Asthma severity and psychopathology in a tertiary care department for children and adolescent

The purpose of this study was to evaluate the relationships between severe asthma, type and incidence of psychiatric problems in a pediatric population. A group of 92 children and adolescents (63 boys and 29 girls) (mean age 11.7) was investigated over one year by a pediatric pneumology/allergy service unit. The psychopathological problems of two groups were compared: "mild" (n = 12) and "moderate/severe" (n = 80) persistent asthma as defined by the National Heart Lung and Blood Institute (NIH). Various questionnaires were completed by the patients including the CBCL and the CPRS. The patients were examined by an experienced psychologist using the French version of the revised semi-structured diagnostic interview Kiddie-SADS. Twelve cases with intermittent or mild persistent asthma and 80 cases with moderate and severe persistent asthma were found. The child gender ratio and the social class of the parents did not differ significantly across groups. Moderate/severe asthma was more often associated with DSM-IV psychiatric disorders. Similarly, there were more symptoms in the severe group as indicated by several questionnaires. The hyperactivity index (CPRS) was higher for the severely affected group, who also exhibited fewer daytime activities. Social skills, school skills, and self esteem were, overall, on a similar level as those of the mildly affected group. Severe persistent asthma and moderate persistent asthma were not significantly different for the prevalence of psychiatric disorders and symptoms, even if children with severe asthma had a trend toward being diagnosed with more DSM-IV anxiety disorders and higher STAIC scores. Both of them had significantly higher total CBCL scores and CPRS hyperactivity index than intermittent and mild asthma. Moderate and severe persistent asthma appears to be associated with both incidence and particular categories of psychiatric problems, particularly anxiety disorders and anxious/depression symptoms. These observations suggest that it would be valuable to pay more attention to psychopathological problems of children suffering from severe asthma.