The differential impact of physical, mental, and social catastrophic cognitions on asthma-related outcomes in Latino patients with comorbid panic disorder
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Background: Research shows that asthma patients with higher levels of anxiety sensitivity report poorer asthma control and health-related quality of life. Less is known, however, about the relative impact of specific subtypes of catastrophic thinking on asthma morbidity. This study therefore investigated whether physical, mental, and social catastrophic cognitions differentially influence illness-related outcomes in Latino asthma patients with comorbid panic disorder (PD). More specifically, the study examined the putative relationship between physical catastrophic cognitions and participants' asthma control, as well as rates of health care utilization. Similar hypothesized associations between social catastrophic cognitions and asthma-related quality of life were tested, as were those between mental catastrophic cognitions and ataques de nervios. Methods: Data originated from an interview conducted prior to a randomized controlled trial in which 53 adult Latino asthma patients were recruited from outpatient clinics in the Bronx, N.Y. The PRIME-MD Patient Health Questionnaire (PHQ) was used to screen for PD symptoms, while the Structured Clinical Interview for DSM-IV (SCID-I) and Panic Disorder Severity Scale (PDSS) were subsequently used to confirm diagnoses of PD. The Thoughts Rating Form (TRF) assessed the degree to which patients endorsed particular panic-related catastrophic cognitions during heightened arousal. Participants were additionally administered the Asthma Control Questionnaire (ACQ) and the Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ). Pulmonary function was objectively measured by spirometry readings of percent predicted FEV 1 at baseline, while annual rates of health care utilization (i.e., emergency room visits and sick visits to the doctor in the past year) and lifetime history of ataques de nervios were based upon self-report. Results: The study sample was predominantly female (94.3%) and Puerto Rican (75.5%), with a mean age of 43.60 +/- 13.02 years. Participants endorsed all three types of catastrophic thinking on the TRF to a moderate degree or greater. Contrary to expectations, results from hierarchical linear regressions indicated that only social catastrophic cognitions were significantly associated with asthma control, after controlling for age and use of inhaled corticosteroids (p= .029). The association remained significant when these covariates were removed from the regression model, such that those participants who endorsed greater social catastrophic cognitions experienced poorer asthma control [F(1, 51) = 6.09,p = .017]. None of the three subtypes of catastrophic cognitions were associated with self-reported annual rates of asthma-related ER visits or sick visits to the doctor, after controlling for age and asthma severity (p= .558 to .978 in separate logistic regression models). Catastrophic cognitions of all three types were also not associated with self-reported asthma-related quality of life on the Mini-AQLQ ( p = .308 to .776) or with lifetime history of ataques de nervios, (p = .131 to .901), after controlling for the same variables. Discussion: The current findings support the general notion that Latino patients with comorbid asthma and PD possess fearful beliefs regarding their acute panic symptoms. Results also suggest that social catastrophic cognitions play a particular role in illness-related outcomes such as poor asthma control among this population. Mental health providers who assess and treat such patients may thus improve illness self-management and reduce morbidity by giving greater attention to dreaded consequences of public disapproval that are experienced during anxious episodes.