Depression, anxiety, and emergency department use for asthma

Naomi S. Bardach, Caroline Neel, Lawrence C. Kleinman, Charles E. McCulloch, Robert Thombley, Bonnie T. Zima, Jacqueline Grupp-Phelan, Tumaini R. Coker, Michael D. Cabana

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: Asthma is responsible for ∼1.7 million emergency department (ED) visits annually in the United States. Studies in adults have shown that anxiety and depression are associated with increased asthma-related ED use. Our objective was to assess this association in pediatric patients with asthma. METHODS: We identified patients aged 6 to 21 years with asthma in the Massachusetts All-Payer Claims Database for 2014 to 2015 using International Classification of Diseases, Ninth and 10th Revision codes. We examined the association between the presence of anxiety, depression, or comorbid anxiety and depression and the rate of asthma-related ED visits per 100 child-years using bivariate and multivariable analyses with negative binomial regression. RESULTS: Of 65 342 patients with asthma, 24.7% had a diagnosis of anxiety, depression, or both (11.2% anxiety only, 5.8% depression only, and 7.7% both). The overall rate of asthma-related ED use was 17.1 ED visits per 100 child-years (95% confidence interval [CI]: 16.7–17.5). Controlling for age, sex, insurance type, and other chronic illness, patients with anxiety had a rate of 18.9 (95% CI: 17.0–20.8) ED visits per 100 child-years, patients with depression had a rate of 21.7 (95% CI: 18.3–25.0), and patients with both depression and anxiety had a rate of 27.6 (95% CI: 24.8–30.3). These rates were higher than those of patients who had no diagnosis of anxiety or depression (15.5 visits per 100 child-years; 95% CI: 14.5–16.4; P, .001). CONCLUSIONS: Children with asthma and anxiety or depression alone, or comorbid anxiety and depression, have higher rates of asthma-related ED use compared with those without either diagnosis.

Original languageEnglish (US)
Article numbere20190856
JournalPediatrics
Volume144
Issue number4
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Hospital Emergency Service
Asthma
Anxiety
Depression
Confidence Intervals
International Classification of Diseases
Insurance
Chronic Disease
Databases
Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Bardach, N. S., Neel, C., Kleinman, L. C., McCulloch, C. E., Thombley, R., Zima, B. T., ... Cabana, M. D. (2019). Depression, anxiety, and emergency department use for asthma. Pediatrics, 144(4), [e20190856]. https://doi.org/10.1542/peds.2019-0856

Depression, anxiety, and emergency department use for asthma. / Bardach, Naomi S.; Neel, Caroline; Kleinman, Lawrence C.; McCulloch, Charles E.; Thombley, Robert; Zima, Bonnie T.; Grupp-Phelan, Jacqueline; Coker, Tumaini R.; Cabana, Michael D.

In: Pediatrics, Vol. 144, No. 4, e20190856, 01.01.2019.

Research output: Contribution to journalArticle

Bardach, NS, Neel, C, Kleinman, LC, McCulloch, CE, Thombley, R, Zima, BT, Grupp-Phelan, J, Coker, TR & Cabana, MD 2019, 'Depression, anxiety, and emergency department use for asthma', Pediatrics, vol. 144, no. 4, e20190856. https://doi.org/10.1542/peds.2019-0856
Bardach NS, Neel C, Kleinman LC, McCulloch CE, Thombley R, Zima BT et al. Depression, anxiety, and emergency department use for asthma. Pediatrics. 2019 Jan 1;144(4). e20190856. https://doi.org/10.1542/peds.2019-0856
Bardach, Naomi S. ; Neel, Caroline ; Kleinman, Lawrence C. ; McCulloch, Charles E. ; Thombley, Robert ; Zima, Bonnie T. ; Grupp-Phelan, Jacqueline ; Coker, Tumaini R. ; Cabana, Michael D. / Depression, anxiety, and emergency department use for asthma. In: Pediatrics. 2019 ; Vol. 144, No. 4.
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abstract = "BACKGROUND AND OBJECTIVES: Asthma is responsible for ∼1.7 million emergency department (ED) visits annually in the United States. Studies in adults have shown that anxiety and depression are associated with increased asthma-related ED use. Our objective was to assess this association in pediatric patients with asthma. METHODS: We identified patients aged 6 to 21 years with asthma in the Massachusetts All-Payer Claims Database for 2014 to 2015 using International Classification of Diseases, Ninth and 10th Revision codes. We examined the association between the presence of anxiety, depression, or comorbid anxiety and depression and the rate of asthma-related ED visits per 100 child-years using bivariate and multivariable analyses with negative binomial regression. RESULTS: Of 65 342 patients with asthma, 24.7{\%} had a diagnosis of anxiety, depression, or both (11.2{\%} anxiety only, 5.8{\%} depression only, and 7.7{\%} both). The overall rate of asthma-related ED use was 17.1 ED visits per 100 child-years (95{\%} confidence interval [CI]: 16.7–17.5). Controlling for age, sex, insurance type, and other chronic illness, patients with anxiety had a rate of 18.9 (95{\%} CI: 17.0–20.8) ED visits per 100 child-years, patients with depression had a rate of 21.7 (95{\%} CI: 18.3–25.0), and patients with both depression and anxiety had a rate of 27.6 (95{\%} CI: 24.8–30.3). These rates were higher than those of patients who had no diagnosis of anxiety or depression (15.5 visits per 100 child-years; 95{\%} CI: 14.5–16.4; P, .001). CONCLUSIONS: Children with asthma and anxiety or depression alone, or comorbid anxiety and depression, have higher rates of asthma-related ED use compared with those without either diagnosis.",
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AU - Neel, Caroline

AU - Kleinman, Lawrence C.

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AU - Zima, Bonnie T.

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N2 - BACKGROUND AND OBJECTIVES: Asthma is responsible for ∼1.7 million emergency department (ED) visits annually in the United States. Studies in adults have shown that anxiety and depression are associated with increased asthma-related ED use. Our objective was to assess this association in pediatric patients with asthma. METHODS: We identified patients aged 6 to 21 years with asthma in the Massachusetts All-Payer Claims Database for 2014 to 2015 using International Classification of Diseases, Ninth and 10th Revision codes. We examined the association between the presence of anxiety, depression, or comorbid anxiety and depression and the rate of asthma-related ED visits per 100 child-years using bivariate and multivariable analyses with negative binomial regression. RESULTS: Of 65 342 patients with asthma, 24.7% had a diagnosis of anxiety, depression, or both (11.2% anxiety only, 5.8% depression only, and 7.7% both). The overall rate of asthma-related ED use was 17.1 ED visits per 100 child-years (95% confidence interval [CI]: 16.7–17.5). Controlling for age, sex, insurance type, and other chronic illness, patients with anxiety had a rate of 18.9 (95% CI: 17.0–20.8) ED visits per 100 child-years, patients with depression had a rate of 21.7 (95% CI: 18.3–25.0), and patients with both depression and anxiety had a rate of 27.6 (95% CI: 24.8–30.3). These rates were higher than those of patients who had no diagnosis of anxiety or depression (15.5 visits per 100 child-years; 95% CI: 14.5–16.4; P, .001). CONCLUSIONS: Children with asthma and anxiety or depression alone, or comorbid anxiety and depression, have higher rates of asthma-related ED use compared with those without either diagnosis.

AB - BACKGROUND AND OBJECTIVES: Asthma is responsible for ∼1.7 million emergency department (ED) visits annually in the United States. Studies in adults have shown that anxiety and depression are associated with increased asthma-related ED use. Our objective was to assess this association in pediatric patients with asthma. METHODS: We identified patients aged 6 to 21 years with asthma in the Massachusetts All-Payer Claims Database for 2014 to 2015 using International Classification of Diseases, Ninth and 10th Revision codes. We examined the association between the presence of anxiety, depression, or comorbid anxiety and depression and the rate of asthma-related ED visits per 100 child-years using bivariate and multivariable analyses with negative binomial regression. RESULTS: Of 65 342 patients with asthma, 24.7% had a diagnosis of anxiety, depression, or both (11.2% anxiety only, 5.8% depression only, and 7.7% both). The overall rate of asthma-related ED use was 17.1 ED visits per 100 child-years (95% confidence interval [CI]: 16.7–17.5). Controlling for age, sex, insurance type, and other chronic illness, patients with anxiety had a rate of 18.9 (95% CI: 17.0–20.8) ED visits per 100 child-years, patients with depression had a rate of 21.7 (95% CI: 18.3–25.0), and patients with both depression and anxiety had a rate of 27.6 (95% CI: 24.8–30.3). These rates were higher than those of patients who had no diagnosis of anxiety or depression (15.5 visits per 100 child-years; 95% CI: 14.5–16.4; P, .001). CONCLUSIONS: Children with asthma and anxiety or depression alone, or comorbid anxiety and depression, have higher rates of asthma-related ED use compared with those without either diagnosis.

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