Prevalence of behavior problems in US children with asthma
R. Bussing, N. Halfon, B. Benjamin and K. B. Wells
Department of Psychiatry, University of Florida, Gainesville, USA.
OBJECTIVES: To present national population-based estimates of the
prevalence of parent-reported emotional and/or behavioral problems in
children with asthma and the relationship of medical comorbidity and asthma
severity with behavior problems. DESIGN: Cross-sectional study of the 1988
National Health Interview on Child Health. MAIN OUTCOME MEASURES: Parent
responses to a checklist of child health conditions were used to assign
school-age children (5 to 17 years old) into one of four groups: children
without reported chronic conditions; children with asthma alone; children
with asthma and additional reported chronic conditions; and children with
the same chronic conditions, but without asthma. Parental responses to the
Behavior Problem Index (BPI) were used for construction of an overall BPI
score, as well as subscale scores. Cross-tabulation and linear and logistic
regression were used to determine the relation of the different condition
categories to emotional and/or behavioral problems expressed by relative
values of the BPI. RESULTS: Children with asthma and comorbid conditions
had a mean BPI score of 7.3, compared with 5.4 for children without chronic
conditions, and all subscale scores, except those for antisocial conduct
and immature behavior, were significantly elevated. Using logistic
regression to control for confounding variables, children with severe
asthma alone had nearly three times the odds (odds ratio, 2.96; 95%
confidence interval, 1.22 to 7.17) and children with asthma plus comorbid
conditions nearly twice the odds (odds ratio, 1.86; 95% confidence
interval, 1.20 to 2.90) of children without chronic conditions to have
severe behavior problems. CONCLUSIONS: Severe asthma and asthma with
medical comorbidity represent significant risk factors for emotional and/or
behavioral problems. Clinicians caring for children with asthma and their
families should be aware of the relationship between asthma and emotional
and/or behavioral problems and anticipate that a substantial number of
their patients may have mental health services needs.
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