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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