A Bidirectional Relationship Between Psychosocial Factors and Atopic Disorders: A Systematic Review and Meta-Analysis

Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom. .
Psychosomatic Medicine (Impact Factor: 3.47). 02/2008; 70(1):102-16. DOI: 10.1097/PSY.0b013e31815c1b71
Source: PubMed


There is growing epidemiological literature focusing on the bidirectional association between psychosocial factors and atopic disorders, but no efforts to quantify the relationship systematically have been published.
We searched Medline, PsycINFO, Web of Science, and PubMed up to June 2007. The studies included were prospective cohort studies investigating the influence of psychosocial factors on atopic disorders and the effect of atopic disorders on mental health. Two investigators independently extracted data and determined study quality.
There were 43 studies (in 22 articles), of which 34 evaluated the effect of psychosocial factors on atopic disorders and 9 evaluated the effect of atopic disorders on mental health. The major atopic disease assessed in these studies was asthma (90.7%) with allergic rhinitis, 4.7%; atopic dermatitis, 2.3%; and food allergies, 2.3%. The overall meta-analysis exhibited a positive association between psychosocial factors and future atopic disorder (correlation coefficient (r) as combined size effect .024; 95% confidence interval, 0.014-0.035; p < .001) as well as between atopic disorders and future poor mental health (r = .044, 95% confidence interval, 0.021-0.067, p < .001). More notably, the subgroup meta-analysis on the healthy and atopic disorder populations showed psychosocial factors had both an etiological and prognostic effect on atopic disorders.
The current review revealed a robust relationship between psychosocial factors and atopic disorders. This supports the use of psychological in addition to conventional physical and pharmacological interventions, in the successful prevention and management of atopic disorders.

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    • "This finding is important because anxious and depressive symptoms and disorders are common in COPD, and they increase suffering, morbidity, utilisation of health services, and even mortality (Abrams et al., 2011; Celli and MacNee, 2004; Divo et al., 2012; Kunik et al., 2005; Ng et al., 2007). Once distressed psychological states develop, they may increase ventilation and worsen perceived dyspnoea to a degree that is disproportionate to impairment in lung function, so creating a vicious cycle of increasing disability (Chida et al., 2008; de Voogd et al., 2011; Parshall et al., 2012; Smoller et al., 1996). Cognitive behaviour therapy (CBT) is an effective treatment for anxious and depressive symptoms and disorders in the physically healthy, and there is evidence of its usefulness in patients with COPD (Baraniak and Sheffield, 2011; Butler et al., 2006; de Godoy and de Godoy, 2003; Eiser et al., 1997; Hynninen et al., 2010; Lamers et al., 2010; Livermore et al., 2010a,b). "
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    ABSTRACT: There is evidence that psychological factors contribute to the perception of increased difficulty of breathing in patients with chronic obstructive pulmonary disease (COPD), and increase morbidity. We tested the hypothesis that cognitive behaviour therapy (CBT) decreases ratings of perceived dyspnoea in response to resistive loading in patients with COPD. From 31 patients with COPD, 18 were randomised to four sessions of specifically targeted CBT and 13 to routine care. Prior to randomisation, participants were tested with an inspiratory external resistive load protocol (loads between 5-45 cmH20/L/s). Six months later we re-measured perceived dyspnoea in response to the same inspiratory resistive loads and compared results to measurements prior to randomisation. There was a significant 17% reduction in dyspnoea ratings across the loads for the CBT group, and no reduction for the routine care group. The decrease in ratings of dyspnoea suggests that CBT to alleviate breathing discomfort may have a role in the routine treatment of people with COPD. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Jun 2015 · Respiratory Physiology & Neurobiology
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    • "In adults with established asthma [37], distinct types of stress were not found to be associated with asthma morbidity, but early traumatic life events were shown to predict asthma at adult age [38]. A meta-analysis concluded that exposure to stressors alone does not increase the risk of allergic disorders, but only exposure to stressors that evoke negative cognition leads to an adverse impact on asthma patients [39]. These findings highlighted the importance of individual variation in perception of stressors, and the importance of perceived stress in the course of asthma. "
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    ABSTRACT: Purpose Psychiatric comorbidity is reported to be common among adolescents with asthma, but little is known about its underlying psychological factors. Objective This study explored the profile of anxiety and depressive comorbidities among adolescents with well-controlled and poorly controlled asthma and the contribution of neuroticism and perceived stress. Methods The Revised Child Anxiety and Depression Scale, Neuroticism subscale of Big Five Inventory, Perceived Stress Scale, and Asthma Control Test were administered to 198 adolescents (aged 12–19 years) with well-controlled (n = 137) and poorly controlled asthma (n = 61) as well as 171 healthy neighborhood controls. Results Adolescents with poorly controlled asthma, compared with well-controlled asthma patients and healthy controls, had higher scores of depression (p = .006), panic attacks (p = .002), total anxiety (p = .038), and total internalizing symptoms (p = .017), after adjusting for gender, age, ethnicity, smoking status, and family housing type. Adolescents with asthma had higher neuroticism (p = .025), perceived stress (p = .022), and body mass index (p = .006) and lower self-rated health (p < .001) than healthy controls. No significant differences in psychiatric comorbidity scores were observed after accounting for differences in underlying psychological and physical factors. Among asthma patients, increased asthma control was associated with decreased scores of psychiatric comorbidity (p < .01), but the association was not significant after allowing for decreased neuroticism and perceived stress. Conclusions The diagnosis of asthma and poor asthma control in adolescents is associated with excess psychiatric comorbidity, which is likely due to increased neuroticism and perceived stress.
    Full-text · Article · Aug 2014 · Journal of Adolescent Health
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    • "Psychological distress and allergic diseases show high comorbidity [25]. Moreover, there is evidence that psychological distress and allergic diseases have a bidirectional relationship [26,27]. A recent study showed that prenatal maternal distress promoted the development of allergic disease in the offspring [28]. "
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    ABSTRACT: Background This paper describes the background, aim, and design of a prospective birth-cohort study in Korea called the COhort for Childhood Origin of Asthma and allergic diseases (COCOA). COCOA objectives are to investigate the individual and interactive effects of genetics, perinatal environment, maternal lifestyle, and psychosocial stress of mother and child on pediatric susceptibility to allergic diseases. Methods/Design The participants in COCOA represents a Korean inner-city population. Recruitment started on 19 November, 2007 and will continue until 31 December, 2015. Recruitment is performed at five medical centers and eight public-health centers for antenatal care located in Seoul. Participating mother-baby pairs are followed from before birth to adolescents. COCOA investigates whether the following five environmental variables contribute causally to the development and natural course of allergic diseases: (1) perinatal indoor factors (i.e. house-dust mite, bacterial endotoxin, tobacco smoking, and particulate matters 2.5 and 10), (2) perinatal outdoor pollutants, (3) maternal prenatal psychosocial stress and the child’s neurodevelopment, (4) perinatal nutrition, and (5) perinatal microbiome. Cord blood and blood samples from the child are used to assess whether the child’s genes and epigenetic changes influence allergic-disease susceptibility. Thus, COCOA aims to investigate the contributions of genetics, epigenetics, and various environmental factors in early life to allergic-disease susceptibility in later life. How these variables interact to shape allergic-disease susceptibility is also a key aim. The COCOA data collection schedule includes 11 routine standardized follow-up assessments of all children at 6 months and every year until 10 years of age, regardless of allergic-disease development. The mothers will complete multiple questionnaires to assess the baseline characteristics, the child’s exposure to environmental factors, maternal pre- and post-natal psychological stress, and the child’s neurodevelopment, nutritional status, and development of allergic and respiratory illnesses. The child’s microbiome, genes, epigenetics, plasma cytokine levels, and neuropsychological status, the microbiome of the residence, and the levels of indoor and outdoor pollutants are measured by standard procedures. Discussion The COCOA study will improve our understanding of how individual genetic or environmental risk factors influence susceptibility to allergic disease and how these variables interact to shape the phenotype of allergic diseases.
    Full-text · Article · Jul 2014 · BMC Pulmonary Medicine
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