Depression Symptoms and Substance Abuse in Adolescents With Asthma
Authors: Lester Mitchell R. 
Published: October 2008

Bender BG. Ann Allergy Asthma Immunol. 2007;99(4):319–324

PURPOSE OF THE STUDY. To determine the frequency of substance abuse and examine rates of depression in youth with asthma.

STUDY POPULATION. The 2005 Youth Risk Behavior Survey (YRBS) was administered to 13 917 students in grades 9 through 12. Students from 159 high schools in 21 cities and 40 states produced a nationally representative distribution according to grade, gender, and race/ethnicity.

METHODS. The YRBS includes 2 questions about asthma. Only students with a physician diagnosis of asthma and symptoms within the previous year were considered to have asthma. The YRBS inquires about many health risk behaviors, and this study focused on substance-abuse queries including the use of cigarettes, smokeless tobacco, marijuana, cocaine, and ≥5 drinks within a couple of hours during the previous 30 days. The YRBS includes 5 questions that follow a progression of seriousness from sadness to suicide-attempt–induced injury. The report of suicidal thoughts was chosen as an indication of probable depression.

RESULTS. Of 13 917 questionnaires completed for the items studied, 2427 (17.4%) respondents had been diagnosed with asthma. A total of 720 students (5.2%) indicated asthma symptoms within the previous year, comprising the asthma group. All others were placed in the no-asthma group. All 5 risk behaviors occurred at least as often in students with asthma as not. Cocaine use (5.8% vs 3.7%; P = .004) and cigarette smoking (23.3% vs 20.5%; P = .02) occurred significantly more frequently in asthmatic respondents. Long-term smokers with asthma smoked more cigarettes than their nonasthmatic counterparts. Marijuana use and binge drinking exceeded 20% in both groups. Depressive feelings (45.3%) and suicidal thoughts (31.0%), plans (24.2%), actions (17.9%), and injuries (6.7%) occurred significantly more often in the asthma group (P &lt; .001 for all). As expected, the frequency of each reported event decreased as the severity indication increased. In the youth with asthma, use of all 5 health-endangering substances was higher in those with depression (P = .004 for alcohol use, P &lt; .001 for all others).

CONCLUSIONS. High school students with asthma reported much higher rates of depressive ideation and used health-endangering substances at a rate equal to or greater than their nonasthmatic peers. These risk behaviors signal a heightened need for intervention.

REVIEWER COMMENTS. The rates of substance abuse and depression in the cohort as a whole are staggering. That high school students with asthma are an especially at-risk group indicates our need for vigilance in identifying depressed or substance-abusing teens with asthma. In addition to some of the risk behaviors (eg, cigarette smoking) that lead to poorer asthma control, the behaviors themselves have a great impact on the students’ overall health and well-being. It is well known that depression and other psychological disorders are risks for fatal asthma, which provides another incentive for us to monitor and respond to risk-taking behaviors in this age group.