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Psychological and Sociocultural Factors That Impact Quality of Life in Childhood Asthma


Quality of life for children with asthma may be influenced by psychological and sociocultural determinants of health.

Negative psychological and sociocultural factors influence the quality of life of children with asthma, with family and social relationships influencing asthma management and quality of life, according to a paper in the International Journal of Environmental Research and Public Health.

The symptoms of asthma, which include coughing, wheezing, chest tightness, and shortness of breath, can cause children to experience daytime fatigue, insomnia, and school absenteeism. In addition to the physical issues caused by asthma, there are psychological and sociocultural factors aswell.

“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,” the authors wrote. “However, other professionals take a completely opposite view, arguing that it is the child’s unexpressed internalizing and externalizing factors that lead to the onset of asthma.”

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

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

Another study found heightened C-reactive protein increased inflammation, which resulted in worse asthma and depression in children with asthma.

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

One study found children with asthma were more prone to attention-deficit/hyperactivity disorder (ADHD), and another found that “asthma is a risk factor for developing ADHD, mainly in children with anxiety and depression who do not have adequate control of the disease.”

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

There were mixed findings on academic performance with one study finding pediatric patients with asthma have poorer academic outcomes and another arguing childhood asthma was not associated with poor performance in school.

Socioeconomic status (SES) had a large impact on children with asthma. Studies found that not only did a lower SES increase the development of diseases like asthma, but it increased mortality, morbidity, and admissions to emergency departments and hospitals for children with asthma. A low SES is also associated with challenges managing asthma, along with feelings of anxiety and helplessness in patients.

Family and social relationships also impact asthma, such as caring maternal behaviors enhancing immune functioning and decreasing internalizing problems that could lead to the onset of asthma. One study found sibling relationships are beneficial for children with asthma. Others found the emotions expressed by parents, such as anger, fear, depression, or helplessness, are also expressed by children with asthma. Specifically, when parents have depression, the children internalize it.

Children with asthma and other conditions, such as anxiety, that would lead to more medications, can cause a reduction in quality of life. Children with asthma who experience anxiety, depression, behavioral disorders, absenteeism, and school interruption feel frustrated and hopeless in a way that prevents them from being able to control their emotions, the authors noted.

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

In patients with non-allergic triggers, asthma can be triggered by an unknown feeling. “Confidence is vital for this type of patient, as children who see themselves as having sufficient skills to stop the asthmatic attack improve their self-confidence and the resolution of the crisis in an adequate manner,” the authors wrote. “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 in childhood asthma disease: impact on quality of life. Int J Environ Res Public Health. 2022;19(5):2652. doi:10.3390/ijerph19052652

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