Mediator Effect of Depressive Symptoms on the Association Between BMI and Asthma Control in Adults

doi:10.1378/chest.13-1796

Chest

Volume 146, Issue 2, August 2014, Pages 348-354

https://doi.org/10.1378/chest.13-1796 Get rights and content

BACKGROUND

Obesity has been associated with worse asthma control. Depression has also been shown to be disproportionally prevalent among patients with asthma and among patients with obesity. However, no studies have examined the mediating effect of depression on the obesity-asthma relationship. This study examined the extent to which depressive symptoms may mediate the obesity-asthma relationship in an adult sample.

METHODS

A total of 798 patients with physician-diagnosed asthma were recruited from the outpatient asthma clinic at Hôpital du Sacré-Cœur de Montréal. Patients provided demographic and medical history information and completed a battery of questionnaires, including the Beck Depression Inventory (BDI)-II and the Asthma Control Questionnaire (ACQ). BMI was calculated from self-reported height and weight.

RESULTS

Analyses adjusted for age, sex, years of education, cohabitation, and inhaled corticosteroid dose revealed an association between BMI and ACQ (β = 0.017, P = .026), between BMI and BDI-II (β = 0.189, P = .002), and between BDI-II and ACQ (β = 0.044, P < .001). However, when both BDI-II and BMI were entered into the same model, BDI-II (β = 0.044, P < .001) but not BMI (β = 0.009, P = .226) remained significantly associated with ACQ.

CONCLUSIONS

The results indicate that depression and a high BMI are both associated with worse asthma control. However, consistent with our hypotheses, the relationship between BMI and worse asthma control was mediated by depressive symptoms. Future studies should examine the precise role of depressive symptoms in both weight and asthma control.

Section snippets

Participants

The current results are a subanalysis of a larger project (the Psychological Risk Factors for Asthma Longitudinal study) that examined the psychologic risk factors for asthma morbidity. Details of the methodology are described elsewhere.19, 20 Briefly, consecutive adult patients with asthma presenting to the asthma clinic of the Hôpital du Sacré-Cœur de Montréal were recruited. Participants had to have been given a primary diagnosis of asthma as demonstrated by methacholine challenge,

Participant Characteristics

Participant characteristics are presented as counts and percentages or mean ± SD for categorical and continuous variables, respectively (Tables 1, 2). The overall sample was predominantly female and middle aged. Most were married or cohabitating, were employed, and had a high school education. Few were current smokers, although more than one-half had a history of smoking. Overall, the sample was moderately overweight (BMI adjusted, 28.3 ± 5.2 kg/m²; range, 17.0-46.8 kg/m²) and minimally

Discussion

The purpose of this study was to clarify the nature of the relationship between BMI and asthma control by concurrently examining the mediational role of depressive symptoms. As predicted, having a higher BMI was associated with worse asthma control. Results also indicated that patients with high levels of depressive symptoms had worse asthma control. Consistent with expectations, the relationship between BMI and asthma control was completely and uniquely mediated by depressive symptoms. That

Acknowledgments

Author contributions: K. L. L. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. M. B., S. L. B., and K. L. L. contributed to the study concept and design; M. B. and S. L. B. contributed to the data analysis and interpretation; and M. B., S. L. B., K. O., A. J., and K. L. L. contributed to the drafting and review of the manuscript for important intellectual content.

Financial/nonfinancial disclosures: The

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In OV/OB children with asthma, depressive symptoms predicted lower baseline FEV₁ (β = −0.67, standard error [SE] = 0.24, P = .008), CDI predicted vagal bias under emotion stress/arousal (β = 0.27, SE = 0.09, P = .009), and vagal bias predicted increased R_int (β = 3.55, SE = 1.54, P = .023).
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FUNDING/SUPPORT: Direct funding support for this study was provided by the Social Sciences and Humanities Research Counsel of Canada. Additional support was received from the Fonds de la recherche en santé du Québec (FRSQ) (Chercheur-boursier awards to Drs Bacon and Lavoie; scholarships to Mss Boudreau, Ouellet, and Jacob), the Canadian Institutes of Health Research (New Investigator awards to Drs Bacon and Lavoie; scholarship to Ms Boudreau), the FRSQ Respiratory Health Network (scholarship to Ms Boudreau), and the Fonds Québecois de la recherche sur la société et la culture (scholarship to Ms Jacob).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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Chest

Original ResearchAsthmaMediator Effect of Depressive Symptoms on the Association Between BMI and Asthma Control in Adults

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

Section snippets

Participants

Participant Characteristics

Discussion

Acknowledgments

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Chest

Respir Med

Nutrition

Gen Hosp Psychiatry

Chest

Respir Med

Ann Allergy Asthma Immunol

J Adolesc Health

J Am Diet Assoc

J Clin Epidemiol

Prog Neuropsychopharmacol Biol Psychiatry

Biol Psychiatry

Fitness of Canadian adults: results from the 2007-2009 Canadian Health Measures Survey

Health Rep

Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report

Causes and consequences of adult obesity: health, social and economic impacts in the United States

Asia Pac J Clin Nutr

Asthma: fact sheet no. 307. World Health Organization website

Global strategy for asthma management and prevention - 2010. Global Initiative for Asthma website

Asthma control in Canada remains suboptimal: The Reality of Asthma Control (TRAC) study

Can Respir J

The association between asthma control and health care utilization, work productivity loss and health-related quality of life

J Occup Environ Med

Original Research
Asthma
Mediator Effect of Depressive Symptoms on the Association Between BMI and Asthma Control in Adults