Racial marginalization and socioeconomic disadvantage are associated with greater baseline depressive symptoms in individuals with asthma, with depressive symptoms decelerating across adolescence and into young adulthood and then increasing across young adulthood and into adulthood. These were among study findings published in the Journal of Pediatric Psychology.
Asthma accompanied by depression is associated with greater asthma morbidity and health care utilization. However, studies of depressive symptom trajectories in individuals with asthma are lacking. Investigators sought to identify depressive symptom trajectories in those with and without asthma, and to determine predictors of depression at baseline and over time in adolescents and young adults with asthma.
The investigators conducted a retrospective study using data from the US National Longitudinal Study of Adolescents to Adult Health (Add Health) that included individuals with asthma at baseline (n=965; mean [SD] age at baseline 15.48 [2.42] years; 53% girls; 72% White, 21% Black, 2% American Indian and Alaska Native [AIAN]; 12% Hispanic) as well as individuals without asthma at baseline (n=7392).
All participants were observed though 4 waves (ie, time periods). Wave 1 data were collected across the 1994 to 1995 academic year (participants in grades 7 to 12; age range, 12 to 19 years) and wave 2 was conducted 1 year after data collection for wave 1; combined, the waves 1 and 2 were considered to represent adolescence. Wave 3 data, representing young adulthood, were collected from 2001 to 2002 (participants 18 to 26 years of age) and wave 4 data (adulthood) were collected in 2008 (participants 24 to 32 years of age). Through all waves, all participants self-reported their depressive symptoms. The data analysis included persistence of asthma and demographics as covariates; depressive symptom trajectories and their predictors were identified using latent growth curve modeling (LGCM).
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The findings suggest that adolescence may be a critical developmental period for the screening and treatment of depressive symptoms given higher baseline levels of depressive symptoms and the identified decelerations in depressive symptoms across adolescence and into young adulthood.
Among individuals with and without asthma, investigators found no significant differences in depressive symptom trajectories (similar curvilinear trajectories).
In analyzing data on those with asthma, the investigators found that depressive symptoms over time were represented by a quadratic shape, revealing depressive-symptom linear deceleration during adolescence (waves 1 and 2) and depressive-symptom acceleration across young adulthood (wave 3) into adulthood (wave 4) (mean level of depressive symptoms at baseline in the quadratic model, Mintercept=5.73; variability in intercept values across participants, Varintercept=11.314; linear slope [revealing significant decreases initially] across time, Mlinear=-.38; Varlinear=0.054; quadratic slope [following the initial decreases revealed symptom acceleration, Mquad=.03]; all P <.001).
The significant association between intercept and linear slope (Cov= -.423; P <.001) indicates individuals with higher depressive symptoms have greater linear depressive-symptom decelerations. Higher baseline levels of depressive symptoms and the decelerations in depressive symptoms across adolescence into young adulthood suggest a critical developmental period for screening and treatment of depressive symptoms during adolescence.
Investigators noted greater baseline depressive symptoms were associated with older age (beta [ß {slope of the line through a regression of data points}] = 0.19; P <.001), lower parent education (ß = -0.57; P <.001), designated female at birth (ß = 0.58; P <.001), and identifying as Black (ß = 0.31; P =.04).
Faster quadratic accelerations (ß = 3.33; P =.007) and faster linear symptom decelerations (ß = -1.98; P =.005) were noted among AIAN individuals. Faster symptom accelerations (ß = 0.73; P <.001) and faster linear symptom decelerations (ß = -0.56; P <.001) were noted among older individuals. The adjusted alpha level is P =.006 using the Bonferroni alpha inflation procedures, and when applied, all results remained significant except the association of baseline depressive symptoms and identifying as Black.
Study limitations include under-representations of individuals with racial/ethnic minority backgrounds, the use of self-reported asthma diagnoses, lack of accounting for disease severity, and lack of asthma medication data.
“The findings suggest that adolescence may be a critical developmental period for the screening and treatment of depressive symptoms given higher baseline levels of depressive symptoms and the identified decelerations in depressive symptoms across adolescence and into young adulthood,” the investigators concluded. They added “When examining predictors of depressive symptom trajectories for those with asthma, socioeconomic disadvantage and racial marginalization were associated with greater baseline depressive symptoms.” Notably, AIAN individuals demonstrated worse trajectories across young adulthood and adulthood, although they revealed more favorable trajectories in adolescence.
