Research indicates that adults with asthma as well as depression, anxiety, or both demonstrate higher asthma-related healthcare use, including emergency department (ED) visits. Naomi S. Bardach, MD, MAS, and colleagues sought to determine whether this pattern was true for pediatric patients with the same diagnosis. “It is possible that pediatric asthma patients with depression or anxiety might not have the same increase in ED visits as we see in adults, if their parents—who may have a protective effect—are helping to manage their asthma,” explains Dr. Bardach. “We conducted this study to try to answer that question.”  

The researchers used 2014-2015 billing data from Massachusetts to conduct a retrospective analysis of ED visits for asthma. “A patient going to the ED for their asthma is having an asthma attack,” says Dr. Bardach. “The study was conducted to better understand whether patients with anxiety and depression need a different approach than those without those diagnoses.”

Among more than 65,000 children with asthma in the study, 24.7% also had depression (5.8%), anxiety (11.2%), or both (7.7%). After controlling for age, sex, insurance type, and other chronic illness, Dr. Bardach and colleagues found increased asthma-related ED use for children with anxiety (18.9 visits per 100 child-years), depression (21.7), and both (27.6) compared with those without anxiety or depression (15.5 visits per 100 child-years). “Our findings suggest that clinicians should consider screening kids with asthma for anxiety and depression in order to identify those who may have a harder time with asthma management,” Dr. Bardach notes. “Strategies may include more intensive counseling to improve chronic medication adherence and symptom recognition for asthma, close outpatient follow-up for chronic issues, and improved mental healthcare for these children.” Dr. Bardach notes these approaches would follow the American Academy of Pediatrics recommendations to screen for behavioral health conditions.

Dr. Bardach suggests the need for more research to better understand the causes behind the ED visits observed in the study, in order to “allow more tailored and appropriate treatment of these patients in the emergency setting, as well as strategies to enhance self-management of chronic conditions to prevent ED visits.”