Lavoie et al. examined [12] the prevalence of psychiatric disorders in asthmatic patients attending an outpatient clinic [N = 504]. Psychiatric assessment was carried out using the Primary Care Evaluation for Mental Disorders (PRIME-MD) [13], a short questionnaire that takes about 20 min to administer. About one-third of the patients met the diagnostic criteria for one or more psychiatric disorders. Eight per cent of the patients met criteria for major depression, 12% for anxiety disorder and 11% for panic disorder. In addition, 11% of these patients had both anxiety and depressive disorders. In addition, major depression was independently associated with poor asthma control (not anxiety). This signify depression compromises individual’s ability initiating and managing complex treatment regimens that require sustained effort, self-monitoring and administration. Furthermore, depression may have compromised patients’ active role in the family, dependency on others for activities of daily living, lowered self-efficacy and social interaction.

In a separate study, Lavoie et al. examined [14] the influence of psychological distress and maladaptive coping styles in patients [n = 84] with moderate and severe patients with asthma. Patients were categorized into moderate to severe lung function impairment using the standard pulmonary function testing according to American Thoracic Society/European Respiratory guidelines [15, 16]. Their findings indicate that patients with severe asthma [n = 42] reported high level of psychological distress, worse cognitive dysfunction, emotional coping, future pessimism and apprehension compared to moderate asthmatics [n = 42]. A cross-sectional study in Spain [17] from outpatient clinic of patients with asthma (n = 354) reported the prevalence of anxiety was 31%, depression was 2% and anxiety plus depression was 10%. Over 77% of the asthmatic patients had poor or partial control of their condition. In addition, patients with poor asthma control are three times more likely to exhibit the risk of developing anxiety plus depression. Elevated level of anxiety was associated with impaired quality of life in patients with asthma. In a community survey [18] of older people (n = 20,888) in Norfolk, England examined the association between psychosocial factors and asthma. Out of these, 1699 (8.1%) of the participants had physicians diagnosed asthma. Major depression, adverse childhood circumstances, difficulties in adulthood and inadequate social support were associated with the chronicity of asthma. Furthermore, Bacon et al. [19] reported that asthmatic patients from the lower socio-economic status (SES) had utilized greater emergency healthcare services and worse self-asthma control compared to patients with higher SES. All these factors signify that psychosocial factors have deleterious effect on psychological well-being and impaired quality of patients with asthma.

Vazquez et al. [20] examined the influence of ‘near-fatal asthma [NFA]’ experience [n = 44] in stable adult patients with asthma compared to patients ‘without near-fatal asthma’ [n = 44], in their coping mechanism, self-management and psychological problems. Patients with asthma who experience a near-fatal experience had higher levels of trait anxiety (a tendency to perceive situations as threatening and consequently increase) and more difficulties describing and communicating feelings compared those who did not have a NFA. There was no difference in self-management in both groups. However, because of the cross-sectional nature of the study, it could not infer whether the association of psychological problems with NFA can be regarded as risk factors or a consequence of the experience of a NFA crisis [20]. Thus, longitudinal study is worthy of consideration to elucidate this point.

Work-related asthma (the cause of the stimuli is individual’s work environment) is a common cause of adult on-onset asthma. It affects 9–15% of adult patients with asthma [21]. Lavoie et al. [22] in a prospective study (n = 219) using the PRIME-MD, examined the prevalence of psychiatric disorders including mood and anxiety disorders and hypochondriasis in patients referred for the occupational asthma assessment. Thirty-four per cent of the patients with occupational asthma had psychiatric disorders. Out of these, 29% mood disorders and 24% anxiety disorders were diagnosed, respectively. Seven per cent of the patients’ with occupational asthma was diagnosed with hypochondriasis. In addition, hypochondriasis is associated with increased risk of not receiving any medical diagnoses. In a large survey of (n = 1267) occupational asthmatic (OA), patients who were exposed to workplace moisture and moulds had worse quality of life compared to patients without OA [23]. Furthermore, being unemployed (due to disability, retirement, job loss or other reasons) and the greater need for asthma medication were associated with poorer quality of life.

In 2010, Goodwin et al. [24] using data from the Canadian Community Health Survey Cycle 1.2 (N = 36,984; age ≥ 15 years) examined the association between mental health disorders and asthma and the impact of asthma and mental disorder on functional impairment and mental healthcare service use among adults in the community. Their findings indicated that asthma was related to mental health disorders such as post-traumatic stress disorder, mania and panic disorder. Thus, asthma patients with comorbid mental health disorders had elevated rates of functional impairment and use of mental health services compared with those either asthma patients or mental health disorders. Furthermore, data that were drawn [25] from the Third National Health and Nutrition Examination Survey, a representative sample of adults (N = 6584) in the USA, showed that current asthma was related with an increased likelihood risk of 77% suicidal ideation (odds ratio: 1.77, confidence interval: 1.11, 2.84) and suicide attempt (odds ratio: 3.26, confidence interval: 1.97, 5.39), respectively. Adult asthmatic patients are prone to a threefold increased risk of attempting to commit suicide compared to patients without asthma counterparts, although the exact cause(s) that instigate asthmatic patients for suicidal ideation are unknown. It is most likely multifactorial including psychosocial factors, hopelessness due to severity of asthma, elevated symptoms of depression and anxiety. Those asthmatic patients identified with suicidal ideation promptly referred to mental health services for treatment. Further studies are needed.