Anxiety, depression tied to more ER visits with childhood asthma

When young people with asthma have anxiety, depression or both, they’re more likely to visit the emergency room than if they didn’t have these mood disorders, a new study suggests.

Compared to young people with asthma but without either mood disorder, those with anxiety were 22% more likely to visit the emergency room for an asthma attack, and those with depression were 43% more likely to go to the ER for asthma flares. And when kids had both anxiety and depression, they were 80% more likely to visit the ER for asthma.

“If your child has asthma and a diagnosis of depression and/or anxiety, your child may need additional help managing medication, so you may need to take a more active role in helping them with asthma medications; or your child may need additional help with relaxation exercises and anxiety-reduction techniques in order to prevent asthma exacerbations,” said Dr. Naomi Bardach, lead author of the study and a researcher at the University of California, San Francisco.

“Parents can partner with their child’s doctor and mental health professional to learn how to support their child’s asthma management and how to support their child in using techniques like reducing stressors, practicing relaxation exercises, getting more sleep, getting exercise, getting support from family and friends, and taking prescribed medications to address depression or anxiety,” Bardach said by email.

Mental health conditions can impact how easy it is for parents to help younger children manage asthma symptoms and also make it more challenging for teens and young adults to take charge of their own asthma management, researchers note in Pediatrics.

Among other things, young people with depression or anxiety might have difficulty taking daily medicines to control asthma or avoiding things in the environment like cigarette smoke, dust, or pollen that might make asthma symptoms worse.

Mood disorders can also be accompanied by symptoms that might seem similar to an asthma flare-up, like shortness of breath, chest pain, or a rapid heartbeat.

Access and affordability of care may also play a role in determining how mood disorders impact the risk of ER visits with asthma, the study results suggest.

The researchers examined health insurance claims data from 2014 to 2015 for 65,342 children and young adults ages 6 to 21 with asthma. Overall, 11.2% had anxiety, 5.8% had depression and 7.7% had both mental health conditions.

Compared to people with private insurance and preferred provider organization (PPO) plans with the most flexible access to doctors and specialists, young people with private insurance and HMOS were 30% more likely to use the ER for asthma care.

And kids with HMOs through Medicaid, the government health program for the poor, were over three times more likely to get asthma care in the ER.

The study wasn’t designed to determine whether or how mood disorders might directly influence asthma severity or emergency department use. And it only looked at young people in Massachusetts, whereas the results might be different elsewhere in the country, the study team notes. It’s also possible that some people in the study had unrecognized mood disorders.

Even so, the results mirror previous research linking mood disorders to asthma flares in adults, said Dr. Deepa Rastogi, director of the pediatric asthma center at Children’s Hospital at Montefiore in New York City.

“Given prior studies linking asthma symptoms with anxiety and depression and this one linking it with more ED visits, it may be beneficial for parents to monitor their child’s anxiety and depression and appropriately seek help for its management,” Rastogi, who wasn’t involved in the study, said by email.

“Appropriate and timely management of anxiety and depression will prevent poor asthma control,” Rastogi added. “Since asthma symptoms can also create anxiety due to the sense of breathlessness, it is important to also simultaneously manage asthma better to keep it under control to prevent poor asthma control from contributing to greater anxiety.”