Abstract
Background and ObjectivesAsthma and depression are common health problems in primary care. Evidence of a relationship between asthma and depression is conflicting. Objectives: to determine 1. The incidence rate and incidence rate ratio of depression in primary care patients with asthma compared to those without asthma, and 2. The standardized mortality ratio of depressed compared to non-depressed patients with asthma.MethodsA historical cohort and nested case control study using data derived from the United Kingdom General Practice Research Database. Participants: 11,275 incident cases of asthma recorded between 1/1/95 and 31/12/96 age, sex and practice matched with non-cases from the database (ratio 1∶1) and followed up through the database for 10 years. 1,660 cases were matched by date of asthma diagnosis with 1,660 controls. Main outcome measures: number of cases diagnosed with depression, the number of deaths over the study period.ResultsThe rate of depression in patients with asthma was 22.4/1,000 person years and without asthma 13.8 /1,000 person years. The incident rate ratio (adjusted for age, sex, practice, diabetes, cardiovascular disease, cerebrovascular disease, smoking) was 1.59 (95% CI 1.48–1.71). The increased rate of depression was not associated with asthma severity or oral corticosteroid use. It was associated with the number of consultations (odds ratio per visit 1.09; 95% CI 1.07–1.11). The age and sex adjusted standardized mortality ratio for depressed patients with asthma was 1.87 (95% CI: 1.54–2.27).ConclusionsAsthma is associated with depression. This was not related to asthma severity or oral corticosteroid use but was related to service use. This suggests that a diagnosis of depression is related to health seeking behavior in patients with asthma. There is an increased mortality rate in depressed patients with asthma. The cause of this needs further exploration. Consideration should be given to case-finding for depression in this population.
Highlights
After hypertension asthma is the most common chronic illness in primary care in the United Kingdom with a prevalence 6% [1]
The age and sex adjusted standardized mortality ratio for depressed patients with asthma was 1.87
Asthma is associated with depression. This was not related to asthma severity or oral corticosteroid use but was related to service use
Summary
After hypertension asthma is the most common chronic illness in primary care in the United Kingdom with a prevalence 6% [1]. Chronic physical health problems are reported to be associated with increased rates of depression [3]. In secondary care populations up to 50% of patients with asthma have been reported to have clinically significant depressive symptoms and over a third of asthmatic outpatients have been found to have a major depressive episode [4,5,6,7,8,9]. Asthma and depression are common health problems in primary care. The incidence rate and incidence rate ratio of depression in primary care patients with asthma compared to those without asthma, and 2. The standardized mortality ratio of depressed compared to non-depressed patients with asthma
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