7 - Associations between Depressive Symptoms, Asthma Morbidity, and Neighborhood Perceptions Among Adolescents with Asthma

Publication Number: 4006.7

Rachel N. White, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Maria Fagnano, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Stephanie Betts, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Michael Mattiucci, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Sean M. Frey, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Jill Halterman, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States

Background: Depression is common among youth with asthma. In addition to symptom burden, socio-environmental factors, such as experiences in local communities, may exacerbate poor mental health outcomes in this population.

Objective: To examine whether neighborhood perceptions and asthma morbidity are associated with depression in a community-based cohort of teens with asthma.

Design/Methods: Baseline data were drawn from the Telemedicine Enhanced Asthma Management-Uniting Providers for Teens study, which enrolled 287 adolescents (age 11-17) with asthma (participation rate: 60%). Teens completed the Center for Epidemiological Studies Depression Scale for Children (CES-DC) (scores >15 suggest depressive symptoms) and an adapted Neighborhood Environment Walkability Scale (NEWS) (subscales: walkability, safety, social, food, aesthetics). Asthma morbidity was measured by symptom-free days (SFD)/past 2 weeks and the Asthma Control Test (ACT) (scores ≤19 indicate poor control). T-tests compared demographics, NEWS, SFD, and ACT ≤19 scores by CES-DC >15. Logistic regressions assessed associations between CES-DC >15, NEWS, and SFDs adjusting for age, sex, and income.

Results: Participants' mean age was 13.7 yrs; 58% were Black, 34% Hispanic, 46% female; 70% from households earning <$35,000. Overall, 43% reported depressive symptoms; they were more likely to be female (60%), have uncontrolled asthma (65% vs 46%; p=.002), and report fewer SFDs (6.8 vs 8.7 days; p<.001). Teens exhibiting depression reported lower mean NEWS scores (3.27 vs 3.42; p=.01), with the most significant subscale being safety (3.12 vs 3.56; p=.004) (Table 1).
In adjusted models, higher odds of depressive symptoms in teens remained independently associated with female sex (aOR 2.66, 95%CI 1.49 - 4.72), fewer SFDs (aOR 1.11, 95%CI 1.04-1.18), and lower safety subscale mean score (aOR 1.53, 95%CI 1.11-2.10) (Table 2). In other models, overall NEWS mean score and subscales were also examined; only lower overall quality mean score remained independently associated with depression (aOR 1.86, 95%CI 1.02-3.37).

Conclusion(s): Among adolescents with asthma, depressive symptoms were very common and linked to worse symptom control and poorer neighborhood perceptions, with safety emerging as the key driving subscale. Perceived overall neighborhood quality and safety each remained significantly associated with depression after adjusting for demographic and clinical factors. These findings highlight the need for clinical support in symptom control and integrated community approaches targeting feelings of safety to reduce mental health disparities for youth with asthma.

Table 1. Demographic, Clinical, and Neighborhood Correlates of Depressive Symptoms (CES-DC >15)


Table 2. Logistic Regression Predicting Depressive Symptoms (CES-DC >15) - Safety Subscale
Predictors were recoded for interpretability: "Female sex" (vs male), "Fewer symptom-free days" (vs more), and "Lower neighborhood safety" (vs higher). Analyses using overall mean NEWS score yielded similar results; depressive symptoms remained independently associated with fewer symptom-free days and lower perceived neighborhood safety.

Telemedicine Enhanced Asthma Management - Uniting Providers for Teens