Depression Among African American Women with Asthma

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Belinda W. Nelson, PhD1, Mary R. Janevic, PhD1, Georgiana Sanders, MD2, Lara J. Thomas, MPH1, & Noreen M. Clark, PhD1
for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor, MI, United States 2 Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, United States
1Center

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Background
• African American women are disproportionately affected by asthma, in terms of higher prevalence, and increased morbidity and mortality (1,2). • Depression has been linked with greater severity of asthma, lower perceived control (5), poorer outcomes (4,7), and worse health related quality of life(6). • Given the burden of asthma among African American women, it is important to understand how depression relates to managing this chronic disease.

Analysis
Age-adjusted logistic regression models were used to assess the relationship between asthma variables and the odds of reporting depression. Linear regression was used to assess the effect of asthma variables on current depressive symptoms (CES-D score), controlling for age.

Table 2: Psychosocial Characteristics
Mean or % Self-reported Depression CES-D Depression Scale (1-4) Asthma Severity (0-1) Asthma Management Challenges (1-5) Social Support for Asthma (0-4) 35.3% 1.9 0.6 2.0 2.7 4.7 7.6

Table 4: CES-D Depression and Asthma Outcomes
DV: CES-D Depression Mean Score Asthma Control Test Asthma Severity Asthma Management Challenges Social Support for Asthma Juniper Quality of Life Confidence in Asthma Management Parameter Estimate 0.21 0.76 0.32 p-value <0.0001 <0.0001 <0.0001

Table 1: Demographic Characteristics
Age (mean years) Income < $40,000 Some College/Associate’s Degree Head of Household Children in Household Employed Married/Partnered Divorced/Widowed/Separated Single/Never Married 43.3 65.7 % 44.0 % 67.2 % 53.8 % 66.4 % 28.1 % 25.4 % 45.9 %

Juniper Quality of Life (1-7) Confidence in Asthma Management (1-10)

-0.078 -0.19 -0.077

0.0491 <0.0001 0.0005

Objectives
We used baseline data from an ongoing randomized controlled trial of an asthmamanagement intervention for African American women (3) to address the following questions: 1. What is the prevalence of depression reported by African American women with asthma? 2. What is the relationship between depression and asthma control, asthma morbidity, and asthma management? •

Conclusions
In our sample of African American women, selfreported depression and depressive symptoms (CES-D) were associated with a number of asthmarelated variables. It is important that health care providers assess and understand women’s level of depression and how this may contribute to their ability to manage asthma. Interventions designed to enhance asthma self-management should consider means to assist women experiencing depression.

Results
The mean age of women in the study was 43 years, most were single, head of household, and employed (Table 1). • Prevalence of self-reported depression was 35% (Table 2). • The odds of reporting depression increased significantly with asthma severity, and the level of asthma management challenges; odds decreased with higher social support, quality of life, and confidence in asthma management. There was not a significant association between self-reported depression and asthma control. (Table 3). • CES-D depression score decreased significantly with greater confidence in ability to manage asthma and higher asthma related quality of life. The CESD score increased with worse asthma control, asthma severity, and asthma management challenges (Table 4).

Methods
A total of 405 women were recruited from the University of Michigan Health System for participation in a randomized controlled trial of the “Women of Color and Asthma Control” telephone-based asthmamanagement intervention. Baseline data were collected via phone survey and included measures of: self-reported depression (yes/ no), current depressive symptoms (Center for Epidemiologic Studies-Depression score), asthma severity (per NAEPP guidelines), asthma control (Asthma Control Test), asthma management challenges, asthmarelated quality of life (Juniper scale), social support for asthma, and confidence in asthma management.

Table 3: Self Reported Depression and Asthma Outcomes
DV: Self-reported Depression Asthma Control Test Asthma Severity Asthma Management Challenges Social Support for Asthma Juniper Quality of Life Confidence in Asthma Management Odds Ratio 1.21 4.80 2.16 95% C.I.
(0.93, 1.58) (1.75, 13.2) (1.65, 2.82)

References
1. American Lung Association (2012). Trends in Morbidity and Mortality. Epidemiology and Statistics Unit. Research and Health Education Division. 2. Centers for Disease Control and Prevention (CDC). Vital signs: Asthma prevalence, disease characteristics, and self-management education: United States, 2001--2009. MMWR Morb Mortal Wkly Rep. 2011 May 6;60(17):547-52 3. Janevic, M., Sanders, G.M., Thomas, L.J., Williams, D.M., Nelson, B., Gilchrist, E., Johnson, R.B. & Clark, N.M. (2012). Study protocol for Women of Color and Asthma Control: a randomized controlled trial of an asthma-management intervention for African American women. BMC Public Health 12:76 http:www.biomedcentral.com/1471-2458/12/76. 4. Eisner, M.D., Katz, P.P., Lactao, G., Iribarren, C. (2005). Impact of depressive symptoms on adult asthma outcomes. Annals of Allergy and Asthma Immunology, 94(5): 566-74. 5. Katz, P.P., Morris, A., Julian, L., Omachi, T., Yelin, E.H., Eisner, M.D. & Blanc, P.D. (2010). Onset of depressive symptoms among adults with asthma: results from a longitudinal observational cohort. Primary Care Respiratory Journal, 19(3): 223-30 6. Mancuso, C.A., Rincon, M., McCullough, C.E., & Charlson, M.E. (2001). Self-efficacy, depressive symptoms, and patients’ expectations predict outcomes in asthma. Medical Care, 39(12): 1326-38. 7. Walters, P., Schofield, P., Howard, L., Ashworth, M., & Tylee, A. (2001). The relationship between asthma and depression in primary care patients: a historical cohort and nested case study. PLOS One 6(6): e20750.

0.75 0.69 0.86

(0.62, 0.91) (0.58, 0.81) (0.77, 0.97)

Acknowledgements:
This research is supported by a grant (#1R18HL09427201) from the National Heart, Lung and Blood Institute.

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