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Effect of depressive symptoms on asthma intervention in urban teens.

ABSTRACT: The literature suggests that depression is an important comorbidity in asthma that can significantly influence disease management and quality of life (QOL).To study the effect of coexisting depressive symptoms on the effectiveness of self-management interventions in urban teens with asthma.We analyzed data from a randomized controlled trial of Puff City, a web-based, tailored asthma management intervention for urban teens, to determine whether depression modulated intervention effectiveness for asthma control and QOL outcomes. Teens and caregivers were classified as depressed based on responses collected from baseline questionnaires.Using logistic regression analysis, we found that a lower percentage of treatment students had indicators of uncontrolled asthma compared with controls (adjusted odds ratios <1). However, for teens depressed at baseline, QOL scores at follow-up were significantly higher in the treatment group compared with the control group for the emotions domain (adjusted relative risk, 2.08; 95% confidence interval, 1.2-3.63; P = .01; interpreted as emotional QOL for treatment students increased by a factor of 2.08 above controls). Estimates for overall QOL and symptoms QOL were borderline significant (adjusted relative risk, 1.57; 95% confidence interval, 0.93-2.63; P = .09; and adjusted relative risk, 1.72; 95% confidence interval, 0.94-3.15; P = .08; respectively). Among teens not depressed at baseline, no significant differences were observed between treatment and control groups in QOL domains at follow-up.Our results suggest that depression modified the relationship between the effectiveness of an asthma intervention and emotional QOL in urban teens. Further assessment of self-management behavioral interventions for asthma should explore the mechanism by which depression may alter the intervention effect.

SUBMITTER: Guglani L

PROVIDER: S-EPMC4017370 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Effect of depressive symptoms on asthma intervention in urban teens.

Guglani Lokesh L Havstad Suzanne L SL Johnson Christine Cole CC Ownby Dennis R DR Joseph Christine L M CL

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 20120815 4

<h4>Background</h4>The literature suggests that depression is an important comorbidity in asthma that can significantly influence disease management and quality of life (QOL).<h4>Objective</h4>To study the effect of coexisting depressive symptoms on the effectiveness of self-management interventions in urban teens with asthma.<h4>Methods</h4>We analyzed data from a randomized controlled trial of Puff City, a web-based, tailored asthma management intervention for urban teens, to determine whether ...[more]

PMID: 23010228

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Project description:IntroductionAsthma is a leading cause of youth morbidity in the USA, affecting >8% of youth. Adherence to inhaled corticosteroids (ICS) can prevent asthma-related morbidity; however, the typical adolescent with asthma takes fewer than 50% of their prescribed doses. Adolescents are uniquely vulnerable to suboptimal asthma self-management due to still-developing executive functioning capabilities that may impede consistent self-regulation and weaken attempts to use problem solving to overcome barriers to ICS adherence.Methods and analysisThe aims of this project are to improve adherence to ICS as an important step towards better self-management among adolescents aged 13-17 years diagnosed with asthma by merging the efficacious behaviour change strategies found in behavioural health interventions with scalable, adaptive mobile health (mHealth) technologies to create the Responsive Asthma Care for Teens programme (ReACT). ReACT intervention content will be developed through an iterative user-centred design process that includes conducting (1) one-on-one interviews with 20 teens with asthma; (2) crowdsourced feedback from a nationally representative panel of 100 adolescents with asthma and (3) an advisory board of youth with asthma, a paediatric pulmonologist and a behavioural health expert. In tandem, we will work with an existing technology vendor to programme ReACT algorithms to allow for tailored intervention delivery. We will conduct usability testing of an alpha version of ReACT with a sample of 20 target users to assess acceptability and usability of our mHealth intervention. Participants will complete a 4-week run-in period to monitor their adherence with all ReACT features turned off. Subsequently, participants will complete a 4-week intervention period with all ReACT features activated. The study started in October 2018 and is scheduled to conclude in late 2019.Ethics and disseminationInstitutional review board approval was obtained at the University of Kansas and the University of Florida. We will submit study findings for presentation at national research conferences that are well attended by a mix of psychologists, allied health professionals and physicians. We will publish study findings in peer-reviewed journals read by members of the psychology, nursing and pulmonary communities.

Project description:IntroductionAsthma-related morbidity is increased in overweight patients, yet providers are given little guidance on how to discuss weight and asthma management with overweight teens.ObjectiveWe piloted an electronic medical record (EMR)-based tailored discussion guide (TDG) and a brief provider training, to address weight management in overweight teens with asthma. The primary outcome was intervention impact on patient-reported asthma outcomes (e.g., asthma control and morbidity). Secondary outcomes included change in BMI, patient-centeredness, and change in healthy behaviors.MethodsTeens aged 13-18 years with persistent asthma and a body mass index ≥ 85th percentile for their age and sex were eligible. Parents of eligible teens were contacted before an upcoming appointment to allow teen enrollment during the clinic visit. Providers reviewed Motivational Interviewing (MI) concepts and were trained in the TDG for support of conversations around weight and asthma management. Measures included asthma outcomes retrieved from the EMR at 6- and 12-month post-baseline, teen impressions of patient-provider communication at 6-week post-enrollment, and teen report of healthy behaviors at 6- and 12-month post-baseline.ResultsOf 44 teens enrolled (77% African-American, 63% female), mean BMI for intervention (n=25) and control groups (n=19) at baseline were similar. Thirty participants (68%) completed a 6-week questionnaire. Compared to controls, at 6 months, intervention teens reported fewer days of limited activity and "uncontrolled asthma," but at 12 months, only restricted activity remained lower, and BMI was not reduced. Intervention teens reported clinic visits that were more patient-centered than controls, including discussion of asthma treatment options with provider, feeling ready to follow an asthma treatment routine, and receiving helpful tips about reaching a healthy weight. The healthy behavior "dinner with family" showed improvement for intervention teens at 6 and 12 months. The feasibility study also revealed a need to improve recruitment strategies and to streamline intervention delivery.ConclusionModest improvements in patient-reported asthma outcomes and health behaviors were observed. There was strong evidence that the TDG supports provider discussion of weight and asthma to create a more patient-centered conversation from the perspective of participating teens. Challenges to recruitment and clinic adaptation must be addressed before advancing to a full-scale trial.Trial registrationNCT02575326 Teen Asthma Control Encouraging a Healthier Lifestyle, www.cllinicaltrials.gov.

Project description:ImportanceProfessionally delivered integrated pest management (IPM) interventions can reduce home mouse allergen concentrations, but whether they reduce asthma morbidity among mouse-sensitized and exposed children and adolescents is unknown.ObjectiveTo determine the effect of an IPM intervention on asthma morbidity among mouse-sensitized and exposed children and adolescents with asthma.Design, setting, and participantsRandomized clinical trial conducted in Baltimore, Maryland, and Boston, Massachusetts. Participants were mouse-sensitized and exposed children and adolescents (aged 5-17 years) with asthma randomized to receive professionally delivered IPM plus pest management education or pest management education alone. Enrollment occurred between May 2010 and August 2014; the final follow-up visit occurred on September 25, 2015.InterventionsIntegrated pest management consisted of application of rodenticide, sealing of holes that could serve as entry points for mice, trap placement, targeted cleaning, allergen-proof mattress and pillow encasements, and portable air purifiers. Infestation was assessed every 3 months, and if infestation persisted or recurred, additional treatments were delivered. All participants received pest management education, which consisted of written material and demonstration of the materials needed to set traps and seal holes.Main outcomes and measuresThe primary outcome was maximal symptom days defined as the highest number of days of symptoms in the previous 2 weeks among 3 types of symptoms (days of slowed activity due to asthma; number of nights of waking with asthma symptoms; and days of coughing, wheezing, or chest tightness) across 6, 9, and 12 months.ResultsOf 361 children and adolescents who were randomized (mean [SD] age, 9.8 [3.2] years; 38% female; 181 in IPM plus pest management education group and 180 in pest management education alone group), 334 were included in the primary analysis. For the primary outcome, there was no statistically significant between-group difference for maximal symptom days across 6, 9, and 12 months with a median of 2.0 (interquartile range, 0.7-4.7) maximal symptom days in the IPM plus pest management education group and 2.7 (interquartile range, 1.3-5.0) maximal symptom days in the pest management education alone group (P = .16) and a ratio of symptom frequencies of 0.86 (95% CI, 0.69-1.06).Conclusions and relevanceAmong mouse-sensitized and exposed children and adolescents with asthma, an intensive year-long integrated pest management intervention plus pest management education vs pest management education alone resulted in no significant difference in maximal symptom days from 6 to 12 months.Trial registrationclinicaltrials.gov Identifier: NCT01251224.

Project description:In hospital settings, depression is an underdetected, undertreated, but prevalent and interfering illness that is associated with significant disability, morbidity, and mortality. A general hospital emergency department (ED) setting may be well suited to identify individuals with clinically significant depressive symptoms, facilitating their referral and treatment.Cross-sectional data of adult ED patients in a general hospital enrolling in a human immunodeficiency virus (HIV) screening study between February 2007 and March 2008 were analyzed. Data included demographic factors, the Center for Epidemiologic Studies Depression Scale (CES-D), alcohol and substance use history, sexual risk taking, and brief medical history. The primary outcome was a dichotomous measure of self-reported clinically significant depressive symptoms. Patients who scored >/= 16 on the CES-D were considered to screen positive for depressive symptoms.Of the 3,262 patients enrolled in the screening trial, 2,588 (79%) completed the survey between February 2007 and March 2008. Among these, 1,945 (75%) completed the psychosocial assessment battery; 596 (31%) survey completers screened positive for clinically significant depressive symptoms. In a multivariable model, female sex (RR = 1.36; 95% CI, 1.16-1.57), being unemployed (RR = 1.61; 95% CI, 1.32-1.93), and lower annual income (RR from 1.73 to 2.24) were associated with increased rates of clinically significant depressive symptoms (CES-D score >/= 16). Clinically significant depressive symptoms were more often present in patients who screened positive for alcohol dependence (RR = 1.48; 95% CI, 1.19-1.78), individuals reporting current smoking (RR = 1.39; 95% CI, 1.17-1.62), those with a prior psychiatric disorder diagnosis (RR = 2.20; 95% CI, 1.80-2.57) or history of hypertension (RR = 1.47; 95% CI, 1.18-1.79), and those who reported ever having sex with an HIV-infected partner (RR = 1.58; 95% CI, 1.08-2.09).This study identified a high frequency of undiagnosed clinically significant depressive symptoms among ED patients and highlights several new demographic and clinical correlates of such symptoms. Screening for and diagnosis of clinical depression in the ED setting introduces important opportunities for acute care providers and for the health care system as a whole.

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Effect of depressive symptoms on asthma intervention in urban teens.

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Effect of depressive symptoms on asthma intervention in urban teens.

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