Psychological factors in asthma outcomes: a research portfolio
Despite enhancements in medical asthma treatments, the disparity in asthma outcomes remains a pressing issue in asthma care and represents a significant personal burden for individuals living with asthma. To further improve available care, it is crucial to better understand which psychological factors might account for such disparity and the mechanisms through which they operate. In two chapters, the current research portfolio aimed to explore the role of psychological factors in asthma morbidity outcomes in adults with asthma. The first chapter is a systematic review exploring the relationship between six emotion regulation strategies: acceptance, avoidance, problem-solving, reappraisal, worry/rumination and suppression and asthma outcomes: asthma control, health-related quality of life (QoL), health care utilisation and medication compliance in adults with asthma. A systematic search of four electronic databases resulted in 18 studies which met the inclusion criteria. The systematic review highlighted significant relationships between emotion regulation strategies and asthma outcomes. The direction of these relationships depended on the type of emotion regulation strategy and the asthma outcome studied. Findings from the current review highlighted that psychological interventions aimed at promoting more adaptive emotion regulation skills in adults with asthma might positively influence their asthma morbidity outcomes. Further research is needed, using improved methodological design and a clearer conceptualisation of emotion regulation construct. The second chapter presents an empirical study. It explored the role of generalised anxiety (GA) in asthma outcomes: asthma QoL, asthma control and short-acting asthma reliever medication use (SAARM) and the potential mediation role of experiential avoidance (EA) and asthma control self-efficacy (SE). A cross-sectional set of questionnaires was completed by 65 participants attending NHS outpatient respiratory clinics. Correlation and mediation path analyses were conducted. Higher GA was associated with poorer asthma outcomes, lower asthma control SE and higher EA. After controlling for covariates, both SE and EA were found to mediate the relationship between GA and both asthma control and QoL. Neither SE nor EA played a mediatory role in the relationship between GA and SAARM use. These results need to be replicated in research using a longitudinal design. However, they provide preliminary support that psychological interventions targeting asthma control SE and EA could promote better asthma control and QoL in adults with asthma and co-morbid anxiety.