Wisnivesky Juan P, Lorenzo Jessica, Feldman Jonathan M, Leventhal Howard, Halm Ethan A
Division of General Internal Medicine, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
J Asthma. 2010 Feb;47(1):100-4. doi: 10.3109/02770900903426989.
Background. Psychological stress has been linked in some studies to asthma prevalence and outcomes in children. The authors sought to evaluate the relationship between perceived stress and morbidity among inner-city adults with asthma. Methods. The authors interviewed a prospective cohort of 326 moderate-to-severe asthmatics receiving care at two large, urban, hospital-based general medicine clinics in New York City and New Jersey. Psychological stress was assessed at baseline using the Perceived Stress Scale (PSS), a validated 4-item instrument. Outcomes included the Asthma Control Questionnaire (ACQ), the Asthma Quality of Life Questionnaire (AQLQ), and the Medication Adherence Reporting Scale (MARS) measured at baseline, 1, 3, and 12 months of enrollment. Results. Higher perceived stress was significantly correlated with worse asthma control (ACQ scores; r = .30 to .37, p < .0001), poor quality of life (AQLQ scores; r = -.49 to - .35, p < .0001), and decreased medication adherence (MARS scores; r = -.25 to -.15, p < .028) at baseline and across the follow-up interviews. In multivariate analyses, increased stress remained a significant predictor of worse ACQ (p < .0001), AQLQ scores (p < .0001), and MARS (p < .0001) after adjusting for age, sex, income, number of years with asthma, and comorbidities. Conclusions. Among inner-city asthmatics, higher perceived stress is strongly associated with increased asthma morbidity across a 1-year follow-up. Further research is needed to identify mechanisms mediating the association between stress and asthma morbidity in adults.
背景。一些研究表明，心理压力与儿童哮喘的患病率及病情转归有关。作者旨在评估城市成年哮喘患者感知到的压力与发病率之间的关系。方法。作者对在纽约市和新泽西州两家大型城市医院普通内科诊所接受治疗的326名中重度哮喘患者的前瞻性队列进行了访谈。使用感知压力量表（PSS，一种经过验证的4项工具）在基线时评估心理压力。结局指标包括在入组时、1个月、3个月和12个月时测量的哮喘控制问卷（ACQ）、哮喘生活质量问卷（AQLQ）和药物依从性报告量表（MARS）。结果。在基线及整个随访访谈中，较高的感知压力与较差的哮喘控制（ACQ评分；r = 0.30至0.37，p < 0.0001）、较差的生活质量（AQLQ评分；r = -0.49至-0.35，p < 0.0001）以及较低的药物依从性（MARS评分；r = -0.25至-0.15，p < 0.028）显著相关。在多变量分析中，在调整年龄、性别、收入、哮喘患病年限和合并症后，压力增加仍然是ACQ评分较差（p < 0.0001）、AQLQ评分较差（p < 0.0001）和MARS评分较差（p < 0.0001）的显著预测因素。结论。在城市哮喘患者中，较高的感知压力与1年随访期间哮喘发病率增加密切相关。需要进一步研究以确定介导成人压力与哮喘发病率之间关联的机制。
