Association of depression, anxiety with asthma outcomes and allergic comorbidities: results from the National Health Interview Survey

Background: Depression and anxiety are common among asthmatic patients and are associated with asthma control. However, there is limited research on the nationwide prevalence of mental disorders and the association of depression/anxiety with asthma outcomes, remission and allergic comorbidities. Objective: Our study aimed to evaluate the effect of depression/anxiety on asthma outcomes and allergic comorbidities. Methods: This study used data from 231,460 adults (19,195 current asthma, 11,972 ever asthma, 200,293 never asthma) participated in the National Health Interview Survey 2010-2022. Depression/anxiety were identified based on self-reported frequency and intensity of mental symptoms. Multivariable logistic regressions and trend tests were employed. Results: Compared with never asthma group, the morbidities of depression/anxiety among participants with current asthma (13.82 % with depression, 25.43 % with anxiety) and ever asthma (8.44 % with depression, 19.12 % with anxiety) were much higher. Depression and anxiety were associated with increased asthma risk (depression: OR 1.34, 95%CI 1.25-1.44; anxiety: OR 1.45, 95%CI 1.38-1.52) and reduced likelihood of asthma remission (depression: OR 1.19, 95%CI 1.04-1.35; anxiety: OR 1.17, 95%CI 1.06-1.28). Patients with depression/anxiety experienced more exacerbations (depression: OR 1.31, 95%CI 1.15-1.50; anxiety: OR 1.30, 95%CI 1.17-1.44), and more comorbid allergic diseases (depression: 1.15 vs 0.99, p = 0.018; anxiety: 1.20 vs 0.95, p < 0.001), including respiratory, skin and food allergy, compared to those without depression/anxiety. Conclusion: Depression and anxiety were associated with an increased risk of asthma, poorer symptoms control and a reduced likelihood of clinical remission. Asthmatic patients experiencing psychological distress were also at an elevated risk of developing comorbid allergic conditions.