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IHOPe Asthma:DEPRESSION AND ANXIETY IN PEDIATRIC ASTHMA PATIENTS
Helen Fetaw & Haley MorinMentor: Dr. Stephanie Doupnik
Helen Fetaw» Milwaukee, WI» Rising Senior, University of Pennsylvania» Studying: Health and Societies
INTRODUCTION
Haley Morin» Pennington, NJ» Rising Senior, University of Pennsylvania» Studying: Nursing and Business
OVERVIEW
Asthma andMental Health IHOPe Study Preliminary
ResultsFuture
Considerations
1.Pediatric Asthma What is asthma? How is it treated? What do we know?
1 in 10 children have asthma
annual economic cost $56,000,000,000hospital admission risk 222% higher than children without asthma
https://www.epa.gov/sites/production/files/2015-10/documents/asthma_fact_sheet_eng_july_30_2015_v2.pdf
ASTHMA» Chronic disease affecting airways of lungs» Airways experience muscle tightening,
inflammation, mucus production causing symptoms such as:⋄ Difficulty breathing⋄ Wheezing⋄ Coughing
» Triggers include infections, exercise, tobacco smoke, weather, allergens, etc.
https://my.clevelandclinic.org/health/articles/asthma-an-overview
DEPRESSION AND ANXIETY» Approximately 30% of patients hospitalized at
CHOP screen positive for clinically significant depression or anxiety symptoms
» Depression and anxiety associated with worse outcomes post-hospitalization
» Worse clinical outcomes for patients with known mental health conditions
Doupnik et al., 2017
» Association between asthma, depression, and anxiety⋄ Mental health conditions associated with higher
asthma symptom burden» Many go undiagnosed and untreated» Diagnostic uncertainty
⋄ Asthma symptoms can mimic depression and anxiety» Many patients miss out on experiences of being a kid
MENTAL HEALTH AND ASTHMA
Goodwin, Bandiera, Steinberg, Ortega, & Feldman, 2012
CostsDepression and anxiety comorbidities associated with higher healthcare utilization and costs.
HEALTH SERVICES RESEARCHQualityOpportunity to better understand factors that lead to worse clinical outcomes in pediatric asthma patients.
AccessAdvocate increased access to mental health services, ensuring patients can access the right care at the right time.
2.IHOPe StudyIdentifying Risk Factors for Poor Hospital Outcomes in Pediatric Asthma Patients
STUDY OBJECTIVES» Describe contribution of depression and anxiety
symptoms to hospital outcomes in children hospitalized for asthma exacerbation
STUDY OVERVIEW» Prospective cohort study» Aim to recruit 100 subjects
⋄ 53 patients enrolled⋄ 36 patients complete⋄ 64 more patients to recruit with follow-up
METHODS AND MEASURES
Screening Initial Study Visit Follow Up 12 Month
Observation
Inclusion» 7 to 17 years of age» Hospitalized with a
primary diagnosis of asthma exacerbation
» Parent/guardian present and english speaking
RECRUITMENT SCREENINGExclusion
» ICU admission» Cognitive impairment
that could impact ability to answer surveys
» Other illnesses such as diabetes or sickle cell
» DHS involvement
PROMIS» Patient Reported Outcome
Measure Information System» Depression (left) and Anxiety» Measure of child depression
and anxiety symptom burden
PREDICTOR VARIABLES
AIM 1 VARIABLES
ACT» Asthma Control Test (right)» Initial study visit and 30-days
post-discharge
Medication Adherence» Pharmacy prescription refill data» Doser inhaler count data
AIM 2 VARIABLES (MECHANISMS) CSI» Coping Strategies Inventory (CSI)» Assesses coping behaviors in
response to stressors
Self Efficacy» Patient Asthma Management Self
Efficacy Scale» Measures efficacy in control of
chronic asthma and management of exacerbations
Care Coordination» Care Coordination Questionnaire» No need, unmet need, met need
CONFOUNDING VARIABLESPHQ-2
» Patient Health Questionnaire» Measures parent mental health
(depression)
CHAOS» Chaos Hubbub and Order Scale» Measures disorder in family life
PASS» Pediatric Asthma Severity Score» Measures severity of asthma exacerbation
3.Preliminary ResultsEarly Analysis
PATIENT CHARACTERISTICS
53 patients enrolledIn IHOPE study
PATIENT RACE AND ETHNICITY
9.43% of patients identified as of Hispanic origin
FAMILY CHARACTERISTICSPARENTAL EDUCATION
FAMILY CHARACTERISTICSMARITAL STATUS
HOUSEHOLD INCOME
About 19%10 familieschose not to report
CHILD DEPRESSION AND ANXIETY SYMPTOMS BY GENDER
ANXIETY AND DEPRESSION MAY NOT BE RELATED TO ASTHMA CONTROL
DEPRESSION AND ANXIETY POSITIVELY ASSOCIATED WITH DISENGAGED COPING
UNMET CARE COORDINATION ASSOCIATED WITH HIGH DISORDER IN FAMILY LIFE
PARENTAL DEPRESSION AND DISORDER IN FAMILY LIFE
4.Next StepsWhat’s next in research and careers.
1. 64 more complete records needed to hit recruitment goal of 1002. Data cleaning and analysis3. Manuscript4. Publish!
IHOPe PAPER
FUTURE RESEARCH» Identify and develop hospital-based interventions to improve
outcomes for asthma patients⋄ Consider including care coordination interventions⋄ Coping support interventions
» Effect of counseling and mental health treatment on asthma outcomes
» Mental health conditions are underdiagnosed and undertreated
» Understanding ways to diagnose, manage, and treat these conditions can lead to better patient outcomes, lower costs of care, and higher quality of life
LESSONS LEARNED» Family and parental factors can
significantly influence a child’s mental and physical health
» Patient recruitment is time intensive and difficult⋄ Patient follow-up is even
tougher
REFERENCESDoupnik, S. K., Henry, M. K., Bae, H., Litman, J., Turner, S., Scharko, A. M., & Feudtner, C.
(2017). Mental Health Conditions and Symptoms in Pediatric Hospitalizations: A Single-Center Point Prevalence Study. Academic Pediatrics, 17(2), 184–190. https://doi.org/http://dx.doi.org/10.1016/j.acap.2016.08.009
Goodwin, R. D., Bandiera, F. C., Steinberg, D., Ortega, A. N., & Feldman, J. M. (2012). Asthma and mental health among youth: etiology, current knowledge and future directions. Expert Review of Respiratory Medicine, 6(4), 397–406. https://doi.org/10.1586/ers.12.34
THANKS!Any questions?
Special thank you to Dr. Stephanie Doupnik, Diana Worsley, Joanne Levy, and Safa Browne
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