Depression common in girls with nonatopic asthma
MedWire News: Adolescent girls with nonatopic asthma are around three times more likely to develop depression than their peers without asthma, results of a cross-sectional analysis show.
Salma Bahreinian (University of Alberta, Edmonton, Canada) and colleagues put forward both psychosocial and physiopathologic theories to explain the findings.
Irrespective of the underlying cause though, they recommend that "all health practitioners who see girls with asthma watch for depressive symptoms and treat comorbid depression seriously."
Although some studies have reported on comorbid anxiety and panic disorders in children with asthma, there is scarce literature on the comorbidity of asthma with depression in children that accounts for variations in depression by weight, gender, age, and ethnicity.
Furthermore, no studies have described the extent of multiple comorbidities in children by asthma phenotype, yet nonatopic asthma is a common variant of asthma in adolescent girls.
In the current study, the researchers recruited 431 children aged 11 to 14 years (136 with asthma and 295 without asthma) from the Study of Asthma, Genes, and Environment in Canada (SAGE).
Children were assessed by a pediatric allergist to confirm asthma, allergic rhinitis, and atopic dermatitis diagnosis, while atopic asthma was defined based on skin prick testing and allergic asthma based on the presence of allergic rhinitis or atopic dermatitis in addition to asthma.
Depressive symptoms were assessed using the Children's Depression Inventory-Short Form.
In logistic regression modeling, girls who had nonatopic or nonallergic asthma were three times more likely to have comorbid depressive symptoms compared with healthy girls (odds ratios=2.84 and 3.47, respectively) after adjusting for co-founders such as waist circumference and ethnicity.
In addition to this independent relationship, Bahreinian et al found that each 10-cm increase in the waist circumference of girls was associated with a 39% to 56% increase in the risk for depression.
In boys, by contrast, neither asthma nor waist circumference showed an association with depression.
Discussing the findings, the researchers note that psychosocial factors clearly play a role in the above relationships.
"Embarrassment, sadness, loneliness, and 'missing out on life' are commonly voiced by adolescents with asthma during focus group discussions," they note.
However, this should apply to both atopic dermatitis and allergic rhinitis in addition to the nonatopic state, which was not found.
They suggest that an underlying physiopathologic pathway involving the hormone leptin may be at work. This adipocytokine is a bioactive protein mainly secreted from adipose tissue, although leptin receptors have been detected in lung tissue.
Indeed, in previous studies, elevated leptin has been associated with a greater likelihood of nonatopic (but not atopic) asthma in children and has also been observed in individuals who present with depressive symptoms.
"Further studies are required to investigate this hypothesis," the researchers conclude in the journal Chest.
By Andrew Czyzewski