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Anxiety in asthma: a systematic review and meta-analysis

Published online by Cambridge University Press:  12 January 2021

Gang Ye ,
David S. Baldwin  and
Ruihua Hou Open the ORCID record for Ruihua Hou [Opens in a new window]
Gang Ye
Affiliation:
Suzhou Guangji Hospital, Suzhou, Jiangsu, China
David S. Baldwin
Affiliation:
Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Ruihua Hou*
Affiliation:
Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
*
Author for correspondence: Ruihua Hou, E-mail: [email protected]
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Abstract

Background

Background: Growing evidence from observational studies indicates a high prevalence of anxiety in asthma. However, prevalence rates of coexisting anxiety symptoms and comorbid anxiety disorders vary widely across studies. We aimed to evaluate the associations between anxiety and asthma and provide more precise comorbidity estimates.

Methods

We systematically reviewed the literature from case-controlled studies and conducted a meta-analysis to evaluate the pooled prevalence estimates and risks of anxiety symptoms and anxiety disorders in asthma individuals. Screening, data extraction, and quality assessment were undertaken following PRISMA guidelines for preferred reporting of systematic reviews and meta-analysis. A random-effects model was used to calculate pooled prevalence rates. Meta-analysis was conducted using Review Manager 5.3. Multiple databases including PubMed, ScienceDirect, PsychINFO, and PsycARTICLES were searched for publications before 1 December 2019. The review protocol was registered on PROSPERO (ref: CRD42020176028).

Results

In total, 19 studies involving 106813 participants were included. The pooled prevalence of anxiety symptoms and anxiety disorders in individuals with asthma was 0.32 (95% CI 0.22–0.43) and 0.24 (95% CI 0.13–0.41), respectively. The risks of coexisting anxiety symptoms and comorbid anxiety disorders were significantly higher in asthma patients than in non-asthma controls indicated by OR 1.89 (95% CI 1.42–2.52; Z = 4.37; p < 0.001) and OR 2.08 (95% CI 1.70–2.56; Z = 6.97; p < 0.001), respectively. Anxiety symptoms and anxiety disorders occur at increased frequency among patients with asthma.

Conclusions

Our findings highlight the need for appropriate assessments for these comorbid conditions, which may help to identify a subgroup of patients who might benefit from interventions designed to reduce anxiety and enhance the quality of life.

Keywords

Anxietyasthmaprevalencereviewmeta-analysis
Type
Review Article
Information
Psychological Medicine , Volume 51 , Issue 1 , January 2021 , pp. 11 - 20
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Arif, A. A., & Korgaonkar, P. (2016). The association of childhood asthma with mental health and developmental comorbidities in low-income families. Journal of Asthma, 53(3), 277–281. doi:10.3109/02770903.2015.1089277.CrossRefGoogle ScholarPubMed
Berkson, J. (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics Bulletin, 2(3), 47–53.CrossRefGoogle ScholarPubMed
Bordoni, B., Marelli, F., Morabito, B., & Sacconi, B. (2017). Depression, anxiety and chronic pain in patients with chronic obstructive pulmonary disease: The influence of breath. Monaldi Archives for Chest Disease, 87(1),811. doi:10.4081/monaldi.2017.811.CrossRefGoogle Scholar
Bussing, R., Burket, R. C., & Kelleher, E. T. (1996). Prevalence of anxiety disorders in a clinic-based sample of pediatric asthma patients. Psychosomatics, 37(2), 108–115. doi:10.1016/S0033-3182(96)71576-1.CrossRefGoogle Scholar
Caccappolo-van Vliet, E., Kelly-McNeil, K., Natelson, B., Kipen, H., & Fiedler, N. (2002). Anxiety sensitivity and depression in multiple chemical sensitivities and asthma. Journal of Occupational and Environmental Medicine, 44(10), 890–901. doi:10.1097/00043764-200210000-00006.CrossRefGoogle ScholarPubMed
Carr, R. E., Lehrer, P. M., Rausch, L. L., & Hochron, S. M. (1994). Anxiety sensitivity and panic attacks in an asthmatic population. Behaviour Research and Therapy, 32(4), 411–418. doi:10.1016/0005-7967(94)90004-3.CrossRefGoogle Scholar
Castillo, E. F., Zheng, H., & Yang, X. O. (2018). Orchestration of epithelial-derived cytokines and innate immune cells in allergic airway inflammation. Cytokine & Growth Factor Reviews, 39,19–25. doi:10.1016/j.cytogfr.2017.11.004.CrossRefGoogle ScholarPubMed
Celano, C. M., Daunis, D. J., Lokko, H. N., Campbell, K. A., & Huffman, J. C. (2016). Anxiety disorders and cardiovascular disease. Current Psychiatry Reports, 18(11),101. doi:10.1007/s11920-016-0739-5.CrossRefGoogle ScholarPubMed
Centanni, S., Di Marco, F., Castagna, F., Boveri, B., Casanova, F., & Piazzini, A. (2000). Psychological issues in the treatment of asthmatic patients. Respiratory Medicine, 94(8), 742–749. doi:10.1053/rmed.1999.0766.CrossRefGoogle ScholarPubMed
Cooper, C. L., Parry, G. D., Saul, C., Morice, A. H., Hutchcroft, B. J., Moore, J., & Esmonde, L. (2007). Anxiety and panic fear in adults with asthma: Prevalence in primary care. BMC Family Practice, 8(1), 62. doi:10.1186/1471-2296-8-62.CrossRefGoogle ScholarPubMed
Del Giacco, S. R., Cappai, A., Gambula, L., Cabras, S., Perra, S., Manconi, P. E., … Pinna, F. (2016). The asthma-anxiety connection. Respiratory Medicine, 120,44–53. doi:10.1016/j.rmed.2016.09.014.CrossRefGoogle ScholarPubMed
Di Marco, F., Santus, P., & Centanni, S. (2011). Anxiety and depression in asthma. Current Opinion in Pulmonary Medicine, 17(1), 39–44. doi:10.1097/MCP.0b013e328341005f.CrossRefGoogle ScholarPubMed
Dorhofer, D. M., & Sigmon, S. T. (2002). Physiological and psychological reactivity in women with asthma: The effects of anxiety and menstrual cycle phase. Behaviour Research and Therapy, 40(1), 3–17. doi:10.1016/s0005-7967(00)00110-8.CrossRefGoogle ScholarPubMed
Dudeney, J., Sharpe, L., Jaffe, A., Jones, E. B., & Hunt, C. (2017). Anxiety in youth with asthma: A meta-analysis. Pediatric Pulmonology, 52(9), 1121–1129. doi: 10.1002/ppul.23689.CrossRefGoogle ScholarPubMed
Ferro, M. A., Van Lieshout, R. J., Scott, J. G., Alati, R., Mamun, A. A., & Dingle, K. (2016). Condition-specific associations of symptoms of depression and anxiety in adolescents and young adults with asthma and food allergy. Journal of Asthma, 53(3), 282–288. doi:10.3109/02770903.2015.1104694.CrossRefGoogle Scholar
Goodwin, R. D., Fergusson, D. M., & Horwood, L. J. (2004). Asthma and depressive and anxiety disorders among young persons in the community. Psychological Medicine, 34(8), 1465–1474. doi:10.1017/s0033291704002739.CrossRefGoogle Scholar
Goodwin, R. D., Jacobi, F., & Thefeld, W. (2003a). Mental disorders and asthma in the community. Archives of General Psychiatry, 60(11), 1125–1130. doi:10.1001/archpsyc.60.11.1125.CrossRefGoogle Scholar
Goodwin, R. D., Olfson, M., Shea, S., Lantigua, R. A., Carrasquilo, O., Gameroff, M. J., & Weissman, M. M. (2003b). Asthma and mental disorders in primary care. General Hospital Psychiatry, 25(6), 479–483. doi:10.1016/s0163-8343(03)00071-9.CrossRefGoogle Scholar
Grigsby, A. B., Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2002). Prevalence of anxiety in adults with diabetes: A systematic review. Journal of Psychosomatic Research, 53(6), 1053–1060. doi:10.1016/s0022-3999(02)00417-8.CrossRefGoogle ScholarPubMed
Han, Y. Y., Forno, E., Marsland, A. L., Miller, G. E., & Celedon, J. C. (2016). Depression, asthma, and bronchodilator response in a nationwide study of US adults. The Journal of Allergy and Clinical Immunology: In Practice, 4(1), 68-73 e1. doi:10.1016/j.jaip.2015.10.004.Google Scholar
Hawker, S., Payne, S., Kerr, C., Hardey, M., & Powell, J. (2002) Appraising the evidence: Reviewing disparate data systematically. Qualitative Health Research, 12(9), 1284–1299. doi: 10.1177/1049732302238251.CrossRefGoogle ScholarPubMed
Katon, W. J., Richardson, L., Lozano, P., & McCauley, E. (2004). The relationship of asthma and anxiety disorders. Psychosomatic Medicine, 66(3), 349–355. doi:10.1097/01.psy.0000126202.89941.ea.Google ScholarPubMed
Kohler, C. A., Freitas, T. H., Stubbs, B., Maes, M., Solmi, M., Veronese, N., … Carvalho, A. F. (2018). Peripheral alterations in cytokine and chemokine levels after antidepressant drug treatment for major depressive disorder: Systematic review and meta-analysis. Molecular Neurobiology, 55(5), 4195–4206. doi:10.1007/s12035-017-0632-1.Google ScholarPubMed
Laveneziana, P., Lotti, P., Coli, C., Binazzi, B., Chiti, L., Stendardi, L., … Scano, G. (2006). Mechanisms of dyspnoea and its language in patients with asthma. European Respiratory Journal, 27(4), 742–747. doi:10.1183/09031936.06.00080505.CrossRefGoogle ScholarPubMed
Lavoie, K. L., Bouthillier, D., Bacon, S. L., Lemiere, C., Martin, J., Hamid, Q., … Ernst, P. (2010). Psychologic distress and maladaptive coping styles in patients with severe vs moderate asthma. Chest, 137(6), 1324–1331. doi:10.1378/chest.09-1979.CrossRefGoogle ScholarPubMed
Lee, Y. C., Lee, C. T., Lai, Y. R., Chen, V. C., & Stewart, R. (2016). Association of asthma and anxiety: A nationwide population-based study in Taiwan. Journal of Affective Disorders, 189,98–105. doi:10.1016/j.jad.2015.09.040.CrossRefGoogle ScholarPubMed
Lehto, K., Pedersen, N. L., Almqvist, C., Lu, Y., & Brew, B. K. (2019). Asthma and affective traits in adults: A genetically informative study. European Respiratory Journal, 53(5), 1802142. doi:10.1183/13993003.02142-2018.CrossRefGoogle ScholarPubMed
Lu, Y., Feng, L., Lim, L., & Ng, T. P. (2013). Asthma, life events and psychiatric disorders: A population-based study. Social Psychiatry and Psychiatric Epidemiology, 48(8), 1273–1282. doi:10.1007/s00127-013-0655-5.CrossRefGoogle ScholarPubMed
Lu, Y., Ho, R., Lim, T. K., Kuan, W. S., Goh, D. Y., Mahadevan, M., … van Bever, H. P. (2014). Psychiatric comorbidities in Asian adolescent asthma patients and the contributions of neuroticism and perceived stress. Journal of Adolescent Health, 55(2), 267–275. doi:10.1016/j.jadohealth.2014.01.007.CrossRefGoogle ScholarPubMed
Martinez-Rivera, C., Vennera, M. D. C., Canete, C., Bardagi, S., & Picado, C. (2011). Psychological profile of patients with bronchial asthma and functional dyspnea: A comparison with a non-asthmatic population and impact on the disease. Archivos De Bronconeumologia, 47(2), 73–78. doi:10.1016/j.arbres.2010.10.003.CrossRefGoogle ScholarPubMed
McCauley, E., Katon, W., Russo, J., Richardson, L., & Lozano, P. (2007). Impact of anxiety and depression on functional impairment in adolescents with asthma. General Hospital Psychiatry, 29(3), 214–222. doi:10.1016/j.genhosppsych.2007.02.003.CrossRefGoogle ScholarPubMed
Meuret, A.E., Tunnell, N., & Roque, A. (2020). Anxiety disorders and medical comorbidity: Treatment implications. Advances in Experimental Medicine and Biology 1191 237–261. doi: 10.1007/978-981-32-9705-0_15.CrossRefGoogle ScholarPubMed
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D.G., & The PRISMA Group. (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. doi: 10.1371/journal.pmed.1000097.CrossRefGoogle ScholarPubMed
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., & Petticrew, M., … PRISMA-P Group. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1. doi:10.1186/2046-4053-4-1.CrossRefGoogle ScholarPubMed
Mrazek, D. A. (2003). Psychiatric symptoms in patients with asthma causality, comorbidity, or shared genetic etiology. Child and Adolescent Psychiatric Clinics of North America, 12(3), 459–471. doi:10.1016/s1056-4993(03)00028-2.CrossRefGoogle ScholarPubMed
Mueller, M., D'Addario, M., Egger, M., Cevallos, M., Dekkers, O., Mugglin, C., & Scott, P. (2018). Methods to systematically review and meta-analyse observational studies: A systematic scoping review of recommendations. BMC Medical Research Methodology, 18(1), 44. doi:10.1186/s12874-018-0495-9.CrossRefGoogle ScholarPubMed
Neuendorf, R., Harding, A., Stello, N., Hanes, D., & Wahbeh, H. (2016) Depression and anxiety in patients with inflammatory bowel disease: A systematic review. Journal of Psychosomatic Research, 87,70–80. doi:10.1016/j.jpsychores.2016.06.001.CrossRefGoogle ScholarPubMed
Ortega, A. N., Huertas, S. E., Canino, G., Ramirez, R., & Rubio-Stipec, M. (2002). Childhood asthma, chronic illness, and psychiatric disorders. Journal of Nervous & Mental Disease, 190(5), 275–281. doi:10.1097/00005053-200205000-00001.CrossRefGoogle ScholarPubMed
Ortega, A. N., McQuaid, E. L., Canino, G., Goodwin, R. D., & Fritz, G. K. (2004). Comorbidity of asthma and anxiety and depression in Puerto Rican children. Psychosomatics, 45(2), 93–99. doi:10.1176/appi.psy.45.2.93.CrossRefGoogle ScholarPubMed
Ortego, G., Villafañe, J.H., Doménech-García, V., Berjano, P., Bertozzi, L., & Herrero, P. (2016). Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis. Journal of Psychosomatic Research, 90,70–81. doi:10.1016/j.jpsychores.2016.09.006.CrossRefGoogle ScholarPubMed
Panek, M., Pietras, T., Szemraj, J., & Kuna, P. (2014). Association analysis of the glucocorticoid receptor gene (NR3C1) haplotypes (ER22/23EK, N363S, BclI) with mood and anxiety disorders in patients with asthma. Experimental & Therapeutic Medicine, 8(2), 662–670. doi:10.3892/etm.2014.1734.CrossRefGoogle ScholarPubMed
Perna, G., Ieva, A., Caldirola, D., Bertani, A., & Bellodi, L. (2002). Respiration in children at risk for panic disorder. Archives of General Psychiatry, 59(2), 185–186. doi:10.1001/archpsyc.59.2.185.CrossRefGoogle ScholarPubMed
Pine, D. S., Klein, R. G., Coplan, J. D., Papp, L. A., Hoven, C. W., Martinez, J., … Gorman, J. M. (2000). Differential carbon dioxide sensitivity in childhood anxiety disorders and nonill comparison group. Archives of General Psychiatry, 57(10), 960–967. doi:10.1001/archpsyc.57.10.960.CrossRefGoogle ScholarPubMed
Protsiuk, T. L., Yablon, O. S., Protsiuk, L. O., Bykovska, O. А., Herasymova, О. V., & Kapitan, T. V. (2019). Features of clinical manifestations of disease and psychological status of adolescents with bronchial asthma of various levels of control and the influence of risk factors. Wiadomoci Lekarskie, 72(5 cz 1), 795–801.CrossRefGoogle ScholarPubMed
Richardson, L. P., Lozano, P., Russo, J., McCauley, E., Bush, T., & Katon, W. (2006). Asthma symptom burden: Relationship to asthma severity and anxiety and depression symptoms. Pediatrics, 118(3), 1042–1051. doi:10.1542/peds.2006-0249.CrossRefGoogle ScholarPubMed
Rosenblat, J. D., & McIntyre, R. S. (2017). Bipolar disorder and immune dysfunction: Epidemiological findings, proposed pathophysiology and clinical implications. Brain Sciences, 7(11), 144. doi:10.3390/brainsci7110144.CrossRefGoogle ScholarPubMed
Roy-Byrne, P. P., Davidson, K. W., Kessler, R. C., Asmundson, G. J., Goodwin, R. D., Kubzansky, L., … Stein, M. B. (2008). Anxiety disorders and comorbid medical illness. General Hospital Psychiatry, 30(3), 208–225. doi:10.1016/j.genhosppsych.2007.12.006.CrossRefGoogle ScholarPubMed
Roy-Byrne, P., & Stein, M. B. (2001). Inspiring panic. Archives of General Psychiatry, 58(2), 123–124. doi:10.1001/archpsyc.58.2.123.CrossRefGoogle ScholarPubMed
Ryu, Y. J., Chun, E. M., Lee, J. H., & Chang, J. H. (2010). Prevalence of depression and anxiety in outpatients with chronic airway lung disease. Korean Journal of Internal Medicine, 25(1), 51–57. doi:10.3904/kjim.2010.25.1.51.CrossRefGoogle ScholarPubMed
Scott, K. M., Von Korff, M., Alonso, J., Angermeyer, M. C., Benjet, C., Bruffaerts, R., … Posada-Villa, J. (2008). Childhood adversity, early-onset depressive/anxiety disorders, and adult-onset asthma. Psychosomatic Medicine, 70(9), 1035–1043. doi:10.1097/PSY.0b013e318187a2fb.CrossRefGoogle ScholarPubMed
Scott, K. M., Von Korff, M., Ormel, J., Zhang, M. Y., Bruffaerts, R., Alonso, J., … Haro, J. M. (2007). Mental disorders among adults with asthma: Results from the world mental health survey. General Hospital Psychiatry, 29(2), 123–133. doi:10.1016/j.genhosppsych.2006.12.006.CrossRefGoogle ScholarPubMed
Sharma, B. B., Singh, S., Sharma, V. K., Choudhary, M., Singh, V., Lane, S., … Copeland, J. (2013). Psychiatric morbidity in chronic respiratory disorders in an Indian service using GMHAT/PC. General Hospital Psychiatry, 35(1), 39–44. doi:10.1016/j.genhosppsych.2012.09.009.CrossRefGoogle Scholar
Spinhoven, P., van Peski-Oosterbaan, A. S., Van der Does, A. J., Willems, L. N., & Sterk, P. J. (1997). Association of anxiety with perception of histamine induced bronchoconstriction in patients with asthma. Thorax, 52(2), 149–152. doi:10.1136/thx.52.2.149.CrossRefGoogle ScholarPubMed
Su, X., Ren, Y., Li, M., Zhao, X., Kong, L., & Kang, J. (2016). Prevalence of comorbidities in asthma and nonasthma patients: A meta-analysis. Medicine (Baltimore), 95(22), e3459. doi:10.1097/MD.0000000000003459.CrossRefGoogle ScholarPubMed
ten Thoren, C., & Petermann, F. (2000). Reviewing asthma and anxiety. Respiratory Medicine, 94(5), 409–415. doi:10.1053/rmed.1999.0757.CrossRefGoogle ScholarPubMed
Thomas, M., Bruton, A., Moffat, M., & Cleland, J. (2011). Asthma and psychological dysfunction. Primary Care Respiratory Journal, 20(3), 250–256. doi:10.4104/pcrj.2011.00058.CrossRefGoogle ScholarPubMed
Tzeng, N. S., Chang, H. A., Chung, C. H., Kao, Y. C., Chang, C. C., Yeh, H. W., … Chien, W. C. (2018). Increased risk of psychiatric disorders in allergic diseases: A nationwide, population-based, cohort study. Frontiers in Psychiatry, 9 133. doi:10.3389/fpsyt.2018.00133.CrossRefGoogle ScholarPubMed
von Leupoldt, A., Sommer, T., Kegat, S., Baumann, H. J., Klose, H., Dahme, B., & Buchel, C. (2009). Dyspnea and pain share emotion-related brain network. Neuroimage, 48(1), 200–206. doi:10.1016/j.neuroimage.2009.06.015.CrossRefGoogle ScholarPubMed
Weiser, E. B. (2007). The prevalence of anxiety disorders among adults with asthma: A meta-analytic review. Journal of Clinical Psychology in Medical Settings, 14(4), 297–307. doi:10.1007/s10880-007-9087-2.CrossRefGoogle Scholar
Wong, K. O., Hunter Rowe, B., Douwes, J., & Senthilselvan, A. (2013). Asthma and wheezing are associated with depression and anxiety in adults: An analysis from 54 countries. Pulmonary Medicine, 2013, 929028. doi:10.1155/2013/929028.CrossRefGoogle ScholarPubMed
Yang, C. J., Liu, D., Xu, Z. S., Shi, S. X., & Du, Y. J. (2017). The pro-inflammatory cytokines, salivary cortisol and alpha-amylase are associated with generalized anxiety disorder (GAD) in patients with asthma. Neuroscience Letters, 656,15–21. doi:10.1016/j.neulet.2017.07.021.CrossRefGoogle ScholarPubMed
Zhu, Z., Zhu, X., Liu, C. L., Shi, H., Shen, S., Yang, Y., … Liang, L. (2019). Shared genetics of asthma and mental health disorders: A large-scale genome-wide cross-trait analysis. European Respiratory Journal, 54(6), 1901507. doi:10.1183/13993003.01507-2019.CrossRefGoogle ScholarPubMed