Anxiety, alexithymia and attitude to the disease in children with severe bronchial asthma

Abstract

The study of psychological characteristics of the children with bronchial asthma (BA) is extremely relevant in determining the severity of the course of the disease. The purpose of the study was to examine associations between BA severity and personal psychological characteristics. Levels of state (SA), trait (TA) and school anxiety (ScA) with self-reported State Trait Anxiety Inventory (Spielberger and Hanin), School Anxiety Inventory (Phillips) were examined, a Bekhterev institute personality questionnaire (LOBI) was used in order to diagnose the types of attitudes to BA, an adapted Toronto Alexithymia Scale (by G. Taylor) was used to detect alexithymia. The first clinical group was formed by 32 children with severe BA, and the II group of comparison included 30 children with moderate BA (GINA). High TA scores were observed in 26.6±1.7% of patients with severe BA versus 9.1±6.1% of children in control group (OR=4,0; 95%CI:0,75-21,2). High SA scores were revealed in 25±8.2% versus 22.7±8.3% of patients with severe and nonsevere BA correspondingly (p>0.05). The patients’ TA levels were associated with more severe children’s fears (r=0.3; p<0.03) and the presence of early warning signs of the BA attack (r=0.3; p <0.04). The experience of child’s social stress was associated with night attacks (r = 0.27; p <0.04). The higher level of ScA correlated with a child’s negative attitude to the need of daily medicines use (r=0.3; p<0.03) and higher scores of the bronchial lability (r=0.36; p<0.01). The high level of SA was a predictor of the lower efficacy of control treatment with inhaled corticosteroids (r=-0.6; p<0.02). The mean scores of the Toronto Alexithymia Scale were 71.2±2.1 versus 70.3±2.7 in groups of comparison (p>0.05), however, the presence of alexithymia correlated with the number of asthma attacks per year (r=0.36; p<0.05), the negative attitude toward hospitalization (r=0.37; p<0.04) and the need of daily intake of drugs (r=0.26; p<0.05). The neurasthenic and / or sensitized type of attitude to the disease was more often noted in children with severe asthma (OR=5.3; 95% CI:1.3-24.7), and euphoric / anosognosic types of attitudes were associated with lower levels of disease control and non-compliance to basic therapy. Thus, there was a tendency to higher TA, ScA and presence of the neurasthenic and / or sensitized type of attitude to the disease in children with severe BA.