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Regina Bussing, MD, MSHS; Neal Halfon, MD, MPH; Bernadette Benjamin, MSc; Kenneth B. Wells, MD, MPH

Arch Pediatr Adolesc Med. 1995;149(5):565-572.

Abstract
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. Crosstabulation 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 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.

(Arch Pediatr Adolesc Med. 1995;149:565-572)

Author Affiliations
From the Department of Psychiatry, University of Florida, Gainesville (Dr Bussing); the Departments of Psychiatry and Biobehavioral Sciences (Drs Bussing and Wells), Pediatrics (Dr Halfon), School of Medicine, and Community Health Services (Dr Halfon), School of Public Health, University of California, Los Angeles (UCLA); and the RAND Corporation, Santa Monica, Calif (Ms Benjamin).

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