Association between asthma and depression in Korean adults

Yeo Jin Kim; Jeoung Eun Kim; Ju Suk Lee

doi:10.4168/aard.2015.3.3.173

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Kim, Kim, and Lee: Association between asthma and depression in Korean adults

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(3): 173-179.

Published online: 29 May 2015

DOI: https://doi.org/10.4168/aard.2015.3.3.173

Association between asthma and depression in Korean adults

Yeo Jin Kim¹, Jeoung Eun Kim², Ju Suk Lee¹

¹Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

²Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Correspondence to: Ju Suk Lee. Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Paryong-ro, Masanhoewon-gu, Changwon 630-723, Korea. Tel: +82-55-290-6045, Fax: +82-55-290-6044, ljs8952194@lycos.co.kr

Received 16 January 2015 Revised 28 March 2015 Accepted 30 March 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

Asthma is one of the most common allergic diseases in which depression is an important comorbidity. However, little is known about the prevalence of depression in Korean adult asthmatics. This study was performed to evaluate the association between asthma and depression and to investigate the clinical characteristics of Korean adult asthmatics with depression.

Methods

Data were acquired from 18,066 men and women, aged older than 19 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys, which was conducted from 2010 to 2012. The presence of asthma was based on self-reported physician diagnosis of asthma in the Health Interview Surveys.

Results

The prevalence of asthma was 3.2%, and that of depression was 4.2%. In univariate analysis, adults with asthma were old age, marital status, unemployment, low education, low monthly family income, low number of household members, obesity (P<0.05) were significantly associated with asthma, but sex, residence area, and smoking status were not associated with asthma. The prevalence of hypertension and depression were higher in asthmatics (P<0.05), while diabetes mellitus was not associated with asthma. After adjustment for age, marital status, number of household members, monthly family income, body mass index, hypertension, unemployment, low educated status, and depression were associated with the higher prevalence of asthma (P<0.01). Depression was associated with female sex, unemployment, while it was not associated with lung function in asthmatics.

Conclusion

The results of this study show that depression may be an important risk factor for asthma in Korean adults. Further studies are needed to explore mechanisms responsible for the association between depression and asthma.

Keywords: Asthma, Depression, Respiratory function tests

Figures and Tables

Table 1

Demographic characteristics of subjects (n= 18,066)

Characteristic	No. (%)
Sex
Male	7,632 (42.3)
Female	10,434 (57.8)
Age (yr)
19-30	2,359 (13.1)
31-40	3,448 (19.1)
41-50	3,156 (17.5)
51-60	3,434 (19.0)
61-70	3,082 (17.1)
> 70	2,587 (14.3)
Marital status, n= 18,065
Married	13,394 (74.1)
Single (separated or divorced)	2,183 (12.1)
Never-married	2,488 (13.8)
Employment status, n= 17,821
Employed	10,480 (58.8)
Unemployed	7,341 (41.2)
Education, n= 17,860
< Middle school	4,606 (25.8)
Middle school	1,948 (10.9)
High school	5,939 (33.3)
> High school	5,367 (30.0)
Monthly family income (quartile), n= 17,856
1	3,538 (19.8)
2	4,597 (25.7)
3	4,841 (27.1)
4	4,880 (27.3)
No. of household members
1	1,368 (7.6)
2	4,741 (26.2)
3	4,461 (24.7)
4	5,040 (27.9)
>5	2,456 (13.6)
Residence area
Urban	14,315 (79.2)
Rural	3,751 (20.8)
Smoking status
Current	3,673 (20.3)
Ex-smoker	3,632 (20.1)
None	10,761 (59.6)
Body mass index (kg/m²), n= 17,961
< 23	8,074 (45.0)
23-25	4,187 (23.3)
> 25	5,700 (31.7)
Hypertension
Yes	4,117 (22.8)
No	13,949 (77.2)
Diabetes mellitus
Yes	1,506 (8.3)
No	16,560 (91.7)
Depression
Yes	758 (4.2)
No	17,308 (95.8)
Asthma
Yes	587 (3.2)
No	17,479 (96.8)

Table 2

Demographic characteristics according to the presence of asthma(n= 18,066)

Characteristic	Asthma (n=587)	Nonasthma (n= 17,479)	P-value
Sex			0.16
Male	231 (39.4)	7401 (42.3)
Female	356 (60.6)	10,078 (57.7)
Age (yr)			< 0.01
19-30	65 (11.1)	2,294 (13.1)
31-40	78 (13.3)	3,370 (19.3)
41-50	63 (10.7)	3,093 (17.7)
51-60	95 (16.2)	3,339 (19.1)
61-70	130 (22.1)	2,952 (16.9)
>70	156 (26.6)	2,431 (13.9)
Marital status, n= 18,065			< 0.01
Married	385 (65.6)	13,009 (74.4)
Single (separated or divorced)	129 (22.0)	2,054 (11.8)
Never-married	73 (12.4)	2,415 (13.8)
Employment status, n = 17,821			< 0.01
Employed	258 (44.3)	10,222 (59.3)
Unemployed	324 (55.7)	7,017 (40.7)
Education, n = 17,860			< 0.01
< Middle school	245 (42.0)	4,361 (25.2)
Middle school	70 (12.0)	1,878 (10.9)
High school	155 (26.6)	5,784 (33.5)
> High school	113 (19.4)	5,254 (30.4)
Monthly family income (quartile), n = 17,856			< 0.01
1	191 (33.0)	3,347 (19.4)
2	139 (24.0)	4,458 (25.8)
3	124 (21.4)	4,717 (27.4)
4	125 (21.6)	4,755 (27.5)
No. of household members			< 0.01
1	70 (11.9)	1,298 (7.4)
2	189 (32.2)	4,552 (26.0)
3	140 (23.9)	4,321 (24.7)
4	124 (21.1)	4,916 (28.1)
>5	64 (10.9)	2,392 (13.7)
Residence area			0.47
Urban	458 (78.0)	13,857 (79.3)
Rural	129 (22.0)	3,622 (20.7)
Smoking status			0.14
Current	104 (17.7)	3,569 (20.4)
Ex-smoker	133 (22.7)	3,499 (20.0)
None	350 (59.6)	10,411 (59.6)
Body mass index (kg/m²), n = 17,961			0.05
< 23	235 (40.2)	7,839 (45.1)
23-25	142 (24.3)	4,045 (23.3)
> 25	207 (35.4)	5,493 (31.6)
Hypertension			< 0.01
Yes	193 (32.9)	3,924 (22.4)
No	394 (67.1)	13,555 (77.6)
Diabetes mellitus			0.07
Yes	61 (10.4)	1,445 (8.3)
No	526 (89.6)	16,034 (91.7)
Depression			< 0.01
Yes	47 (8.0)	711 (4.1)
No	540 (92.0)	16,768 (95.9)

Values are presented as number (%).

Table 3

Adjusted odds ratio (OR) and their 95% confidence intervals (CIs) for the prevalence of asthma

Characteristic	Adjusted^* OR	95% CI	P-value
Age (yr)			0.24
19-30	0.788	0.465-1.335	0.38
31-40	0.781	0.520-1.173	0.23
41-50	0.646	0.438-0.952	0.28
51-60	0.698	0.510-0.957	0.26
61-70	0.839	0.649-1.085	0.18
>70	Reference
Marital status, n = 18,065			0.04
Married	0.763	0.547-1.149	0.20
Single	1.050	0.655-1.684	0.84
Never-married	Reference
Employment status, n = 17,821			< 0.01
Unemployed	1.429	1.192-1.712	< 0.01
Education			< 0.01
< Middle school	Reference
Middle school	0.884	0.662-1.182	0.41
High school	0.685	0.521-0.901	< 0.01
> High school	0.583	0.422-0.806	< 0.01
No. of household members			0.51
1	Reference
2	1.130	0.804-1.588	0.48
3	1.239	0.865-1.776	0.24
4	1.081	0.739-1.581	0.69
>5	0.962	0.642-1.443	0.85
Monthly family income (quartile)			0.21
1	Reference
2	0.785	0.613-1.007	0.06
3	0.779	0.592-1.025	0.08
4	0.844	0.636-1.120	0.24
Body mass index (kg/m²)			0.15
< 23	Reference
23-25	1.168	0.940-1.452	0.16
> 25	1.203	0.985-1.469	0.07
Hypertension
Yes	1.075	0.872-1.325	0.50
Depression
Yes	1.577	1.140-2.182	< 0.01

^*Adjusted for age, marital status, occupation, education, number of household members, monthly family income, body mass index, hypertension, depression.

Table 4

Demographic characteristics of asthma with and without depression (n= 587)

Characteristic	Asthma
Characteristic	Depressed (n= 47)	Nondepressed (n= 540)	P-value
Sex			< 0.01
Male	9 (3.9)	222 (41.1)
Female	38 (96.1)	318 (58.9)
Age (yr)			0.12
19-30	2 (4.3)	63 (11.7)
31-40	7 (14.9)	71 (13.1)
41-50	6 (12.8)	57 (10.6)
51-60	7 (14.9)	88 (16.3)
61-70	17 (36.2)	113 (20.9)
>70	8 (17.0)	148 (27.4)
Marital status			0.32
Married	31 (66.0)	354 (65.6)
Single (separated or divorced)	13 (27.7)	116 (21.5)
Never-married	3 (6.4)	70 (13.0)
Employment status, n=582			< 0.01
Employed	10 (21.7)	248 (46.3)
Unemployed	36 (78.3)	288 (53.7)
Education, n=583			0.65
<middle school	21 (45.7)	224 (41.7)
Middle school	7 (15.2)	63 (11.7)
High school	12 (26.1)	143 (26.6)
>High school	6 (13.0)	107 (19.9)
Monthly family income (quartile), n=579			0.26
1	18 (40.9)	173 (32.3)
2	13 (29.5)	126 (23.6)
3	5(11.4)	119 (22.2)
4	8 (18.2)	117 (21.9)
No. of household members			0.22
1	7 (14.9)	63 (11.7)
2	15 (31.9)	174 (32.3)
3	14 (29.8)	126 (23.3)
4	4 (8.5)	120 (22.2)
>5	7 (14.9)	57 (10.6)
Residence area			0.94
Urban	37 (78.7)	421 (78.0)
Rural	10 (21.3)	119 (22.0)
Smoking status			0.65
Current	31 (66.0)	319 (59.1)
Ex-smoker	7 (14.9)	97 (18.0)
None	9 (19.1)	124 (23.0)
Body mass index (kg/m²), n=584			0.69
< 23	20 (42.6)	215 (40.0)
23-25	9 (19.1)	133 (24.8)
>25	18 (38.3)	189 (35.2)

Values are presented as number (%).

Table 5

Lung function of asthma with and without depression (n=587)

Characteristic	Asthma		P-value
Characteristic	Depressed (n= 26)	Nondepressed (n= 263)	P-value
FVC (L)	2.82 ± 0.88	3.10 ± 0.84	0.11
FEV₁ (% predicted)	83.9 ± 20.0	80.4 ± 20.1	0.40
FEV₁/FVC (%)	0.72 ± 0.11	0.69 ± 0.13	0.27
FEF_25%-75% (L/sec)	2.39 ± 2.02	2.77 ± 1.95	0.35
PEFR (L/sec)	5.22 ± 1.97	5.47 ± 1.94	0.53

Values are presented as mean± standard deviation.

FVC, functional vital capacity; FEV₁, forced expiratory volume in one second; FEF_25%-75%, forced expiratory flow during 25%-75%; PEFR, peak expiratory flow rate.

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