Psychological and sociocultural factors that influence the quality of life of children with asthma

According to an article in the International Journal of Environmental Research and Public Health.

Asthma symptoms, which include coughing, wheezing, chest tightness and shortness of breath, can cause children to experience daytime fatigue, insomnia and school absenteeism. Besides the physical problems caused by asthma, there are also psychological and socio-cultural factors.

“Psychologists and specialists in the field of psychosomatic diseases point to asthma as a major factor in the development of emotional, social and economic difficulties,” write the authors. “However, other professionals take a completely opposite view, claiming that it is the child’s unspoken internalizing and externalizing factors that lead to the onset of asthma.”

They sought to understand how the quality of life of asthmatic children may be influenced by psychological and sociocultural determinants using a literature search that resulted in a narrative review of 48 articles.

Some articles have found a link between anxiety and depression and asthma. For example, the stress of asthma comorbidities not only increased the number of asthma attacks, but also the frequency of health service use and school absenteeism.

Another study found that increased C-reactive protein increased inflammation, which worsened asthma and depression in children with asthma.

The research also showed that stress and depression, in turn, impact treatment adherence, the authors noted. Poor adherence could not only lead to poorer asthma control, but also trigger additional comorbidities and death.

One study found that children with asthma were more prone to attention deficit/hyperactivity disorder (ADHD), and another found that “asthma is a risk factor for developing ADHD, primarily in children with ‘anxiety and depression that do not adequately control the disease’. .”

Other studies suggest that emotions, such as laughing or crying, play a bigger role in triggering asthma attacks. On the other hand, a study found that behavioral and emotional problems result from poor disease control due to stress. “Positive thinking combined with symptom distraction reduces emotional and behavioral problems,” the authors wrote.

There were mixed results on school performance, with one study finding that pediatric patients with asthma had poorer school performance and another claiming that childhood asthma was not associated with poor school performance.

Socioeconomic status (SES) had a significant impact on children with asthma. Studies have shown that low SES not only increases the development of diseases like asthma, but it also increases mortality, morbidity, and admissions to emergency departments and hospitals for children with asthma. Low SES is also associated with difficulties managing asthma, as well as feelings of anxiety and helplessness in patients.

Family and social relationships also impact asthma, such as nurturing maternal behaviors that improve immune function and decrease internalizing issues that could lead to asthma onset. A study found that sibling relationships are beneficial for children with asthma. Others have found that emotions expressed by parents, such as anger, fear, depression, or helplessness, are also expressed by children with asthma. Specifically, when parents suffer from depression, children internalize it.

Children with asthma and other conditions, such as anxiety, that would require more medication can lead to reduced quality of life. Children with asthma who suffer from anxiety, depression, behavioral problems, absenteeism and school interruption feel frustrated and hopeless in ways that make it difficult for them to control their emotions, the authors noted.

Avoiding asthma triggers is one of the best ways to improve quality of life, a study has found. Another noted that allergic triggers, which are easier to manage and control than non-allergic triggers, have less reduction in quality of life.

In patients with non-allergic triggers, asthma may be triggered by an unknown sensation. “Confidence is vital for this type of patient, because children who see themselves as having sufficient skills to stop the asthma attack improve their self-confidence and resolution of the attack adequately,” write the authors. “For this reason, it is essential that patients know why an asthma attack occurs and the best way to resolve it.”


Plaza-González S, del Carmen Zabala-Baños M, Astasio-Picado Á, Jurado-Palomo J. Psychological and sociocultural determinants of childhood asthma: impact on quality of life. Int J Environ Res Public Health. 2022;19(5):2652. doi:10.3390/ijerph19052652

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