Risk behaviors and health-related quality of life among adults with asthma - The role of mental health status

Background: Previous research indicates that asthma is strongly associated with depressive disorders. Depression among persons with asthma is associated with poor adherence to medication regimens, more severe asthma, and poorer disease outcomes. The objective of our study was to examine the association of frequent mental distress (FMD) [ie, greater than or equal to 14 days in the past 30 days in which respondents reported that their mental health was not good] with modifiable risk behaviours (ie, smoking, physical inactivity, and obesity) and health-related quality of life among adults with asthma. Methods: The Behavioural Risk Factor Surveillance System is an ongoing, state-based survey that is conducted by random-digit dialing of noninstitutionalized US adults aged greater than or equal to 18 years. In 2001, all 50 states administered the asthma and risk behaviour questionnaires (15,080 questionnaires). A total of 12 states administered the health-related quality-of-life questionnaire (3,226 questionnaires). We estimated prevalences, 95% confidence intervals, odds ratios, and adjusted odds ratios (AORs) using a statistical software program to account for the complex survey design. Results: The prevalence of FMD among adults with asthma was 18.8%. After adjusting for sociodemographic characteristics, the overall associations between smoking and FMD (AOR, 1.9), and between physical inactivity and FMD (AOR, 1.7) were statistically significant. In addition, among those with asthma, persons with FMD were significantly more likely than those without FMD to report fair/poor general health, frequent physical distress, frequent activity limitations, frequent anxiety, and frequent sleeplessness. Conclusions: FMD is highly prevalent among persons with asthma, suggesting an apparent synergistic effect of these two conditions. The assessment of the mental health status of persons with asthma by health-care providers appears to be warranted and may prevent the emergence of risk behaviours yielding deleterious effects on the management of this disease.