Longitudinal Pathways Between Major Depressive Disorder and Asthma Outcomes in Older Adults.

BACKGROUND: Older adults are at increased risk for depression and worse asthma morbidity. OBJECTIVE: To examine mediational pathways in longitudinal associations between major depressive disorder (MDD) and asthma outcomes in older adults. METHODS: A prospective cohort study was conducted on 336 participants with asthma aged ≥60 years in New York City. Measures included a clinical interview to assess current MDD, inhaled corticosteroid (ICS) adherence from electronic medication monitors, asthma and medication beliefs, asthma control, quality of life (QoL), oral corticosteroid (OCS) bursts, and asthma-related health care use. Measures were collected at baseline, 6, 12, and 18 months. Data regarding ICS adherence were collected for 4 weeks after each session. Latent variable structural equation modeling assessed longitudinal outcomes. RESULTS: MDD was associated longitudinally with more threatening, emotional views of asthma (β = 0.31, P < .001), worse ICS adherence (β = -0.20, P = .005), and more emergency department (ED) visits (β = 0.15, P = .03). Negative beliefs about asthma mediated the longitudinal relationships between MDD and worse asthma control (β = 0.18, P < .001) and QoL (β = -0.22, P < .001), more OCS bursts (β = 0.10, P < .001), sick outpatient visits (β = 0.10, P < .001), ED visits (β = 0.05, P = .03), and hospitalizations (β = 0.07, P = .001). CONCLUSIONS: MDD was associated with negative asthma beliefs, worse ICS adherence, and ED visits across 18 months. Emotional reactions and beliefs about asthma are important targets in older adults with asthma and MDD.