Depressive Symptoms and Adherence to Asthma Therapy After Hospital Discharge

To evaluate the effect of depressive symptoms on adherence to therapy after discharge in patients hospitalized for asthma exacerbations. Prospective cohort study in which depressive symptoms were assessed during hospitalization and use of asthma medications was electronically monitored for 2 weeks a...

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Veröffentlicht in:Chest Jg. 130; H. 4; S. 1034 - 1038
Hauptverfasser: Smith, Amena, Krishnan, Jerry A., Bilderback, Andrew, Riekert, Kristin A., Rand, Cynthia S., Bartlett, Susan J.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Northbrook, IL Elsevier Inc 01.10.2006
American College of Chest Physicians
Schlagworte:
adherence
Administration, Oral
Adrenal Cortex Hormones - administration & dosage
Adult
Adult and adolescent clinical studies
Androstadienes - administration & dosage
Anti-Asthmatic Agents - administration & dosage
Asthma
Asthma - drug therapy
Asthma - epidemiology
Asthma - psychology
Biological and medical sciences
Cardiology. Vascular system
Chronic obstructive pulmonary disease, asthma
Cohort analysis
Cohort Studies
Comorbidity
Depression
Depression - complications
Depression - epidemiology
Depression - psychology
Directly Observed Therapy - psychology
Drug dosages
Education
Female
Fluticasone
Hospitalization
Hospitals, Teaching
Humans
Inhalers
Inner city
Male
Medical sciences
Mental depression
Metered Dose Inhalers
Middle Aged
Miscellaneous
Mood disorders
Patient Compliance - psychology
Patient Discharge
Personality Inventory
Pneumology
Poverty Areas
Prednisone - administration & dosage
Prospective Studies
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Sociodemographics
Statistics as Topic
Steroids
Urban Population - statistics & numerical data
Variables
inner city
MDI
adherence
CES-D
ICS
asthma
depression
OCS
Mood disorder
Lung disease
Hospital discharge
Urban environment
Respiratory disease
Cardiovascular disease
Depression
Adhesion
Asthma
Treatment
Bronchus disease
Treatment compliance
Obstructive pulmonary disease
ISSN:0012-3692, 1931-3543
Online-Zugang:Volltext
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Zusammenfassung:To evaluate the effect of depressive symptoms on adherence to therapy after discharge in patients hospitalized for asthma exacerbations. Prospective cohort study in which depressive symptoms were assessed during hospitalization and use of asthma medications was electronically monitored for 2 weeks after discharge. Inner-city academic hospital in Baltimore, MD. Patients were 59 adults with a mean age of 43.2 ± 10.9 years (± SD), who were mostly female (64%), African American (80%), and were hospitalized for an asthma exacerbation. Depressive symptoms were assessed with the Center for Epidemiological Studies-Depression scale. Electronic monitors were used to evaluate inhaled corticosteroid and oral corticosteroid use for up to 2 weeks after discharge. Forty-one percent of patients had high levels of depressive symptoms. Mean adherence to therapy was significantly lower in patients with (vs without) high levels of depressive symptoms (60 ± 26% vs 74 ± 21%, p + 0.02). Even after controlling for age, gender, and education, depressive symptoms were a significant and independent predictor of poorer adherence. High levels of depressive symptoms were associated with a 11.4-fold increase (95% confidence interval, 2.2 to 58.2) in the odds of poor adherence to therapy after adjustment for potential confounders. Depressive symptoms are common in inner-city adults hospitalized for asthma exacerbations and identify a subset of patients at high risk for poor adherence to asthma therapy after discharge. Further research is needed to determine if screening for and treating depression improves adherence and asthma outcomes in this population.
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ISSN:0012-3692
1931-3543
DOI:10.1378/chest.130.4.1034