Psychological Defenses and Coping Styles in Patients Following a Life-Threatening Attack of Asthma: Outcome

The issue of family conflicts was one of the four psychological risk factors identified by Strunk et al in children. Although the population studied here is very different from that reported by Strunk, in that they are adults who survived a life-threatening attack of asthma, rather than children who succumbed to one, some parallels in terms of risk of death from asthma can be drawn. Apart from the issues of family conflicts, these relate mainly to the high denial seen in adult asthmatics and the “disregard of asthmatic symptoms” seen in children, as well as the presence of psychiatric illness seen in both groups, a variety of disorders prior to the NMAD in adults, and “depressive symptoms” in children. From this study, there is little doubt that high denial of asthma and the presence of psychiatric illness may be risk factors that are likely to increase the risk of death in asthma, while the issue of disturbed family relationships is less certain as several of these situations appeared to have arisen at least partly as a result of the effect of the NMAD in the family. read

The psychiatrically diagnosed NMAD patients, interestingly, had a significantly increased perception of their level of disability as measured on the QL Index, despite the fact that their level of impairment from asthma was probably similar to the non-diagnosed patients. It is impossible to say whether the addition of a psychiatric illness led to a reduced perception of quality of life or whether the high denial levels of the nonpsychiatrically diagnosed patients led to a relatively increased perception of quality of life. This is an issue that is clearly important to elucidate further in the future, because both asthma and psychiatric disorders can lead to reduced perception of the level of quality of life. With respect to clinical treatment, it would be useful to know whether patients are functioning at a worse level than they might wish for physiologic or psychological reasons, or for a combination of both.

There are various methodologic criticisms of this study, the major one of which is that it is retrospective. Given that asthma is a very common disorder and life-threatening asthma is relatively uncommon, it is not practicable to mount such a study as this in a prospective manner. Considerable effort has been made to validate the clinical psychiatric diagnoses as comprehensively as possible, and this has been discussed elsewhere. The significantly elevated scores of the GHQ and the MHQ in the psychiatrically diagnosed patients vs the nonpsychiatrically diagnosed patients are further validation of the accuracy of the clinical groupings. Psychiatric disorders are episodic in nature, and the patients in this study were seen on one occasion only an average of 13 months following their NMAD. The patients are being followed up both medically and psychiatrically as part of a longitudinal study, and it is hoped that this longitudinal data will allow increased confidence about the prevalence rates of psychiatric disorders following NMADs.