Asthma severity and anxiety levels in secondary schoolchildren

Stress can adversely affect asthma and is a risk factor for fatal and near-fatal asthma attacks. Recent studies suggest that mental stress is increasing among children. This study investigated the relationship between emotional anxiety and asthma among secondary school children. Subjects completed Spielberger's State-Trait Anxiety Inventory for Children (STAIC). This measures current (State) and general (Trait) anxiety. Asthma severity was assessed in a structured interview with parents attending asthma clinics. Four measures of asthma severity were used: The Jones Morbidity Index, location of care, BTS treatment step and previous hospital admissions for asthma. Family structure and social factors were also recorded. The study was performed in three general practice clinics (n=29) and in the hospital's asthma clinic (n=58). A group of children from two local secondary schools (n=390) also completed the STAIC questionnaire. 17.9% self-reported having asthma and recorded higher STAIC-Trait scores than children who did not regard themselves as asthmatic (p=0.01). Clinic data suggested children with more severe asthma were more anxious than those with milder illness. This was highly significant (p<0.001) for children who had been admitted with asthma in the previous 5 years (STAIC Trait: n=23, mean=37.13, SD=6.56) who were more anxious than those who had not been admitted (STAIC Trait: n=57, mean=31.11, SD=6.10). Data also demonstrated that family structure influences anxiety levels. Children in single-parent families were more anxious than children with two parents living at home (p<0.05). In three of the four measures of asthma severity, children in single-parent families appeared to have more severe asthma. Asthma and anxiety appear to be related with the more severe illness occurring in children with higher levels of anxiety. Family structure might be important in generating anxiety in children.