B98-05 Identifying Mental Health Risk and Resilience Factors in Exacerbation-prone Asthma

Rationale Mental health disorders are increasingly recognized among pediatric patients with chronic diseases, yet the relationship between mental health and outcomes in exacerbation-prone asthma remains poorly understood. Anxiety, depression, and perceived stress are common in asthma, may affect symptom perception and medication adherence, and could contribute to more severe disease. We aimed to identify mental health profiles in children with exacerbation-prone asthma and determine whether these profiles are associated with asthma control and clinical response to systemic corticosteroids. Methods Children aged 8-17 years with asthma and ≥1 corticosteroid-treated exacerbation in the prior year completed PROMIS® surveys assessing anxiety, depression, and perceived stress at baseline. K-means cluster analysis was performed on T-scores from these three domains to derive mental health clusters. Participants were followed over 12 months. Asthma outcomes included Asthma Control Questionnaire (ACQ6), Asthma Control Test (ACT), Asthma Impact (quality of life), spirometry, exhaled nitric oxide, and exacerbation frequency. A subset received intramuscular triamcinolone (1 mg/kg, max 40 mg) at enrollment. Cluster differences were evaluated using Chi-square and analysis of variance with Tukey’s Least Significant Difference post hoc tests. Results Ninety-eight participants were enrolled. Cluster analysis identified three groups: Cluster 1 - “Typical mental health” (n = 37) with PROMIS T-scores near population norms, Cluster 2 - “Resilient” (n = 42) with lower-than-average anxiety, depression, and stress, and Cluster 3 - “At risk for mental health disorder” (n = 19) who demonstrated the highest anxiety, depression, and stress. Cluster 3 participants had significantly worse anger, fatigue, physical stress, peer and family relationships, life satisfaction, meaning and purpose, and positive affect (all p < 0.001). They were more often female (74% vs. 29-40%, p = 0.004) and less likely to be using inhaled corticosteroids despite similar prior exacerbation frequency (p = 0.022). Following triamcinolone, asthma control (ACQ6, ACT) and asthma-related quality of life improved in Cluster 1 and Cluster 2 (all p ≤ 0.037) but did not improve in Cluster 3 (p ≥ 0.248). Lung function (FEV₁) did not significantly change in any cluster. Over 12 months, exacerbation rates were similar across clusters; however, Cluster 3 reported more weekly cough, higher short-acting β-agonist use, and worse quality of life. Conclusions Children with exacerbation-prone asthma and high anxiety, depression, and stress form a distinct mental health phenotype characterized by higher symptom burden, lower ICS use, and reduced clinical response to systemic corticosteroids. Routine mental health screening in asthma care may identify high-risk patients and support targeted interventions to improve outcomes.