Psychological Distress in Allergic Diseases: Risk Factors, Prevalence

teenage girl using asthma inhaler
Relatively low levels of serious psychological distress were observed in a cohort of Australian young adults with a high prevalence of allergic diseases.

Relatively low levels of serious psychological distress were observed in a cohort of Australian young adults with a high prevalence of allergic diseases, possibly because of positive social factors serving as a buffer, according to a study published in Journal of Asthma.

Atopic conditions, particularly asthma, are associated with increased risk of mental health issues. This longitudinal birth cohort study sought to illuminate the potential associations between a range of allergic diseases in young people and psychological distress. A total of 620 infants were recruited into the study between 1990 and 1994 and followed until the age of 18, at which time skin-prick testing was used to determine atopic sensitization for individuals still participating in the study (N=419).

Self-reporting from questions derived from the European Community Respiratory Health Survey and International Study of Asthma and Allergies in Childhood was used to determine respiratory symptoms, and current asthma was defined by physician diagnosis and asthma episodes, wheezing, or use of asthma medication in the past year. Psychological distress was assessed by the Kessler 6, and the total score (range, 6-30) was used to categorize level of distress. Serious psychological distress was defined as ≥19. Scores for quality of life were calculated using the mental component summary scales and the physical component summary described in the Short Form 12 manual. While controlling for potential confounders, predictors of quality of life and psychological distress were identified using regression models.

Overall psychological distress in this cohort was quite low, with a relatively small percentage scoring in the range classified as serious psychological distress (n=22; 5.3%). Level of psychological distress did not significantly differ by parental education, socioeconomic status, or sex, but was higher among individuals who had ever smoked ≥100 cigarettes (11.6 [4.7] vs 10.4 [3.8]; P =.004), and when controlling for sociodemographic variables, a history of smoking was associated with serious psychological distress (P =.02).

During skin-prick testing, approximately two-thirds of participants reacted to ≥1 allergens (n=266 of 394; 67.5%), and no associations were found between atopic sensitization and occurrence of serious psychological distress (P =.79) or psychological distress total score (P =.56). Also, no associations were found between serious psychological distress and current symptoms of asthma, eczema, or hay fever (P >.25 for all). Although there was a trend toward increasing total score for psychological distress and total number of current atopic conditions, (𝜌=0.097; P =.055), this correlation was weak and the proportion of serious psychological distress by number or conditions was not statistically significant. Quality of life was no different between young people with or without atopic sensitization.

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Study limitations included using cross-sectional data and self-reporting, and the small sample for the physical component summary subgroup analysis.

Study investigators concluded, “Psychological distress was the strongest predictor for [mental component summary] score on the [Short Form 12] reinforcing the need to identify and address any emotional concerns of patients to support health related quality of life.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Barton CA, Dharmage SC, Lodge CJ, Abramson MJ, Erbas B, Lowe A. Asthma, atopy and serious psychological distress: prevalence and risk factors among young people in the Melbourne atopy cohort study [published online August 5, 2019]. J Asthma. doi:10.1080/02770903.2019.1645850