Self-efficacy, depressive symptoms, and patients' expectations predict outcomes in asthma

BACKGROUND. Certain psychosocial variables are relatively unexplored as pos sible predictors of asthma outcomes. OBJECTIVE. To determine if asthma self-efficacy, depressive symptoms, and u nrealistic expectations predict urgent care use and change in health-relate d quality of life measured by the Asthma Quality of Life Questionnaire and the SF-36 during 2 years. RESEARCH DESIGN. Prospective cohort study in a primary care internal medici ne practice at a tertiary care center in New York City. PATIENTS. Adults with moderate asthma who were fluent in either English or Spanish. MEASUREMENTS. At enrollment patients were interviewed in-person and complet ed a series of questionnaires including the Asthma Quality of Life Question naire (AQLQ), the SF-36, the Asthma Self-efficacy Scale, the Geriatric Depr ession Scale, and open-ended questions regarding their expectations of trea tment. Patients also completed the AQLQ and SF-36 at various time intervals throughout the study and were interviewed by telephone every 3 months to r ecord recent hospitalizations, emergency department visits and nonroutine o ffice visits for asthma. RESULTS. A total of 224 patients were followed for a mean of 23.8 months. I n hierarchical analysis, independent predictors of lower AQLQ scores were l ess self-efficacy, more depressive symptoms, expecting to be cured of asthm a, requiring methylxanthines, being Hispanic or black, and having difficult or very difficult access to asthma care (all at P < 0.05). Similar predict ors were found for lower SF-36 scores. Another outcome, use of urgent care, was required by 60% of patients during the study period. Predictors of usi ng urgent care were having more depressive symptoms, expecting a cure, bein g female, requiring oral beta -agonists, and having a history of prior hosp italizations for asthma (all at P < 0.05). CONCLUSIONS. Less asthma self-efficacy, more depressive symptoms, and unrea listic expectations predict worse asthma outcomes. These relatively unexplo red patient-centered variables in asthma are potentially modifiable and may offer new ways to intervene to improve asthma outcomes.