Symptoms of Depression and Inhaler Adherence Among Adolescents With Asthma: Is There an Association?

Background: The prevalence of depression among adolescents with asthma is reported to be 27%-34% across different geographical regions. Asthma control depends on inhaler adherence. Studies on the association of depression and inhaler adherence among adolescents with asthma are few, especially in the Indian subcontinent. Therefore, this study was carried out to find the prevalence of depression and its association with inhaler adherence among adolescents with asthma.

Methods: A hospital-based analytical cross-sectional study was carried out among 102 adolescents with asthma in a tertiary care setting. Symptoms of depression were assessed using the Center for Epidemiological Studies-Depression Scale for Children (CES-DC) and inhaler adherence using Test of Adherence to Inhalers (TAI).

Result: Among the 102 adolescents with asthma, depression was detected in 39 (38.2%). As per the TAI scores, good, intermediate, and poor adherence to inhalers were, respectively, found among 35 (34.3%), 41 (40.2%), and 26 (25.5%) of the adolescents with asthma. On multivariable binary logistic regression analysis, the adolescents with intermediate and poor adherence to inhalers, respectively, had 7.093 odds (95% CI 2.189-22.977) and 9.002 odds (95% CI: 2.501-32.405) of having depression compared to those with good adherence. Those adolescents with families whose monthly income was INR 12,000 or less had 2.490 odds (95% CI: 1.002-6.187) of depression compared to those with more than INR 12,000 monthly family income.

Conclusion: The level of inhaler adherence in a dose-dependent manner and lower family income were independent predictors of depression among adolescents with asthma. The findings indicate the need to screen and assess adherence and symptoms of depression among them and manage appropriately, focusing on those with low family income.