childhood in the U.S., disproportionately affecting urban, poor, and minority children. Adolescents are at high risk for poor asthma outcomes and for depressive symptoms. The purpose of this study is to investigate associations between depressive symptoms and asthma-related clinical and functional outcomes among urban teens.

METHODS: We used baseline data from a 3-arm randomized trial, School-Based Asthma Care for Teens (SB-ACT), in Rochester, NY. We used the Center for Epidemiological Studies -Depression scale with a standard cutoff score of 16 to identify subjects at risk for clinical depression. We used structured in-home surveys and validated scales to assess clinical and functional outcomes and conducted bivariate and multivariate analyses to evaluate differences between groups.

RESULTS: We identified 277 eligible teens (ages 12-16, participation 80%, 54% Black, 34% Hispanic, 45% Female, 84% Medicaid). Overall, 28% reported depressive symptoms. Teens with depressive symptoms experienced greater asthma symptom severity and more acute healthcare utilization for asthma (all p<.001), however there was no difference in preventive care use between groups. Teens with depressive symptoms also reported lower asthma-related quality of life (p<.001), less sleep (p<.001), and more limitation in mild (aOR 2.60, [1.34,5.02]) and moderate (2.56, [1.41,4.61]) activity and in gym (2.33, [1.30,4.17]).

CONCLUSIONS: Depressive symptoms are prevalent among urban teens with asthma and are associated with worse asthma-related clinical outcomes, functional limitation, and quality of life. Providers should consider depression as a significant comorbidity that may impact multiple aspects of daily life for this population.

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