Asthma is the most common chronic illness of childhood and adolescence, and the prevalence rate is increasing. Results from prior studies have suggested an increased prevalence of panic disorder and other anxiety disorders in populations of children and adults with asthma. However, these studies have been limited by having been carried out in tertiary-care settings with small numbers of patients and by a lack of information on the effect of comorbid anxiety and depressive disorders on asthma outcomes. In this epidemiologic study, we propose to (1) compare adolescents with panic disorder and asthma to those with asthma alone in order to measure the impact of panic comorbidity on the personal, familial and societal impacts of asthma such as symptom burden, functional status, quality of life, medical costs and on the quality of asthma self-management; (2) compare adolescents with asthma with one or more anxiety and depressive disorders to adolescents with asthma alone in order to measure the impact of anxiety/depression on the same outcomes as Aim #1. By self-management, we refer to both patients' and providers' roles in ongoing care of a recurrent or chronic illness. These analyses will control for severity of asthma, medical comorbidity and, in Aim #1, psychiatric comorbidity. In addition, two secondary aims include (3) estimating the prevalence of panic disorder and other anxiety and affective disorders in a population-based sample of 1,300 12- to 17-year-olds with asthma enrolled in an HMO and the accuracy of mental health diagnoses and quality of the mental health care provided for these anxiety and depressive disorders; and (4) demonstrating that adolescents with asthma and DSM IV anxiety and/or depressive disorders will have higher parental- and self-ratings of anxiety and depressive symptoms. We anticipate that the results of this study will increase epidemiologic knowledge regarding the effects of comorbid panic disorder and other important anxiety and depressive disorders in adolescents with asthma, and will increase awareness of the impact of these psychiatric disorders on asthma management and outcomes in adolescents. Our research team has over a decade of experience designing population-based intervention studies to improve outcomes for both patients with anxiety and depressive disorders as well as asthma within primary care settings. The results of this grant will be used to develop future treatment programs for adolescent patients with comorbid asthma and anxiety. ? ?
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