Association between mental disorders and subsequent adult onset asthma

Background and objectives: Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. Methods: During face-to-face household surveys in community-dwelling adults (n=52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. Results: 1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR=1.8; 95%CI 1.3-2.5), panic (OR=1.4; 95%CI 1.0-2.0), generalized anxiety (OR=1.3; 95%CI 1.1-1.7), specific phobia (OR=1.3; 95%CI 1.1-1.6); post-traumatic stress (OR=1.5; 95%CI 1.1-1.9); binge eating (OR=1.8; 95%CI 1.2-2.9) and alcohol abuse (OR=1.5; 95%CI 1.1-2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). Conclusions: A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.