Are the presence of asthma and the COVID-19 infection associated with behavioral changes in Lebanese adolescents?

Main Article Content

Vanessa Azzi
Joya Maria Karam
Wendy D’Andrea
Diana Malaeb
Sami El Khatib
Fouad Sakr
Mariam Dabbous
Souheil Hallit
Michel Soufia

Keywords

adolescents, asthma, behavioral problems, Lebanon

Abstract

Background: Little evidence is available about psychological stressors in Lebanese asthmatic adolescents, where health-risk behaviors are a serious threat to public health. In addition, the COVID-19 epidemic has had a substantial influence on adolescents’ mental health globally, especially in Lebanon, where the ongoing economic and political challenges have largely impacted their psychological well-being. This study aimed to explore the association of asthma and the COVID-19 infection with behaviors among Lebanese adolescents.


Methods: Data were collected in July 2023, using the snowball sampling technique. Inclusion criteria for participation in the study included being of a resident and citizen of Lebanon and aged 12–18 years. Behavioral problems were assessed using the Youth Self-Report (YSR) scale, which yields nine subscales (anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, aggressive behavior, and other problems) and a total score.


Results: Asthma was significantly associated with somatic complaints (Beta [β] = 2.98), attention problems (β = 0.01), and other behavioral problems (β = 0.68). Having contracted the COVID-19 infection, compared to healthy asymptomatic state (β = 1.55), was significantly associated with more anxious behaviors. In the case of stratifying the analysis in terms of gender, the results showed that the presence of asthma was significantly associated with more social behaviors (β = 3.31), thought problems (β = 2.91), attention problems (β = 0.02), other behavioral problems (β = 1.71), and total behavioral problems (β = 5.71) in males. In case stratifying the analysis as to school type, the presence of asthma was significantly associated with more somatic complaints (β = 2.77) in participants from private schools whereas it was significantly associated with more total behavioral problems (total YSR scores) (β = 5.05) in participants from public schools.


Conclusion: It is confirmed that asthma and psychiatric disorders are interconnected, so it would be of great importance to include screening through a psychological intervention in treating asthmatic adolescents by means of (1) recognizing factors affecting patients’ mental health, and (2) regulating uncontrolled behaviors that can exacerbate symptoms in order to avoid the future morbidity.

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References

1. Grant TL, Wood RA: The influence of urban exposures and residence on childhood asthma. Pediatr Allergy Immunol 2022, 33(5):e13784. 10.1111/pai.13784

2. Dharmage SC, Perret JL, Custovic A: Epidemiology of Asthma in Children and Adults. Front Pediatr 2019, 7:246. 10.3389/fped.2019.00246

3. Schluger NW, Koppaka R: Lung disease in a global context. A call for public health action. Annals of the American Thoracic Society 2014, 11(3):407–416. 10.1513/AnnalsATS.201312-420PS

4. Wang Z, Li Y, Gao Y, Fu Y, Lin J, Lei X, Zheng J, Jiang M: Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Respir Res 2023, 24(1):169. 10.1186/s12931-023-02475-6

5. Asher MI, Garcia-Marcos L, Pearce NE, Strachan DP: Trends in worldwide asthma prevalence. Eur Respir J 2020, 56(6). 10.1183/13993003.02094-2020

6. Braido F, Blasi F, Canonica GW, Paggiaro P, Beghe B, Bonini M, Carpagnano GE, Del Giacco S, Lavorini F, Milanese M et al: Mild/Moderate Asthma Network in Italy (MANI): a long-term observational study. J Asthma 2022, 59(9):1908–1913. 10.1080/02770903.2021.1968895

7. Hallit S, Salameh P: Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study. J Epidemiol Glob Health 2017, 7(3):147–154. 10.1016/j.jegh.2017.04.004

8. Hallit S, Sacre H, Kheir N, Hallit R, Waked M, Salameh P: Prevalence of asthma, its correlates, and validation of the Pre-School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon. Allergol Immunopathol (Madr) 2021, 49(1):40–49. 10.15586/aei.v49i1.25

9. Ramji R, Nilsson M, Arnetz B, Wiklund Y, Arnetz J: Taking a stand: An untapped strategy to reduce waterpipe smoking in adolescents. Substance use & misuse 2019, 54(3):514–524. 10.1080/10826084.2018.1521429

10. Akcakaya N, Aydogğan M, Hassanzadeh A, Camciogğlu Y, Çokugğras H: Psychological problems in Turkish asthmatic children and their families. Allergologia et immunopathologia 2003, 31(5):282–287. 10.1016/S0301-0546(03)79197-6

11. Calam R, Gregg L, Simpson B, Morris J, Woodcock A, Custovic A: Childhood asthma, behavior problems, and family functioning. Journal of Allergy and Clinical Immunology 2003, 112(3):499–504. 10.1016/S0091-6749(03)00008-3

12. Wamboldt MZ, Fritz G, Mansell A, McQuaid EL, Klein RB: Relationship of asthma severity and psychological problems in children. Journal of the American Academy of Child & Adolescent Psychiatry 1998, 37(9):943–950. 10.1097/00004583-199809000-00014

13. Caulfield JI: Anxiety, depression, and asthma: New perspectives and approaches for psychoneuroimmunology research. Brain Behav Immun Health 2021, 18:100360. 10.1016/j.bbih.2021.100360

14. Baiardini I, Sicuro F, Balbi F, Canonica GW, Braido F: Psychological aspects in asthma: do psychological factors affect asthma management? Asthma Res Pract 2015, 1:7. 10.1186/s40733-015-0007-1

15. Christiansen H, Reck C, Zietlow AL, Otto K, Steinmayr R, Wirthwein L, Weigelt S, Stark R, Ebert DD, Buntrock C et al: Children of Mentally III Parents at Risk Evaluation (COMPARE): Design and Methods of a Randomized Controlled Multicenter Study-Part I. Front Psychiatry 2019, 10:128. 10.3389/fpsyt.2019.00128

16. Ahmad A, Sorensen K: Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review. J Asthma 2016, 53(8):862–878. 10.3109/02770903.2016.1155217

17. Attia M, Ibrahim FA, Elsady MA, Khorkhash MK, Rizk MA, Shah J, Amer SA: Cognitive, emotional, physical, and behavioral stress-related symptoms and coping strategies among university students during the third wave of COVID-19 pandemic. Front Psychiatry 2022, 13:933981. 10.3389/fpsyt.2022.933981

18. Robinson OJ, Vytal K, Cornwell BR, Grillon C: The impact of anxiety upon cognition: perspectives from human threat of shock studies. Front Hum Neurosci 2013, 7:203. 10.3389/fnhum.2013.00203

19. Devoto C, Arcurio L, Fetta J, Ley M, Rodney T, Kanefsky R, Gill J: Inflammation Relates to Chronic Behavioral and Neurological Symptoms in Military Personnel with Traumatic Brain Injuries. Cell Transplant 2017, 26(7):1169–1177. 10.1177/0963689717714098

20. Ahmed GK, Elbeh K, Gomaa HM, Soliman S: Does COVID-19 infection have an impact on children's psychological problems? Middle East Current Psychiatry 2021, 28(1):1–9. 10.1186/s43045-021-00155-z

21. El Othman R, Touma E, El Othman R, Haddad C, Hallit R, Obeid S, Salameh P, Hallit S: COVID-19 pandemic and mental health in Lebanon: a cross-sectional study. Int J Psychiatry Clin Pract 2021, 25(2):152–163. 10.1080/13651501.2021.1879159

22. Mahfoud D, Fawaz M, Obeid S, Hallit S: The co--moderating effect of social support and religiosity in the association between psychological distress and coping strategies in a sample of lebanese adults. BMC Psychol 2023, 11(1):61. 10.1186/s40359-023-01102-9

23. Difference between public and private schools in Lebanon. Global History Dialogues. Available from: https://globalhistorydialogues.org/projects/difference-between-public-and--private-schools-in-lebanon/ [Access date: November 30, 2023]

24. Lebanon-Education. Available from: https://www.usaid.gov/lebanon/education#:~:text=Lebanese%20public%20schools%20suffer%20from,broken%20windows%20and%20leaking%20roofs [Access date: November 30, 2023]

25. Azzi V, Malaeb D, El Khatib S, Sakr F, Dabbous M, Hallit S, Soufia M: Association of behaviors and asthma control in a sample of Lebanese adolescents with asthma. Allergol Immunopathol (Madr) 2024, 52(2):1–9.

26. Akiki Z, Saadeh D, Farah R, Hallit S, Sacre H, Hosseini H, Salameh P: Asthma prevalence and associated factors among lebanese adults: the first national survey. BMC Pulm Med 2021, 21(1):162. 10.1186/s12890-021-01529-z

27. Achenbach TM: Manual for ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth & Families 2001.

28. D'Andrea W, Aboagye A, Lee KA, Freed S, Joachim B, Khedari-DePierro V, Yates E, Wilmes A, Krohner S, Madhoun S et al: Growing Up on the Edge: A Community-Based Intervention for Children in Gaza. Res Child Adol Psychopath 2023. 10.1007/s10802-023-01124-2

29. Samaha HMS, Elsaid AR, Sabri Y: Depression, anxiety, distress and somatization in asthmatic patients. Egyptian Journal of Chest Diseases and Tuberculosis 2015, 64(2):307–311. 10.1016/j.ejcdt.2015.02.010

30. Moore M, Duncan C, Gonis A: Uncon-trolled Asthma is Associated with Comorbid Stress and Somato-form Symptoms. Ann Pulmonol 2020, 4(1):45–49. 10.36959/918/451

31. Goldbeck L, Bundschuh S: Illness perception in pediatric somatization and asthma: complaints and health locus of control beliefs. Child and adolescent psychiatry and mental health 2007, 1:1–7. 10.1186/1753-2000-1-5

32. Park HJ, Kim YH, Na DY, Jeong SW, Lee MG, Lee J-H, Yang YN, Kang MG, Yeom SW, Kim JS: Long-term bidirectional association between asthma and attention deficit hyperactivity disorder: A big data cohort study. Frontiers in Psychiatry 2023, 13:1044742. 10.3389/fpsyt.2022.1044742

33. McQuaid EL, Weiss-Laxer N, Kopel SJ, Koinis Mitchell D, Nassau JH, Wamboldt MZ, Klein RB, Fritz GK: Pediatric asthma and problems in attention, concentration, and impulsivity: Disruption of the family management system. Families, Systems, & Health 2008, 26(1):16. 10.1037/1091-7527.26.1.16

34. McQuaid EL, Walders N, Kopel SJ, Fritz GK, Klinnert MD: Pediatric asthma management in the family context: The family asthma management system scale. Journal of pediatric psychology 2005, 30(6):492–502. 10.1093/jpepsy/jsi074

35. McQuaid EL, Kopel SJ, Nassau JH: Behavioral adjustment in children with asthma: a meta-analysis. Journal of Developmental & Behavioral Pediatrics 2001, 22(6):430–439. 10.1097/00004703-200112000-00011

36. Feitosa CA, Santos DN, do Carmo MBB, Santos LM, Teles CA, Rodrigues LC, Barreto ML: Behavior problems and prevalence of asthma symptoms among Brazilian children. Journal of psychosomatic research 2011, 71(3):160–165. 10.1016/j.jpsychores.2011.02.004

37. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, Huang E, Zuo QK: The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Annals of the New York Academy of Sciences 2021, 1486(1):90–111. 10.1111/nyas.14506

38. Liu H, Ma X, Shi L, Wang J, Juan JTH, Ma D, Sun J: Associations between tobacco and alcohol use and aggressive behavior among adolescents in 55 Low-and Middle-Income countries. Journal of affective disorders 2023, 329:519–524. 10.1016/j.jad.2023.02.131

39. Treur JL, Willemsen G, Bartels M, Geels LM, van Beek JH, Huppertz C, van Beijsterveldt CE, Boomsma DI, Vink JM: Smoking during adolescence as a risk factor for attention problems. Biological Psychiatry 2015, 78(9):656–663. 10.1016/j.biopsych.2014.06.019

40. Antia K, Račaitė J, Šurkienė G, Winkler V: The gender gap in adolescents' emotional and behavioural problems in Georgia: a cross-sectional study using Achenbach's Youth Self Report. Child and Adolescent Psychiatry and Mental Health 2023, 17(1):1–11. 10.1186/s13034-023-00592-0

41. Omisore A, Omisore B, Adelekan B, Afolabi O, Olajide F, Arije O, Agunbiade O: A comparative study of school based violence and strategies for control in public and private secondary schools in Osun State. Nigerian journal of medicine 2012, 21(1):81–88.

42. Letourneau NL, Duffett-Leger L, Levac L, Watson B, Young-Morris C: Socioeconomic status and child development: A meta-analysis. Journal of Emotional and Behavioral Disorders 2013, 21(3):211–224. 10.1177/1063426611421007

43. Papi A, Blasi F, Canonica GW, Morandi L, Richeldi L, Rossi A: Treatment strategies for asthma: reshaping the concept of asthma management. Allergy, Asthma & Clinical Immunology 2020, 16:1–11. 10.1186/s13223-020-00472-8

44. Baiardini I, Sicuro F, Balbi F, Canonica GW, Braido F: Psychological aspects in asthma: do psychological factors affect asthma management? Asthma research and practice 2015, 1(1):1–6. 10.1186/s40733-015-0007-1