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Mental Disorders Among Adults with Asthma: Results from the World Mental Health Survey Kate M

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Mental Disorders Among Adults with Asthma: Results from the World Mental Health Survey Kate M General Hospital Psychiatry 29 (2007) 123–133 Mental disorders among adults with asthma: results from the World Mental Health Survey Kate M. Scott, Ph.D.a,4, Michael Von Korff, Sc.D. b, Johan Ormel, Ph.D.c, Ming-yuan Zhang, M.D.d, Ronny Bruffaerts, Ph.D.e, Jordi Alonso, M.D., Ph.D.f, Ronald C. Kessler, Ph.D.g, Hisateru Tachimori, Ph.D.h, Elie Karam, M.D.i, Daphna Levinson, Ph.D.j, Evelyn J. Bromet, Ph.D.k, Jose´ Posada-Villa, M.D.l, Isabelle Gasquet, M.D., Ph.D.m, Matthias C. Angermeyer, M.D.n, Guilherme Borges, Ph.D.o, Giovanni de Girolamo, M.D.p, Allen Herman, M.D., Ph.D.q, Josep Maria Haro, M.D., Ph.D.r aDepartment of Psychological Medicine, Wellington School of Medicine and Health Sciences, University of Otago, P.O. Box 7343, Wellington South, New Zealand bCenter for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA cDepartment of Psychiatry, University Medical Center Groningen, Groningen 9700 RB, The Netherlands dShanghai Mental Health Center, Shanghai 200030, China eDepartment of Neurosciences and Psychiatry, University Hospital Gasthuisberg, Leuven B-300, Belgium fHealth Services Research Unit, Institut Municipal d’Investigacio Medica (IMIM), E-08003 Barcelona, Spain gDepartment of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA hNational Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira-Shi, Tokyo 187-8502, Japan iInstitute for Development, Research, Advocacy and Applied Care (IDRAAC), 166227 Achrafieh, Beirut 1100 2110, Lebanon jMental Health Services, Ministry of Health, Jerusalem 91010, Israel kDepartment of Psychiatry, State University of New York at Stony Brook, NY 11794-8790, USA lColegio Mayor de Cundinamarca University, Saldarriaga Concha Foundation, Bogota 57, Colombia mHoˆpitaux de Paris, Paris, F-94000 France nDepartment of Psychiatry, National Institute of Psychiatry, University of Leipzig, Leipzig 04317, Germany oDivision of Epidemiological Research, Calzada Mexico Xochimilco No 101 Mexico City, DF 14370, Mexico pDepartment of Mental Health, AUSL di Bologna, Bologna 40123, Italy qNational School of Public Health at Medical University of Southern Africa (MEDUNSA), South Africa rSant Joan de Deu-SSM, Barcelona 08830, Spain Received 2 November 2006; accepted 20 December 2006 Abstract Objective: Our objectives were (a) to determine which common mental disorders are associated with asthma in the general population after controlling for age and sex, and (b) to assess whether the associations of mental disorders with asthma are consistent across diverse countries. Method: Eighteen population surveys of household-residing adults were carried out in 17 countries (N =85,088). Mental disorders were assessed with the Composite International Diagnostic Interview 3.0, a fully structured diagnostic interview. The disorders considered here are 12-month anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, posttraumatic stress disorder and social phobia), depressive disorders (dysthymia and major depressive disorder) and alcohol use disorders (abuse and dependence). Asthma was ascertained by self-reports of lifetime diagnosis among a subsample (n =42,697). Results: Pooled estimates of age-adjusted and sex-adjusted odds of mental disorders among persons with asthma relative to those without asthma were 1.6 [95% confidence interval (95% CI)=1.4, 1.8] for depressive disorders, 1.5 (95% CI=1.4, 1.7) for anxiety disorders and 1.7 (95% CI=1.4, 2.1) for alcohol use disorders. 4 Corresponding author. Tel.: +64 4 385 5999x6584; fax: +64 4 389 5725. E-mail address: [email protected] (K.M. Scott). 0163-8343/$ – see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.genhosppsych.2006.12.006 124 K.M. Scott et al. / General Hospital Psychiatry 29 (2007) 123–133 Conclusion: This first cross-national study of the relationship between asthma and mental disorders confirms that a range of common mental disorders occurs with greater frequency among persons with asthma. These results attest to the importance of clinicians in diverse settings being alert to the co-occurrence of these conditions. D 2007 Elsevier Inc. All rights reserved. Keywords: Adult; Asthma; Cross-sectional; Mental disorders 1. Introduction disorders, rather than with major depressive disorder. One of the challenges in determining the association of comorbid Asthma is a major public health problem in industrialized mental and physical conditions is obtaining samples big countries, and its prevalence has been increasing in both enough to provide sufficient numbers with both conditions. developed and developing countries in recent decades [1,2]. The current study aims to extend this literature in two main A considerable number of studies have suggested that there is ways. First, it provides information on the association an association between asthma, particularly at the severe end, between mental disorders and lifetime asthma from a meta- and some mental disorders. In research among adults, studies analysis of surveys from the World Mental Health Surveys, conducted among clinical and general practice samples have an approach that has the advantage of being able to provide found higher-than-expected rates of anxiety disorders (par- pooled estimates that overcome the problems of small sample ticularly panic disorder) and major depression among those sizes from individual surveys. Second, this study is based on with asthma [3–10]. However, treatment-seeking biases limit general population surveys that used consistent diagnostic the extrapolation of findings from clinical studies to resolving measures of a range of mental disorders, representing both the question of whether asthma and mental disorders are developed and developing regions of the world, thus associated in the general population [11]. providing a more global perspective on the association Some studies have investigated the asthma–mental between asthma and mental disorders than has been available disorder relationship in the adult general population thus far. The World Mental Health Surveys have been [11–16]. Collectively, these studies suggest that asthma is conducted in over 20 countries using the latest structured related to both mood and anxiety disorders, although this psychiatric interviews, generating DSM-IV diagnoses for a conclusion could be considered premature due to the range of mental disorders and collecting information on limitations of many of these studies. These limitations chronic physical conditions and other covariates. include nonuse of diagnostic measures of mental disorders The objectives of this paper are (a) to determine which [12–14], limited age range of participants [16,17] or a common mental disorders (depressive disorders, anxiety limited number of mental disorders investigated [12–15,17]. disorders and alcohol use disorders) are significantly The study by Goodwin et al. [11], an exception to these associated with asthma after controlling for age and sex, limitations, investigated the association between asthma and and (b) to assess whether the associations of mental a range of Diagnostic and Statistical Manual of Mental disorders with asthma are consistent across adult popula- Disorders, Fourth Edition (DSM-IV) mental disorders in a tions in diverse countries in Europe, the Americas, Asia and general population sample of adults in Germany. They the Middle East. found that lifetime severe asthma was significantly associ- ated with a number of anxiety disorders, bipolar disorder and any severe mental disorder. Lifetime nonsevere asthma 2. Methods was significantly associated with any anxiety disorder, 2.1. Samples anxiety disorder not otherwise specified and any somato- form disorder. Current severe asthma was associated with a Eighteen surveys were carried out in 17 countries in the number of anxiety disorders, and current nonsevere asthma Americas (Colombia, Mexico and United States), Europe was associated with any affective disorder, although not (Belgium, France, Germany, Italy, The Netherlands, Spain with major depressive disorder on its own. This latter result and Ukraine), the Middle East (Israel and Lebanon), Africa may have been a power issue, suggested by the fact that the (Nigeria and South Africa), Asia [Japan and separate odds ratio (OR) for the association between current surveys in Beijing and Shanghai, People’s Republic of nonsevere asthma and any affective disorder was signifi- China (PRC)] and the South Pacific (New Zealand). An cant, while the ORs for the two components of the any- effort was made to recruit as many countries as possible for affective-disorder group (major depressive disorder and the initiative. The final set of countries was determined by bipolar disorder) were of a magnitude similar to that for any the availability of collaborators in the country who were affective disorder, yet nonsignificant. able to obtain funding for the survey. All surveys were In summary, findings from adult population studies based on multistage clustered area probability household suggest that both mood and anxiety disorders are associated samples. All interviews were carried out face-to-face by with asthma; yet, in the most informative of these studies trained lay interviewers. The six Western European surveys [11], asthma was more consistently associated with anxiety were carried out jointly [18]. Sample sizes ranged from K.M. Scott et al. / General Hospital Psychiatry 29 (2007) 123–133 125 2372 (The Netherlands) to 12,992 (New Zealand), with a 2.3. Mental
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