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Childhood Adversity, Early-Onset Depressive/Anxiety Disorders, and Adult-Onset Asthma

Scott, Kate M. PhD; Von Korff, Michael ScD; Alonso, Jordi MD, PhD; Angermeyer, Matthias C. MD; Benjet, Corina PhD; Bruffaerts, Ronny PhD; de Girolamo, Giovanni MD; Haro, Josep Maria MD, PhD; Kessler, Ronald C. PhD; Kovess, Viviane MD, PhD; Ono, Yutaka MD; Ormel, Johan PhD; Posada-Villa, José MD

doi: 10.1097/PSY.0b013e318187a2fb
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Objectives: To investigate a) whether childhood adversity predicts adult-onset asthma; b) whether early-onset depressive/anxiety disorders predict adult-onset asthma; and c) whether childhood adversity and early-onset depressive/anxiety disorders predict adult-onset asthma independently of each other. Previous research has suggested, but not established, that childhood adversity may predict adult-onset asthma and, moreover, that the association between mental disorders and asthma may be a function of shared risk factors, such as childhood adversity.

Methods: Ten cross-sectional population surveys of household-residing adults (>18 years, n = 18,303) assessed mental disorders with the Composite International Diagnostic Interview (CIDI 3.0) as part of the World Mental Health surveys. Assessment of a range of childhood family adversities was included. Asthma was ascertained by self-report of lifetime diagnosis and age of diagnosis. Survival analyses calculated hazard ratios (HRs) for risk of adult-onset (>age 20 years) asthma as a function of number and type of childhood adversities and early-onset (<age 21 years) depressive and anxiety disorders, adjusting for current age, sex, country, education, and current smoking.

Results: Childhood adversities predicted adult-onset asthma with risk increasing with the number of adversities experienced (HRs = 1.49–1.71). Early-onset depressive and anxiety disorders also predicted adult-onset asthma (HRs = 1.67–2.11). Childhood adversities and early-onset depressive and anxiety disorders both predicted adult-onset asthma after mutual adjustment (HRs = 1.43–1.91).

Conclusions: Childhood adversities and early-onset depressive/anxiety disorders independently predict adult-onset asthma, suggesting that the mental disorder-asthma relationship is not a function of a shared background of childhood adversity.

CIDI = Composite International Diagnostic Interview; HR = hazard ratio; WMH = World Mental Health; HPA = hypothalamic-pituitary-adrenal; CI = Confidence Interval.

From the Department of Psychological Medicine (K.M.S.), School of Medicine and Health Sciences, Otago University, Wellington, New Zealand; Center for Health Studies (M.V.K.), Group Health Cooperative of Puget Sound, Seattle, Washington; Health Services Research Unit (J.A.), Institut Municipal d'Investigacio Medica (IMIM) and CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain; Center for Public Mental Health (M.C.A.), Gösing am Wagram, Austria; National Institute of Psychiatry (C.B.), Calzada Mexico Xochimilco, Mexico City, Mexico; Department of Neurosciences and Psychiatry (R.B.), University Hospital, Gasthuisberg, Leuven, Belgium; Regional Health Care Agency (G.G.), Emilia-Romagna Region, Bologna, Italy; Sant Joan de Deu-SSM (J.M.H.), RETICS RD06/0011 REM-TAP, Barcelona, Spain; Department of Health Care Policy (R.K.), Harvard Medical School, Boston, Massachusetts; Fondation MGEN pour la Santé Publique (V.K.), Université Paris 5, Paris, France; Health Center (Y.O.), Keio University, Tokyo, Japan; Department of Psychiatry (J.O.), University Medical Center, Groningen, Netherlands; and Colegio Mayor de Cundinamarca University (J.P.-V.), Bogota, Colombia.

Address correspondence and reprint requests to Kate M. Scott, Department of Psychological Medicine, School of Medicine and Health Sciences, Otago University, Wellington, PO Box 7343, Wellington South, New Zealand. E-mail: kate.scott@otago.ac.nz

The work in this study was supported by Grant R01MH070884 from the United States National Institute of Mental Health; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; Grants R13-MH066849, R01-MH069864, and R01 DA016558 from the US Public Health Service; Grant FIRCA R01-TW006481 from the Fogarty International Center; the Pan American Health Organization; Eli Lilly and Company; Ortho-McNeil Pharmaceutical, Inc.; GlaxoSmithKline; and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection, with supplemental support from the Saldarriaga Concha Foundation. The European surveys were funded by Contracts QLG5-1999-01042; SANCO 2004123 from the European Commission; the Piedmont Region (Italy); Fondo de Investigación Sanitaria; Grant FIS 00/0028 from the Instituto de Salud Carlos III, Spain; Grant SAF 2000-158-CE from the Ministerio de Ciencia y Tecnología, Spain; Departament de Salut, Generalitat de Catalunya, Spain; Grants CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP from the Instituto de Salud Carlos III; other local agencies; and by an unrestricted educational grant from GlaxoSmithKline. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labor and Welfare. The Mexican National Comorbidity Survey (MNCS) is supported by Grant INPRFMDIES 4280 from the National Institute of Psychiatry Ramon de la Fuente and Grant CONACyT-G30544-H from the National Council on Science and Technology, with supplemental support from the PanAmerican Health Organization (PAHO). The US National Comorbidity Survey Replication (NCS-R) is supported by Grant U01-MH60220 from the National Institute of Mental Health (NIMH) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF) (Grant 044708), and the John W. Alden Trust.

Received for publication December 19, 2007; revision received May 22, 2008.

Copyright © 2008 by American Psychosomatic Society
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