4 | DISCUSSION
In this research, the authors determine that mindfulness has a partial
mediator effect in the relationship between perceived stress and the
quality of life, in the relationship between perceived stress and
activity limitation and the relationship between perceived stress and
emotional function. However, there is no correlational relationship
between mindfulness and symptoms which is subscale of the quality of
life.
There are studies investigating the relationship between stress and the
quality of life in asthmatics7, between stress and
mindfulness14, 15 and between mindfulness and quality
of life21 there are studies investigating the
relationship. These studies have similar results with our study. They
found significant correlative relationships between perceived stress,
mindfulness and quality of life in people with asthma. According to the
literature, it is been shown that when mindfulness increases, health and
psychological well-being also increase.14 In chronic
diseases when stress reduces due to mindfulness, psychological
well-being increases.15 Mindfulness practises improve
the quality of life in asthmatic people.17 Mindfulness
increases asthma-based quality of life and asthma-based stress has a
small part in this relationship.21
Even though there are research that shows the significant relationship
between mindfulness and activity limitation17, our
finding showed that, there is no correlational relationship between
mindfulness and activity limitation. When mindfulness training was
applied to an asthma group for eight weeks, a relationship was found
between mindfulness and activity limitation and controlled asthma rate
increased from 7.3% to 19.4%.17 There is a
difference between our study and the research in question in terms of
distribution of asthma control levels. In our study, controlled asthma
rate (51%) was higher than partially-controlled (36%) and uncontrolled
asthma rate (13%); therefore, the result might be not significant.
Furthermore, the seasonal activity rates of the participants might be a
confusing factor that may differentiate. There are studies showing that
asthma control levels improve due to the low activity rates of people
with asthma in winter. For example, adults with asthma may think that
their asthma control levels are better in winter because they restrict
their activities in winter compared to the summer
seasons.29 The data collection process of our study
coincided with the months of January, February and March, our
participant group attends to school during the winter months, coincides
with most daily activities.
In literature, the symptoms of the disease positively correlate with the
stress level of asthmatic people.30 Asthma symptoms
decrease with the increase of mindfulness.16 In our
study, it was understood that mindfulness in pediatric asthma had a
partial effect on the relationship between perceived stress and
symptoms.
People with asthma decrease their emotional functionality due to
inefficient coping with stress.31 Conversely, it has
been observed that the increase of mindfulness levels affects emotional
functionality.32 In our study, it was determined that
mindfulness has a partial effect on the relationship between perceived
stress and emotional function.
In this study, it was discovered that the perceived stress does not
differ according to the asthma control levels, but the perceived stress
level decreases hierarchically with the increase of the asthma control
level. Literature has shown that the level of stress varies according to
asthma control and consistent with our research, low asthma control and
excessive stress are associated.21, 33 In a study,
perceived stress increased in direct proportion with both the incidence
of asthma and asthma severity.34
Mindfulness level did not change according to asthma control level.
Similarly, it has been observed that asthma control has no effect on
mindfulness scores in adolescents.21
Quality of life, activity limitation, symptoms and emotional function
differed according to asthma control. When the level of asthma control
increase; the quality of life and emotional function also increase;
however, activity limitation, symptoms scores decreased. A similar study
found that as asthma control decreases, quality of life
decreases.35 Uncontrolled asthma had a higher activity
limitation.36 According to GINA criteria, there is a
negative correlation between asthma control and
symptoms.37 Moreover, aggression, which is one of the
emotional factors known to influence emotional functionality, has been
found to decrease with increasing asthma control.38
When the previous studies were investigated, it might be said that our
research has limitations. Compared to other studies, the number of
participants was limited and study design was cross-sectional.
Therefore, mindfulness may not have full mediator effect on the
relationships in question. Although perceived stress decreases when
asthma control increases, this model was not significant. It also may be
related to the low number of participants. Thus, further research might
investigate the same relationships with higher number of participants
and design might be longitudinal. Moreover, in further studies, studying
activity limitation via equally asthma control group division might
occur crucial consequences. It may also be advisable to add a control
group in the study to make the results more reliable on a scientific
scale.
In conclusion, our study found that there is a relationship between
perceived stress, mindfulness and the quality of life in pediatric
asthma. Our results suggest mindfulness has a partial mediator impact on
the relationship between perceived stress and quality of life, on the
relationship between perceived stress and activity limitation which is
the subscale of quality of life with on the relationship between
perceived stress emotional function which is the quality of life’s
subscale. Adding mindfulness-based practices to the current medical
treatments might reduce perceived stress and increase the quality of
life via reducing activity limitation, increasing emotional function.
Moreover, health professionals working with asthmatic children, it may
be advisable to consider the quality of life including the activities
limitation, symptoms of the disease and emotional function in order to
control asthma.
ACKNOWLEDGEMENTS
We would like to thank all the collaboration by the medical doctors in
İstanbul University İstanbul Medical Faculty Hospital’s “Child Allergy
Policlinic” and the participants.
ORCHID
Ayşe Sena Ayhan https://orcid.org/0000-0002-1192-2575
Zekeriya Deniz Aktan https://orcid.org/0000-0003-1757-2024
Zeynep Ülker Tamay https://orcid.org/0000-0002-3200-5493
REFERENCES
- The Global Initiative for Asthma (GINA). Global strategy for asthma
management and prevention. 2018 Update.
- Lai, CK, Beasley, R, Crane, J, Foliaki, S, Shah, J, Weiland, S, &
ISAAC Phase Three Study Group. Global variation in the prevalence and
severity of asthma symptoms: phase three of the international study of
asthma and allergies in childhood (ISAAC). Thorax 2009; 64(6),
476-483.
- Kurt, E, Metintas, S, Başyiğit, I, Bulut, I, Coşkun, E, Dabak, S,
Deveci, F, Fidan, F, Kaynar, H, Uzaslan, EK, et al, AF. Prevalence and
risk factors of allergies in Turkey: Results of a multicentric
cross‐sectional study in children. Pediatric Allergy and Immunology
2007; 18(7), 566-574.
- Blackman, JA, & Gurka, MJ. Developmental and behavioral comorbidities
of asthma in children. Journal of Developmental & Behavioral
Pediatrics 2007; 28(2), 92-99.
- Grizenko, N, Osmanlliu, E, Fortier, MÈ, & Joober, R. Increased risk
of asthma in children with ADHD: Role of prematurity and maternal
stress during pregnancy. Journal of the Canadian Academy of Child and
Adolescent Psychiatry 2015; 24(2), 109.
- Katon, W, Lozano, P, Russo, J, McCauley, E, Richardson, L, & Bush, T.
The prevalence of DSM-IV anxiety and depressive disorders in youth
with asthma compared with controls. Journal of Adolescent Health 2007;
41(5), 455–463.
- Kimura, T, Yokoyama, A, Kohno, N, Nakamura, H, & Eboshida, A.
Perceived stress, severity of asthma and quality of life in young
adults with asthma. Allergology International 2009; 58(1), 71-79.
- Ramratnam, S, Jaffee, K, Visness, C, & Gern, JE. (2017). Exposure to
early life maternal stress and depression and risk of asthma. In C26.
Asthma in infants and children. American Thoracic Society 2009;
A5088-A5088.
- Rona, RJ, Smeeton, NC, Amigo, H, & Vargas, C. Do psychological
distress and somatization contribute to misattribution of asthma? A
Chilean study. Journal of Psychosomatic Research 2007; 62(1), 23-30.
- Bellin, MH, Kub, J, Frick, KD, Bollinger, ME, Tsoukleris, M, Walker,
J, Land, C, & Butz, AM. Stress and quality of life in caregivers of
inner-city minority children with poorly controlled asthma. Journal of
Pediatric Health Care 2013; 27(2), 127-134.
- Boran, P, Tokuç, G, Pişgin, B, & Öktem, S. Assessment of quality of
life in asthmatic Turkish children. Turkish Journal of Pediatrics
2008; 50(1).
- Türk Toraks Derneği, astım tanı ve tedavi rehberi güncellemesi.
Turkish Thoracic Journal 2016.
- Kabat‐Zinn, J. Mindfulness‐based interventions in context: Past,
present and future. Clinical Psychology: Science and Practice 2003;
10(2), 144-156.
- Bränström, R, Duncan, LG, & Moskowitz, JT. The association between
dispositional mindfulness, psychological well‐being and perceived
health in a Swedish population‐based sample. British Journal of Health
Psychology 2011; 16(2), 300-316.
- Creswell, JD, & Lindsay, EK. How does mindfulness training affect
health? A mindfulness stress buffering account. Current Directions in
Psychological Science 2014; 23(6), 401-407.
- Shi, L, Liang, D, Gao, Y, Huang, J, Nolan, C, Mulvaney, A, Poole, T,
& Zhang, H. Mindfulness and asthma symptoms: A study among college
students. Journal of Asthma 2018; 55(1), 101-105.
- Pbert, L, Madison, JM, Druker, S, Olendzki, N, Magner, R, Reed, G, &
Carmody, J. Effect of mindfulness training on asthma quality of life
and lung function: A randomised controlled trial. Thorax 2012; 67(9),
769-776.
- Nadiri, M, & Khanpour, F. The effect of teaching mindfulness-based
stress reduction on the quality of life of patients with asthma.
Depiction of Health 2019; 10(2), 144-156.
- Delgado, LC, Guerra, P, Perakakis, P, Vera, MN, Reyes del Paso, G, &
Vila, J. Treating chronic worry: Psychological and physiological
effects of a training programme based on mindfulness. Behaviour
Research and Therapy 2010; 48(9), 873–882.
- Vlemincx, E, Vigo, D, Vansteenwegen, D, Van den Bergh, O, & Van
Diest, I. Do not worry, be mindful: Effects of induced worry and
mindfulness on respiratory variability in a nonanxious population.
International Journal of Psychophysiology 2013; 87(2), 147-151.
- Cillessen, L, van de Ven, MO, & Karremans, J. C. The role of trait
mindfulness in quality of life and asthma control among adolescents
with asthma. Journal of Psychosomatic Research 2017; 99, 143-148.
- Snoeren, F, & Hoefnagels, C. Measuring perceived social support and
perceived stress among primary school children in the Netherlands.
Child Indicators Research 2014; 7(3), 473-486.
- Oral, T & Ersan, C. Çocuklarda (8-11 yaş) Algılanan Stres Ölçeği’nin
Türkçeye uyarlama çalışması. Selçuk Üniversitesi Edebiyat Fakültesi
Dergisi 2017; (37), 419-428.
- Greco, L, Baer, RA, & Smith, GT. Assessing mindfulness in children
and adolescents: Development and validation of the child and
adolescent mindfulness measure (CAMM). Psychological Assessment 2011;
23(3), 606-614.
- Sünbül, ZA. Psychometric evaluation of child and adolescent
mindfulness measure (CAMM) with Turkish sample. Online Submission
2018; 7(2), 56-59.
- Juniper, EF, Guyatt, GH, Feeny, DH, Ferrie, PJ, Griffith, LE, &
Townsend, M. Measuring quality of life in children with asthma.
Quality of life research 1996; 5(1), 35-46.
- Yüksel, H, Yılmaz, O, Kırmaz, C, & Eser, E. Validity and reliability
of the Turkish translation of the pediatric asthma quality of life
questionnaire. The Turkish Journal of Pediatrics 2009; 51(2), 154.
- Baron, RM, & Kenny, DA. The moderator-mediator variable distinction
in social psychological research: Conceptual, strategic and
statistical considerations. Journal of Personality and Social
Psychology 1986; 51, 1173-1182.
- Bacon, SL, Lemiere, C, Moullec, G, Ninot, G, Pepin, V, & Lavoie, KL.
Association between patterns of leisure time physical activity and
asthma control in adult patients. BMJ Open Respiratory Research 2015;
2(1).
- Luria, CJ, Sitarik, AR, Havstad, S, Wegienka, GR, Kim, H, Zoratti, EM,
FAAAAI, Joseph, CLM & Cassidy-Bushrow, A. Association between asthma
symptom scores and increased perceived stress and trait anxiety in
asthmatic adolescents. Journal of Allergy and Clinical Immunology
2016; 137(2).
- Lewandowska, K, Specjalski, K, Jassem, E, & Słomiński, JM. Style of
coping with stress and emotional functioning in patients with asthma.
Advances in Respiratory Medicine 2009; 77(1), 31-36.
- Borders, A, Earleywine, M, & Jajodia, A. Could mindfulness decrease
anger, hostility and aggression by decreasing rumination? Aggressive
Behavior: Official Journal of the International Society for Research
on Aggression 2010; 36(1), 28-44.
- Kishore, N. The impact of severe housing stress on child asthma
control and pediatric asthma caregiver quality of life (PACQOL)
(Doctoral Dissertation). 2014.
- Rod, NH, Kristensen, TS, Lange, P, Prescott, E, & Diderichsen, F.
Perceived stress and risk of adult‐onset asthma and other atopic
disorders: A longitudinal cohort study. Allergy 2012; 67(11),
1408-1414. (Li et al., 2016
- Li, Z, Thompson, LA, Gross, HE, Shenkman, EA, Reeve, BB, DeWalt, DA,
& Huang, IC. Longitudinal associations among asthma control, sleep
problems and health-related quality of life in children with asthma: A
report from the PROMIS® pediatric asthma study. Sleep Medicine 2016;
20, 41-50.
- Haselkorn, T, Jones, C. A, Chen, H, Rhoa, M, Miller, DP, Peters, SP,
& Weiss, ST. Relationship between asthma control and activity
limitation: Insights from the REACT study. Journal of Allergy and
Clinical Immunology 2008; 121(2), S160.
- The Global Initiative for Asthma (GINA). A pocket guide for health
professionals (Updated 2019) 2019.
- Coban, H, & Aydemir, Y. The relationship between allergy and asthma
control, quality of life and emotional status in patients with asthma:
A cross-sectional study. Allergy, Asthma & Clinical Immunology 2014;
10(1), 67.