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Self-efficacy, depressive symptoms, and patients' expectations predict outcomes in asthma
Abstract
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.
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“comorbid depression is often associated with a worse course of the physical disorder.114–116 A number of reasons could be involved here, but one of the most consistently documented is that depression is often associated with non-adherence to treatment regimens.112, 117, 118”
From The Costs of Depression (2012) · cites this paper as [114]
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Metadata
- Authors
- Mancuso, C. A., Rincon, M., McCulloch, C. E., & Charlson, M. E.
- Affiliations
- Hospital for Special Surgery (US)
- University of California, San Francisco (US)
- NewYork–Presbyterian Hospital (US)
- Corresponding author
- Mancuso, Carol A.
- Charlson, Mary E.
- Venue
- Medical Care
- Published
- 2001-12
- Volume
- 39
- Issue
- 12
- Pages
- 1326-1338
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2072744554
- Cited by
- 158
- References
- 63
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 3 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 9 · 2015: 8 · 2014: 3 · 2013: 6 · 2012: 13
- FWCI
- 3.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- asthma, asthma self-efficacy, depressive symptoms, patient expectations, health-related quality of life, asthma outcomes, Hispanic patients, methylxanthines, asthma hospitalization
- MeSH terms
- Adolescent, Adult, Asthma, Depression, Emergency Treatment, Female, Humans, Male, Middle Aged, New York City, Prospective Studies, Quality of Life, Surveys and Questionnaires, Cohort Studies, Treatment Outcome, Sickness Impact Profile, Self Efficacy
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