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Allied Health: Articles of Interest Asthma and depression Depression is the most commonly diagnosed mental disorder. Prevalence rates are 12.7% for men and 21.3% for women. According to the DSM-IV, Major Depressive Disorder is diagnosed when five or more of the following symptoms have been present during a two-week period:
Estimates of depression affecting individuals with asthma range from 20% to 50%, with higher numbers frequently occurring in individuals living in the inner city. The co-morbidity of asthma and depression may be related to the daily experiences of living with a chronic disease. Missing school days, not being able to play with other children, waking up in the middle of the night with an asthma attack and going to the emergency room can lead to feelings of learned helplessness. Research has indicated that individuals with asthma may have a negative self-focusing style whereby they react to asthma attacks by blaming themselves and never attempt to get better. This type of learned helplessness can negatively affect self-efficacy, problem-solving skills, family interactions and lead to depression. Research has also indicated that individuals with asthma who are depressed may not adhere to their medical management plan and that they may have more long-term behavioral adjustment difficulties. By far, the most frequently used effective medications to treat depression are the selective serotonin re-uptake inhibitors. These treatments work centrally at the synaptic gap by blocking the re-uptake of serotonin and thus increase the amount of serotonin available in the synapse. Changing behavior Effective asthma management programs should also address cognitive and behavioral issues. It is critical that the individual with asthma acquires knowledge and makes behavioral changes to improve both physical and psychological well-being. Asthma management programs that include social support and effective teaching and learning can make a huge difference. It is imperative that the individual with asthma learns that the disease is controllable if medications are taken and they make lifestyle modifications. In your everyday clinical practice, effective management of depression and asthma also depends on patients self-disclosing disease-relevant information to you. Patients will disclose this information when they have developed a strong trusting relationship with you. Listening skills (empathy and positive reinforcement, both verbally and non-verbally) will allow you to build this type of relationship with your patient and will lead to the most effective outcomes for depression, asthma and other chronic diseases. Recommended Reading on Depression and Asthma Nejtek et al. Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic. Ann. Allergy. Asthma and Immunol. 2001;87:129-33 Chaney J, et al. An Experimental Examination of Learned Helplessness in Older Adolescents and Young Adults with Long-standing Asthma. J. Ped. Psych. 199;259-270. Katon W, Von Korff M, Lin E, Simon G. Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. Gen. Hosp. Psychiatry. 2001;3:138-44. |
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