The asthma-anxiety connection

Respir Med. 2016 Nov:120:44-53. doi: 10.1016/j.rmed.2016.09.014. Epub 2016 Sep 21.


Background: The literature reports a significant association between various mental disorders and asthma, in particular depression and/or anxiety, with some more robust data regarding anxiety disorders. However, the nature of this association remains largely unclear.

Objectives: (1) To test the hypothesis of a specific association of anxiety and depressive disorder (according to the DSM-IV) with asthma and (2) to test the bidirectional hypothesis of causality between asthma and psychiatric disorders.

Methods: Ninety-six adults were compared with 96 control subjects matched according to main socio-demographic variables (i.e., gender, age, marital status, cohabiting/non-cohabiting, and BMI). Subjects with asthma were divided according to GINA and ACT classifications. All subjects underwent Structured Clinical Interviews for DSM-IV Axis I (SCID-I) diagnosis.

Results: Significant association between asthma and lifetime anxiety disorders emerged (OR 3.03; p = 0.003); no significant association with other psychiatric diagnosis emerged. Moreover, lifetime and current anxiety were associated with asthma severity levels (p < 0.01 and p = 0.001 based on age). Asthma preceded anxiety in 48% of cases; in 52% of cases, anxiety preceded asthma, without significant group differences. The risk of asthma, particularly of severe, uncontrolled forms (p < 0.01), resulted higher in lifetime anxiety disorder patients (p = 0.003 and p = 0.001 based on age at onset). Current anxiety increased the risk of asthma, and that of an uncontrolled form (p < 0.05). Asthma increased the risk of lifetime anxiety disorders (p = 0.002 and p = 0.018 using ages). Intermittent asthma increased the risk of lifetime and current anxiety disorders (p < 0.01).

Conclusions: Anxiety disorders, in particular Lifetime Anxiety Disorders, represent the only psychiatric disorder significantly associated with asthma, with a possible bidirectional, anxiety-asthma relationship, each of which can be caused or result from the other.

Keywords: Anxiety; Asthma; DSM-IV; Depression; Psychiatric disorders; SCID.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Anxiety Disorders / complications*
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / psychology
  • Asthma / complications*
  • Asthma / epidemiology
  • Asthma / psychology*
  • Body Mass Index
  • Case-Control Studies
  • Comorbidity
  • Cost of Illness
  • Depressive Disorder / complications*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Female
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Prevalence
  • Risk
  • Severity of Illness Index
  • Young Adult