Self-efficacy, depressive symptoms, and patients' expectations predict outcomes in asthma

Med Care. 2001 Dec;39(12):1326-38. doi: 10.1097/00005650-200112000-00008.


Background: Certain psychosocial variables are relatively unexplored as possible predictors of asthma outcomes.

Objective: To determine if asthma self-efficacy, depressive symptoms, and unrealistic expectations predict urgent care use and change in health-related quality of life measured by the Asthma Quality of Life Questionnaire and the SF-36 during 2 years.

Research design: Prospective cohort study in a primary care internal medicine practice at a tertiary care center in New York City.

Patients: Adults with moderate asthma who were fluent in either English or Spanish.

Measurements: At enrollment patients were interviewed in-person and completed a series of questionnaires including the Asthma Quality of Life Questionnaire (AQLQ), the SF-36, the Asthma Self-efficacy Scale, the Geriatric Depression Scale, and open-ended questions regarding their expectations of treatment. Patients also completed the AQLQ and SF-36 at various time intervals throughout the study and were interviewed by telephone every 3 months to record recent hospitalizations, emergency department visits and nonroutine office visits for asthma.

Results: A total of 224 patients were followed for a mean of 23.8 months. In hierarchical analysis, independent predictors of lower AQLQ scores were less self-efficacy, more depressive symptoms, expecting to be cured of asthma, requiring methylxanthines, being Hispanic or black, and having difficult or very difficult access to asthma care (all at P <0.05). Similar predictors were found for lower SF-36 scores. Another outcome, use of urgent care, was required by 60% of patients during the study period. Predictors of using urgent care were having more depressive symptoms, expecting a cure, being female, requiring oral beta-agonists, and having a history of prior hospitalizations for asthma (all at P <0.05).

Conclusions: Less asthma self-efficacy, more depressive symptoms, and unrealistic expectations predict worse asthma outcomes. These relatively unexplored patient-centered variables in asthma are potentially modifiable and may offer new ways to intervene to improve asthma outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Asthma / complications
  • Asthma / psychology*
  • Asthma / therapy*
  • Cohort Studies
  • Depression / complications*
  • Emergency Treatment / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • New York City
  • Prospective Studies
  • Quality of Life*
  • Self Efficacy*
  • Sickness Impact Profile
  • Surveys and Questionnaires
  • Treatment Outcome*