Depressive symptoms are associated with poor asthma control in adults and adolescents

Background Clinically significant depressive symptoms are common among those with asthma, yet their impact on asthma outcomes is not well defined. Objective Evaluate the association between depressive symptoms and asthma outcomes. Methods In this pooled cross-sectional analysis of 741 participants aged ≥15 years from three multicenter studies, we examined whether depressive symptoms (through use of validated surveys) were associated with asthma control, symptoms, quality of life, lung function, and exacerbations. Associations between clinically significant depressive symptoms and asthma-related outcomes were analyzed using analysis of covariance (ANCOVA) and corrected for included age, sex, race, body mass index (BMI), education level, and parent study to account for potential confounding and between-study differences. Results Clinically significant depressive symptoms were present in a substantial proportion of participants (n=483/65.2%) and were associated with worse asthma control, with higher odds of poorly controlled asthma (Odds Ratio 1.98; 95% CI 1.45–2.71; p <0.001). 68.1% (n=329) of participants with depressive symptoms had poorly controlled asthma compared with 50.2% (n=130) without depressive symptoms. Symptom burden was greater among those with depressive symptoms, (0.727 vs 0.768; p <0.001). Asthma-specific quality of life scores were lower among those with depressive symptoms (4.85 vs 5.35; p <0.001). Health-related quality of life was also lower among those with depressive symptoms (63.62 vs 73.34; p <0.001). Depressive symptoms were not associated with spirometric measures or exacerbation frequency. Conclusions Clinically significant depressive symptoms in adults with uncontrolled asthma are associated with worse perceived disease burden and quality of life but not with objective measures of lung function or exacerbation risk.