MAJOR depressive disorder predicted long-term asthma outcomes in adults 60+ with beliefs mediating control QoL, and steroid bursts.
Major Depressive Disorder and Asthma Outcomes in Older Adults
Depression and asthma often coexist in later life, yet the pathways linking mood disorders to asthma morbidity are not always clear. In a prospective cohort study of 336 adults with asthma aged 60 years and older in New York City, investigators assessed whether current major depressive disorder (MDD) shaped asthma outcomes across 18 months.
At baseline and at 6, 12, and 18 months, participants completed a clinical interview for current MDD alongside measures of asthma and medication beliefs, asthma control, and asthma-related quality of life. Asthma health care use and exacerbation-related events were also tracked, including oral corticosteroid (OCS) bursts, sick outpatient visits, emergency department visits, and hospitalizations. Inhaled corticosteroid (ICS) adherence was captured objectively using electronic medication monitors for four weeks after each session. Longitudinal outcomes were assessed using latent variable structural equation modeling.
Negative Beliefs About Asthma as a Key Pathway
Over time, MDD was associated with more threatening, emotional views of asthma, worse ICS adherence, and more emergency department visits. The analysis further indicated that negative beliefs about asthma mediated the link between MDD and multiple downstream outcomes.
Through this pathway, MDD was connected with worse asthma control and poorer quality of life, as well as more OCS bursts and higher rates of asthma-related health care use. These included sick outpatient visits, emergency department visits, and hospitalizations across follow-up.
Clinical Takeaways for Older Adults with Asthma
The findings suggest that, in older adults with asthma, MDD may influence asthma control and health care use partly by shaping emotional reactions and illness beliefs, alongside reduced adherence to inhaled corticosteroids. The authors highlight emotional responses and beliefs about asthma as important targets in older adults living with asthma and MDD.
Reference: Feldman JM et al. Longitudinal Pathways Between Major Depressive Disorder and Asthma Outcomes in Older Adults. J Allergy Clin Immunol Pract. 2025; DOI: 10.1016/j.jaip.2025.11.025.
