Psychological Factors in Severe Chronic Asthma

Abstract

Objective: Levels of psychological distress, social support factors, and emotional adjustment to illness were measured in a sample of patients with severe asthma. These were then examined in terms of their interrelationships and their ability to predict self-management knowledge. Method: A sample of 80 patients was recruited from a hospital-based asthma clinic designed for patients with severe asthma. Thirty-four percent of consecutive attenders approached took part. Morbidity and asthma management were recorded from case records. Anxiety, depression, social support, emotional adjustment to asthma and asthma knowledge were measured using self-report instruments selected for their acceptability and ease of administration. Results: Twenty-five percent of the sample had possible or definite caseness for anxiety; 10.3% had possible or definite caseness for depression. Twenty-five percent had inadequate social support in some way. Three independent attitudinal factors were found: emotional maladjustment to asthma, the doctor-patient relationship, and asthma-related stigma. Level of asthma knowledge was very low. None of the measures of psychosocial function chosen were predictive of asthma knowledge. Conclusions: Levels of asthma knowledge were dangerously low, despite apparently adequate educational intiatives. In addition, patients with severe asthma have high levels of distress, particularly of anxiety, even between attacks. Their attitudes to their illness are multifactorial, and are significantly correlated with emotional distress, morbidity indices and some demographic factors. While this may point the way to interventions designed to relieve patients' distress, the hypothesis that this might in turn relate to practical asthma knowledge was not confirmed.