Depression, Anxiety, and Emergency Department Use for Asthma

To assess whether having a mental health diagnosis (anxiety and/or depression) increases the rate of asthma-related ED use in children with asthma.

The study identified 65 342 pediatric patients (aged 6 to 21 years old) with asthma from the Massachusetts All-Payer Claims Database for 2014–2015.

Eligible asthma patients were identified based on having a previous hospitalization, ambulatory visits with asthma as a diagnosis, and/or having asthma-related controller prescriptions. Patients with less severe asthma (those only using short-acting β-agonists) and/or a diagnosis of either cystic fibrosis or emphysema were excluded. Mental health diagnoses were determined by ICD 9 and 10 Revision Codes. The primary outcome was the rate of asthma ED visits per 100 child-years (the number of ED visits that occur in 100 children with asthma who are in the plan for 1 year) in patients with identifiable asthma. The association between the rate of asthma-related ED visits (per 100 child-years) and the presence of anxiety and/or depression was measured using bivariate and multivariable analyses with negative binomial regression.

Of 65 342 children with asthma, 24.7% had a diagnosis of anxiety and/or depression (11.2% anxiety only, 4.8% depression only, 7.7% both anxiety and depression). There were a total of 6835 asthma-related ED visits from 2014–2015, with the overall rate of asthma-related ED use being 17.1 ED visits per 100 child-years. After controlling for age, sex, insurance status, and presence of chronic illness, the rates of ED visits for patients with anxiety only, depression only, and both anxiety and depression were, respectively, 18.9, 21.7, and 27.6 ED visits per 100 child-years. Patients without a diagnosis of either anxiety or depression had a lower rate of ED use compared with their counterparts (15.5 ED visits per 100 child-years 95% CI: 14.1–16.3; P < .001 for all comparisons).

This study found that children with asthma and anxiety and/or depression had higher rates of asthma-related ED visits compared with those without a mental health diagnosis.

This is the first study to demonstrate an association between anxiety, depression, and asthma-related emergency department use in children, replicating results seen in adults. In this study, nearly one-quarter of children with asthma had anxiety and/or depression, which is 2–4 times higher than prevalence rates for these disorders in the general pediatric population. This at-risk population may potentially benefit from closer outpatient follow-up, more intensive counseling, and improved mental health care. Further studies to understand the relationship between asthma and mental health conditions may identify bidirectional factors at play.