Health care costs in persons with asthma and comorbid mental disorders: A systematic review

doi:10.1016/j.genhosppsych.2011.06.013

General Hospital Psychiatry

Volume 33, Issue 5, September–October 2011, Pages 443-453

https://doi.org/10.1016/j.genhosppsych.2011.06.013 Get rights and content

Abstract

Objective

The aim of this study was to systematically review the impact of comorbid mental disorders on health care costs in adult persons with asthma.

Method

A comprehensive search for studies investigating adult persons (≥18 years) with asthma was conducted. All studies were included, which allowed a comparison of health care utilization and costs between asthma patients with mental disorders and asthma patients without.

Results

The literature search revealed 1977 potentially relevant studies. Eighteen primary studies (20 publications) fulfilled the inclusion criteria. Mood disorders (n=14) and anxiety disorders (n=9) were studied most often. Increased rates of hospitalizations (odds ratio range, 0.9–6.1; n=7), emergency department visits (odds ratio range, 1.8–17.2; n=7) and general practitioner visits (standardized mean difference range, 0.1–1.1; n=6) were found in asthma patients with mental comorbidity. Indirect costs of work absence were investigated in two studies pointing in the same direction of increased costs. Evidence is sparse regarding other outcomes due to a lack of primary studies.

Conclusion

The present systematic review highlights a meaningful impact of comorbid mental disorders on health care utilization and costs in adult patients with asthma. Thus, psychodiagnostic routines and appropriate mental health treatments are needed to reduce health care costs in asthma care.

Section snippets

Methods

The data collection for this study was part of the project “Meta-analysis of quality of life and health care costs in somatically ill patients with comorbid mental disorders” [3], [12].

Results

The database search yielded 1977 potentially relevant articles (see Fig. 1). Eighteen primary studies (20 publications) fulfilled the inclusion criteria [6], [7], [8], [9], [10], [11], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31].

Discussion

The present systematic review investigated the association of comorbid mental disorders with health care utilization and costs in adult asthma patients based on 18 primary studies. Substantially increased health care utilization in asthma patients with mental comorbidities was found regarding asthma-related hospitalizations, asthma-related emergency department visits and general practitioner visits. Findings regarding indirect costs of work absence point in the same direction.

Asthma is one of

Conclusion

The results of this systematic review indicate a meaningful impact of comorbid mental disorders on health care utilization and costs in adult patients with asthma. Similar to other diseases [12], [13], patients with asthma and comorbid mental disorders show an increased health care utilization in terms of hospital readmissions, asthma-related emergency department visits and asthma-related general practitioner visits as well as increased indirect costs. Future studies, however, need to adjust

Acknowledgments

We would like to thank the Landesstiftung Baden-Württemberg for funding the research project.

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Citation Excerpt :
Additionally, the presence of mental disorders decreases compliance with pharmacological treatment, causing poor control of the disease, and consequently, a deficient health condition [43]. In a systematic review, an increased healthcare services use and a higher medical cost were documented in asthmatic patients with mental comorbidities [26]. This finding is consistent with the results of our study.
This study's objectives were to compare the prevalence of mental disorders and consumption of psychiatric medications in asthmatic subjects with non-asthmatic controls and identify risk factors associated with psychiatric conditions.
This was an epidemiological case-control study based on the 2020 European Health Survey in Spain self-reported data. Each asthmatic subject was paired with a non-asthmatic control. Study variables included demographics, use of healthcare services, comorbidities, and risky behaviours were compared.
There were 22,072 participants in the survey; 1151 cases and 1151 controls were selected. The prevalence of mental disorders (25.5% versus 13.4%; p < 0.001) and consumption of psychiatric medications (25.8% versus 15.6%; p < 0.001) were higher in cases than controls. In asthmatic subjects, female gender (OR 1.814; p = 0.001), age over 80 years (OR 2.558; p = 0.002), poor self-rated health (OR 2.047; p < 0.001), visits to a psychologist (OR 10.854; p < 0.001) and chronic pain (OR 1.938; p < 0.001) were independently associated with mental disorder diagnoses. Meanwhile, female sex (OR 1.710; p < 0.001), age over 80 years (OR 3.802; p < 0.001), poor self-rated health (OR 2.482; p < 0.001), visits to a psychologist (OR 2.694; p < 0.001) and chronic pain (OR 1.494; p = 0.012) were risk factors independently associated with psychiatric medication consumption.
The prevalence of psychiatric conditions were higher in asthmatic subjects. Female gender, older age, worse self-rated health, visits to a psychologist and chronic pain were associated with psychiatric conditions in asthmatic subjects.
Anxiety disorders and healthcare utilization: A systematic review
2020, Clinical Psychology Review
Anxiety disorders and related traits have become increasingly relevant to the study of physical health and health behaviors over the years. One important health behavior is healthcare utilization, and both over- and under-use have important implications within both personal and public health domains. Anxiety disorders are associated with reassurance-seeking, avoidance behaviors, and other characteristics and traits that may impact patterns of healthcare utilization. The current paper reviews the literature on the known associations between anxiety disorders and healthcare utilization, including studies (N = 70) that examined the association of healthcare utilization with generalized anxiety disorder, social anxiety disorder, panic disorder and agoraphobia, dental and blood-injection-injury phobias, and illness anxiety disorder/health anxiety. Overall, the majority of the studies reviewed indicate that anxiety disorders and health anxiety are associated with increased healthcare utilization across multiple care settings. In addition, there is preliminary but limited evidence that, in some cases, anxiety can be associated with delayed, irregular, or inconsistent use of healthcare services. More work is needed to fine-tune our understanding of the impact of anxiety disorders in healthcare settings.
Influence of post-traumatic stress disorder on asthma
2019, Presse Medicale
L’exposition à un évènement traumatique peut favoriser la survenue de troubles psychiatriques dont le trouble stress post-traumatique (TSPT) mais également des symptômes et/ou pathologies respiratoires, dont l’asthme.
Revue systématique de la littérature sur les données concernant l’influence d’un TSPT sur le développement d’un asthme ou l’aggravation d’un asthme préexistant au traumatisme.
Medline sur la période 1980–2018 avec pour mots-clés : « PTSD » ou « post-traumatic stress disorder » ou « post-traumatic stress disorder » et « asthme », avec les limites « Title/Abstract » ; les langues retenues étaient l’anglais et le français. Parmi 141 articles, 59 résumés sélectionnés ont donné lieu à une double lecture aboutissant à retenir 14 études.
Si le TSPT peut survenir 4 semaines après l’exposition à un traumatisme au cours duquel l’intégrité physique de la personne a été menacée, il peut également se développer plusieurs mois ou années plus tard. Le TSPT est un facteur de risque de développement de l’asthme et peut également aggraver les symptômes d’un asthme préexistant. Il est important de noter que cette relation a été démontrée sur différentes populations, divers traumatismes et quel que soit le genre et/ou l’ethnie. Outre son impact sur le développement de l’asthme, chez les patients asthmatiques, le TSPT peut être responsable d’un mauvais contrôle de l’asthme, de taux plus élevés de recours aux soins (visites au service des urgences et/ou hospitalisation pour asthme) et d’une moindre qualité de vie liée à l’asthme. La présente revue a également suggéré que l’étude de l’association entre le TSPT et l’asthme doit tenir compte des facteurs confondants potentiels, notamment le tabagisme et l’exposition aux poussières (ex : asthme consécutif aux attaques du World Trade Center). Les mécanismes possibles de l’association entre TSPT et asthme sont imparfaitement connus. Plusieurs facteurs incluant le système nerveux, l’axe hypothalamo-hypophyso-surrénalien, la réponse inflammatoire et le système immunitaire pourraient expliquer ce lien.
Le TSPT est un facteur de risque de développement de l’asthme et d’aggravation d’un asthme préexistant. Chez les patients asthmatiques, il est donc important de rechercher systématiquement un TSPT survenu après l’évènement traumatique ou préexistant à cet évènement. De plus, lors d’exposition à un évènement traumatique, une attention particulière doit être prêtée aux troubles somatiques dont l’asthme. La majorité des études ayant été menées sur des populations américaines ; il semble important de répliquer les études en population Européenne afin d’apporter de nouveaux éléments de connaissance sur cette association.
Exposure to a traumatic event may not only lead to a large variety of mental disorders, such as post-traumatic stress disorder (PTSD) but also respiratory symptoms and/or respiratory diseases, as asthma.
Systematic literature review of data on the impact of post-traumatic stress disorder on asthma.
Medline, on the period 1980–2018 with the following keywords: “PTSD” or “post-traumatic stress disorder” or “post-traumatic stress disorder” and “asthma”, limits “title/abstract”; the selected languages were English or French. Among 141 articles, 23 abstracts have given use to a dual reading to select 14 studies.
While PTSD may develop 4 weeks after being exposed to a traumatic event during which the physical integrity of the person has been threatened, it might also develop several months or years later. PTSD has been reported to be a risk factor for asthma and also a factor that might enhance a preexisting asthma. It is also important to note that this relation has been highlighted among several populations, traumatic events and regardless the gender and/or cultural factors. Despite its impact on the development of asthma, in asthmatic patients, PTSD may be responsible for poor asthma control, increased rates of healthcare use (visit in the emergency department and/or hospitalization for asthma) and poor asthma-related quality of life. The study of the association between PTSD and asthma have to take into account some potentially confounding factors, such as smoking status and dust exposure (e.g.: asthma following the terrorist attacks of the World Trade Center). Less is known regarding the potential mechanisms involved in the association between PTSD and asthma. Several factors including the nervous system, the hypothalamo-pituitary-adrenal axis, the inflammatory response and the immune system may explain the association.
PTSD is a risk factor for the development of asthma and for the worsening of preexisting asthma. In asthmatic patients, it is of primary importance to systematically screen potential PTSD that might be developed after a traumatic event or a preexisting traumatic condition. Moreover, after exposure to a traumatic event, a special attention needs to be paid to somatic reactions such as asthma. The majority of studies having been conducted on American samples, replicating studies among European samples appears of prime importance in order to add a body of knowledge on the association between somatic and psychiatric conditions.
Nonallergic Triggers and Comorbidities in Asthma Exacerbations and Disease Severity
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Citation Excerpt :
Cocaine and heroin insufflation have been directly correlated with worsening asthma symptoms and increased rates of exacerbation and should be avoided in all asthma patients.52 Anxiety and depression are very common comorbidities in patients with asthma53–56 and associated with increased health care utilization and high indirect costs from work-related absence (absenteeism).57,58 Patients with preexisting asthma are just as likely to suffer from worsening anxiety, whereas anxiety is likely to trigger asthma symptoms.
Anxiety Contributes to Poorer Asthma Outcomes in Inner-City Black Adolescents
2018, Journal of Allergy and Clinical Immunology: In Practice
The factors associated with poor asthma control, exacerbations, and health care utilization in black adolescents are complex and not well understood. Although psychological comorbidities such as anxiety are common in patients with asthma, these have not been studied in this population.
This study characterized anxiety and associated asthma features in a cohort of black inner-city adolescents with persistent asthma and determined the association between anxiety symptoms, persistent uncontrolled asthma, and prospective health care utilization over 1 year.
Eighty-six black adolescents were enrolled, phenotyped, and screened for anxiety symptoms with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A). Participants were telephoned every 2 months and a second study visit was completed at 1 year. Primary outcomes included persistent uncontrolled asthma, asthma exacerbations requiring systemic corticosteroids, and unscheduled health care utilization during the 1-year study period.
A total of 31% (n = 27) of adolescents had probable anxiety (ie, HADS-A score >7) and 27% (n = 23) had possible anxiety (ie, HADS-A score 5-7) at the baseline visit. Anxiety symptoms were associated with poorer asthma control, more impaired quality of life, and more insomnia symptoms. Adolescents with probable anxiety disorders also had increased odds of persistent uncontrolled asthma and emergency department utilization, with no differences in physician visits or systemic corticosteroid receipt.
Inner-city black adolescents with persistent asthma have a high prevalence of anxiety symptoms associated with poorer asthma control, impaired quality of life, insomnia, and increased prospective emergency department utilization for asthma. Routine screening for anxiety disorders may be useful in the clinical management of adolescents with asthma.
Cluster Analysis of Acute Care Use Yields Insights for Tailored Pediatric Asthma Interventions
2017, Annals of Emergency Medicine
Citation Excerpt :
Being homeless is associated with both greater asthma severity and greater likelihood of suboptimal treatment.29 Mental health comorbidities were also included because of their previously observed effect on lengthening hospital stays and increasing costs for children with asthma.30-32 Previous research indicates that asthma is common in children with sickle cell anemia and is associated with increased risk of sickle cell crises.18
We undertake this study to understand patterns of pediatric asthma-related acute care use to inform interventions aimed at reducing potentially avoidable hospitalizations.
Hospital claims data from 3 Camden city facilities for 2010 to 2014 were used to perform cluster analysis classifying patients aged 0 to 17 years according to their asthma-related hospital use. Clusters were based on 2 variables: asthma-related ED visits and hospitalizations. Demographics and a number of sociobehavioral and use characteristics were compared across clusters.
Children who met the criteria (3,170) were included in the analysis. An examination of a scree plot showing the decline in within-cluster heterogeneity as the number of clusters increased confirmed that clusters of pediatric asthma patients according to hospital use exist in the data. Five clusters of patients with distinct asthma-related acute care use patterns were observed. Cluster 1 (62% of patients) showed the lowest rates of acute care use. These patients were least likely to have a mental health–related diagnosis, were less likely to have visited multiple facilities, and had no hospitalizations for asthma. Cluster 2 (19% of patients) had a low number of asthma ED visits and onetime hospitalization. Cluster 3 (11% of patients) had a high number of ED visits and low hospitalization rates, and the highest rates of multiple facility use. Cluster 4 (7% of patients) had moderate ED use for both asthma and other illnesses, and high rates of asthma hospitalizations; nearly one quarter received care at all facilities, and 1 in 10 had a mental health diagnosis. Cluster 5 (1% of patients) had extreme rates of acute care use.
Differences observed between groups across multiple sociobehavioral factors suggest these clusters may represent children who differ along multiple dimensions, in addition to patterns of service use, with implications for tailored interventions.

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^☆: Duality of interest: The authors declare that there is no duality of interest associated with this manuscript.

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Psychiatric-Medical ComorbidityHealth care costs in persons with asthma and comorbid mental disorders: A systematic review☆

Abstract

Objective

Method

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgments

Gen Hosp Psychiatry

Gen Hosp Psychiatry

J Clin Epidemiol

Ann Allergy Asthma Immunol

Resp Med

Resp Med

Am J Med

Ann Allergy Asthma Immunol

J Psychosom Res

Resp Med

Chest

J Allergy Clin Immunol

J Clin Epidemiol

J Clin Epidemiol

J Clin Epidemiol

Quality of life in medically ill persons with comorbid mental disorders: a systematic review and meta-analysis

Psychother Psychosom

Bronchial asthma and mental disorders - a systematic review of empirical studies

Psychother Psych Med

Impact of depression and anxiety on quality of life, health behaviors, and asthma control among adults in the United States with asthma, 2006

J Asthma

Health care use and quality of life among patients with asthma and panic disorder

J Asthma

Health care costs in persons with diabetes mellitus and comorbid mental disorders-a systematic review

Diabetologia

Psychiatric-Medical Comorbidity
Health care costs in persons with asthma and comorbid mental disorders: A systematic review☆