MDD in Asthma Patients Associated With Worse Outcomes in Older Adults
Older adults with asthma and major depressive disorder (MDD) show persistent associations between mood symptoms and adverse asthma outcomes, according to a Journal of Allergy and Clinical Immunology: In Practice study published online ahead of print.
Study Findings
In this prospective cohort study of 336 adults aged ≥60 years with physician-diagnosed asthma in New York City, investigators assessed longitudinal pathways between clinically diagnosed MDD and asthma outcomes over 18 months. Participants underwent standardized psychiatric interviews to ascertain current MDD and repeated measures of asthma control, inhaled corticosteroid (ICS) adherence, quality of life (QoL), and healthcare use (oral corticosteroid bursts, outpatient and emergency department visits, and hospitalizations).
The authors found that MDD was longitudinally associated with:
- Worse ICS adherence (β = –0.20; P = .005)
- More threatening/emotional illness beliefs (β = 0.31; P < .001)
- Increased emergency department visits (β = 0.15; P = .03)
Structural equation modeling showed that negative beliefs about asthma mediated relationships between MDD and multiple clinical outcomes, including poorer asthma control (β = 0.18; P < .001), lower QoL (β = –0.22; P < .001), more oral corticosteroid bursts (β = 0.10; P < .001), and higher rates of outpatient visits, ED encounters, and hospitalizations. These findings suggest multifaceted behavioral and cognitive pathways linking depressive symptoms to disease burden.
Clinical Implications
For clinicians managing older adults with asthma, this study reinforces the importance of screening for depressive symptoms and maladaptive illness beliefs as part of comprehensive asthma care. Suboptimal adherence to ICS — a cornerstone of asthma control — was significantly tied to depressive features, indicating that psychological factors contribute to pharmacologic nonadherence and downstream morbidity.
Behavioral and cognitive interventions — such as motivational interviewing, cognitive behavioral therapy, or integrated collaborative care models — may help improve adherence, symptom control, and patient-reported quality of life, the authors concluded. Addressing depression may also reduce acute healthcare utilization that drive cost and burden in elder populations. Clinicians should consider interdisciplinary collaboration with mental health providers and incorporate validated screening tools for depressive symptoms and asthma-related beliefs into routine practice.
Reference:
Feldman JM, Arcoleo K, Wysocki M, et al. Longitudinal pathways between major depressive disorder and asthma outcomes in older adults. J Allergy Clin Immunol Pract. 2025;S2213-2198(25)01130-4. doi:10.1016/j.jaip.2025.11.025.
