Dr Nnamdi Mgbemena

Australian men with asthma were significantly more likely to develop depression, anxiety and both conditions together over eight years of follow-up, according to a large longitudinal study that adds to calls for mental health to become a routine part of asthma care.

Researchers analysed data from 16,021 participants in the national Ten to Men study across four survey waves between 2014 and 2022, comparing mental health outcomes among men with and without doctor-diagnosed asthma. After adjusting for sociodemographic factors, smoking, obesity, physical activity, sleep and other comorbidities, asthma remained independently associated with poorer mental health.

Writing in the American Journal of Health Promotion [link here], Dr Nnamdi Mgbemena, researcher in the Faculty of Health at Southern Cross University, and colleagues reported that men with asthma had a 23% higher risk of depression, a 12% higher risk of anxiety and a 27% higher risk of experiencing both conditions compared with men without asthma.

The researchers focused specifically on men because chronic respiratory diseases are common in Australian males, who also have lower rates of health-seeking behaviour and are more likely to experience health complications than women. Despite this, the mental health impacts of asthma in men remain comparatively under-studied.

They said the findings highlighted “the need for an integrated approach to respiratory and mental health care, with particular emphasis on targeted screening and interventions”.

The study also found the greatest mental health burden occurred among men experiencing both depression and anxiety, suggesting asthma was associated not only with individual psychological conditions but with more complex psychiatric comorbidity.

Rates of mental health conditions fluctuated substantially over the study period.

Among men with asthma, depression affected around 30% of participants in 2014 and 2016 before rising to 33.2% in 2020 and falling to 12.8% in 2022. Anxiety showed a more pronounced increase, climbing from 17.3% in 2014 to 51.3% in 2020 before easing to 40.6% in 2022. Comorbid depression and anxiety more than doubled during the same period, peaking at 28% in 2020.

The investigators noted the spike coincided with the COVID-19 pandemic and likely reflected broader psychosocial disruption, including prolonged lockdowns, social isolation, concerns about infection and interruptions to healthcare.

“Our findings emphasise the importance of integrated healthcare strategies that include ongoing mental health assessments as well as links to mental health support services,” Dr Mgbemena and colleagues wrote.

“Although the longitudinal nature of the data strengthens temporal interpretation, the observational design precludes causal inference, and findings should be interpreted as associations,” they added.

The analysis also identified several characteristics associated with poorer mental health among men with asthma.

Sleep disturbance emerged as the strongest modifiable risk factor across depression, anxiety and their comorbidity, while both former and current smoking were consistently associated with higher risks. Younger men aged 20-39 years were particularly vulnerable to depression and combined depression with anxiety. Obesity and hypertension were also linked to worse mental health outcomes.

By contrast, being married or in a de facto relationship and having a university education appeared to reduce the risk of depression and comorbid depression with anxiety.

The authors said several mechanisms may underlie the association, including the chronic burden of asthma symptoms, the demands of disease self-management and poor sleep related to nocturnal coughing and wheeze.

They also discussed hypotheses that systemic inflammation associated with asthma may influence neurobiological pathways involved in mood regulation, but cautioned that these mechanisms remain speculative because inflammatory markers were not measured in the study.

The researchers acknowledged several limitations, including reliance on self-reported asthma diagnoses rather than objective clinical measures such as spirometry, and the observational design, which prevented conclusions about causality.

However, they said the nationally representative cohort, eight years of follow-up and adjustment for a broad range of confounding factors strengthened confidence in the findings.

They concluded that the results support greater integration of mental health into asthma management, particularly for men with sleep problems or a history of smoking.

“Future interventional research is necessary to evaluate the effectiveness of integrated care models that concurrently address chronic respiratory and psychological health,” they wrote.

“Tailoring such interventions to the high-risk subgroups identified in this study may enhance their clinical relevance and impact.”