Emotional and Behavioral Problems in Children and Adolescents With Asthma and Their Association With Disease Severity

Asthma is a common chronic disease in childhood and is often associated with psychological comorbidities. This study aimed to assess emotional and behavioral problems in children and adolescents with asthma, comparing findings by disease severity.

An analytical cross-sectional study was conducted with children and adolescents (6-18 years) followed at a specialized asthma clinic. Patients were classified as having mild (GINA steps 1-2) or moderate/severe asthma (steps 3-5). Caregivers completed the Child Behavior Checklist for ages 6-18 (CBCL/6-18), validated in Portuguese.

One Hundred patients were evaluated (median age 11; 52% male); 67 had moderate/severe asthma. A high proportion of participants showed low total competence (74%), particularly in activity-related domains (58%), and elevated internalizing symptoms, such as anxiety and depressive symptoms (50%). Compared to the mild group, the moderate/severe group showed higher prevalence of clinical/borderline scores for depressive problems (37% vs. 12%), anxiety problems (43% vs. 18%), internalizing problems (61% vs. 27%), total problems (47% vs. 15%), somatic complaints (40% vs. 18%), and stress problems (31% vs. 6%) (all p < 0.05). Critical items were positive in 26 patients, mostly in the moderate/severe group.

We observed a high prevalence of emotional and behavioral problems in asthmatic patients, particularly in internalizing disorders. Our findings consistently demonstrated an association between various types of emotional and behavioral problems and asthma severity. These findings support the need for routine psychological screening and integration of mental health care in asthma management.