Toward Improving Our Understanding of the Link between Mental Health, Lung Function, and Asthma Diagnosis

摘要

A link between asthma and mental disorders, including post-traumatic stress disorder (PTSD), has been documented in numerous population-based studies over the past two decades. Despite relatively consistent findings, several key methodological challenges have hindered progress in our understanding of this relationship. First, the measurement of asthma is complex; the clinical diagnosis requires both clinical history and physical exam, as well as reversibility. NHLBI guidelines for diagnostic classification encompass both timing (intermittent or persistent) and severity (mild, moderate, or severe). Self-report of asthma does not have well-documented reliability or validity, nor do single-item self-report assessments offer much information about disease severity. Hardly any longitudinal, prospective, epidemiologic studies are designed at the outset to measure both mental health and physical health. Studies with detailed, well-validated measures of mental disorders tend to have vague or limited self-report measures of asthma, and those with detailed measurement of asthma and lung function have limited indicators of mental health. To our knowledge, only two studies have included objective measures of asthma/respiratory health in relation to mental health in representative, community-based samples. The first study included asthma diagnosed by physicians in a large, community-based sample of adults in Germany and found that severe asthma was robustly associated with anxiety and other mental disorders. In contrast, the association between mild asthma and mental disorders was considerably weaker, suggesting that the severity and persistence of asthma is relevant to this question. The second such study found that obstructive and restrictive respiratory disease defined using objective measurement of lung function via spirometry was associated with depression among adults in the United States. In sum, the vast majority of epidemiologic studies on asthma and mental health to date have relied on self-report of asthma.