Psychological factors in severe chronic asthma

Objective: Levels of psychological distress, social support factors, and em otional adjustment to illness were measured in a sample of patients with se vere asthma. These were then examined in terms of their interrelationships and their ability to predict self-management knowledge. Method: A sample of 80 patients was recruited from a hospital-based asthma clinic designed for patients with severe asthma. Thirty-four percent of con secutive attenders approached took part. Morbidity and asthma management we re recorded from case records. Anxiety, depression, social support, emotion al adjustment to asthma and asthma knowledge were measured using self-repor t instruments selected for their acceptability and ease of administration. Results: Twenty-five percent of the sample had possible or definite casenes s for anxiety; 10.3% had possible or definite caseness for depression. Twen ty-five percent had inadequate social support in some way. Three independen t attitudinal factors were found: emotional maladjustment to asthma, the do ctor-patient relationship, and asthma-related stigma. Level of asthma knowl edge was very low. None of the measures of psychosocial function chosen wer e predictive of asthma knowledge. Conclusions: Levels of asthma knowledge were dangerously low, despite appar ently adequate educational intiatives. In addition, patients with severe as thma have high levels of distress, particularly of anxiety, even between at tacks. Their attitudes to their illness are multifactorial, and are signifi cantly correlated with emotional distress, morbidity indices and some demog raphic factors. While this may point the way to interventions designed to r elieve patients' distress, the hypothesis that this might in turn relate to practical asthma knowledge was not confirmed.