Psychiatric Comorbidity, Illness Management, and Psychological Factors in Cypriot Asthma Patients
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Introduction: Comorbidity between asthma and psychiatric disorders is reported to have a significant impact upon illness management factors such as asthma control, functional status, and utilization of medical services. Both anxiety sensitivity and psychological acceptance are associated with psychiatric comorbidity, as well as each other. Methods: The present study examined the impact of psychiatric comorbidity upon illness management factors in a clinic sample of Greek-speaking Cypriot asthma patients (N = 212, Mage = 60.42, SD = 13.24, % female 65.1). Multiway frequency analysis was conducted to examine associations between diagnostic groups and to empirically derive the following diagnostic groups used in the subsequent analyses: Somatoform disorder and/or Any Depressive disorder, Somatoform disorder and/or Other Anxiety disorder, Somatoform disorder and/or Any Eating disorder, and Any Anxiety group which included participants with Panic Disorder (PD) and/or Other Anxiety disorder. In each analysis, participants within the empirically-derived diagnostic groups examined were compared with the rest of the sample. Furthermore, the role of experiential avoidance in the relationship between psychiatric comorbidity and anxiety sensitivity was explored using mediation analysis. Results: Results indicated substantial prevalence rates of psychiatric conditions in this sample with somatoform (23.6%), depression (15.6%), and anxiety (14.6%) disorders as the most prevalent. Across the four diagnostic groups examined, psychiatric illness was associated with and significantly predicted worse asthma control (p < .01) and greater functional impairment (p < .01). However, only Somatoform and/or Other Anxiety disorder group, OR = 2.75, 95% CI [1.35 --- 5.60], Any Anxiety group, OR = 4.61, 95% CI [1.90, 11.15], and Somatoform and/or Any Depressive disorder, OR = 2.06, 95% CI [1.04 --- 4.09], significantly predicted asthma-related ER visits. Somatoform and/or Any Depressive disorder, OR = 3.67, 95% CI [1.60, 8.42], Somatoform and/or Other Anxiety disorder, OR = 5.50, 95% CI [2.34 --- 12.74], and Somatoform and/or Any Eating disorder, OR = 4.98, 95% CI [2.14 -11.60] groups were predictors of asthma-related hospitalizations. Mediation analyses indicated that for Somatoform and/or Any Depressive disorder ( z = 4.29, p < .01) and Any Anxiety ( z = 4.53, p < .01) groups, psychological acceptance fully mediated the relationship between the psychiatric illness and anxiety sensitivity. For the Somatoform and/or Other Anxiety disorder (z = 3.08, p < .01) and Somatoform and/or Any Eating disorder (z = 3.10, p < .01) groups partial mediation was found and remained a significant predictor of anxiety sensitivity even when psychological acceptance was controlled for. Discussion: Comorbid psychiatric conditions were found to have a significant negative impact upon asthma illness management, specifically, asthma control, functional status, and asthma-related emergency healthcare utilization. Both psychological acceptance and anxiety sensitivity were associated with psychiatric comorbidity in asthma and psychological acceptance may be an important factor to consider across a number of psychiatric conditions.