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Solunum Yolu Allerjik Hastalığı Olan Ergenlerin ve Ailelerinin Psikolojik Durumları

Year 2016, Volume: 17 Issue: 3, 120 - 128, 01.12.2016

Abstract

Amaç: Çalışmanın amacı solunum yolu allerjileri olan adölesanların ve ailelerinin psikolojik durumlarının değerlendirilmesidir.Gereç ve Yöntemler: Çocuk ve adölesan psikiyatristleri adölesanların psikiyatrik durumlarını Çocuklar için Depresyon Ölçeği (CDI) ve Çocuk ve Ergenlerde Anksiyete ve İlgili Bozukluklar için Tarama ve Değerlendirme Ölçeği (SCARED) ile değerlendirdi. Psikiyatristler ailelerin psikolojik durumlarını Hamilton Depresyon Değerlendirme Ölçeği (HAM-D) ve Hamilton Aksiyete Değerlendirme Ölçeği (HAM-A) ile değerlendirdi. Bulgular: Anksiyete semptomları hastaların 63’ünden 21’inde saptandı. CDI skorları kontrollerde hastalara göre yüksekti (p=0,03). HAM-D skorları allerjik rinit ve eşlik eden astımı olan adölesanların ailelerinde kontrollere göre yüksekti (p=0,025). Hiçbir skor astım ve allerjik rinitin ağırlığından, astım kontrol düzeyinden, son bir yıl içindeki astım atak varlığından ve akciğer fonksiyon testlerinden etkilenmedi (p>0,05). SCARED ve CDI arasında orta düzeyde (r=0,644, p<0,001), HAM-A ve HAM-D skorları arasında yüksek düzeyde pozitif korelasyon saptandı (r=0,860, p<0,001).Sonuç: Aksiyete semptomların hastaların üçte birinde görüldü. HAM-D skorları allerjik rinit ve eşlik eden astımı olan adölesanların ailelerinde kontrollere göre yüksekti

References

  • 1. Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004; 59: 469-78.
  • 2. Cruz AA, Popov T, Pawankar R, Annesi-Maesano I, Fokkens W, Kemp J, et al. ARIA Initiative Scientific Committee. Common characteristics of upper and lower airways in rhinitis and asthma: ARIA update, in collaboration with GA(2)LEN. Allergy 2007; 62: 1-41.
  • 3. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733-43.
  • 4. Slattery MJ, Essex MJ. Specificity in the association of anxiety, depression, and atopic disorders in a community sample of adolescents. J Psychiatr Res 2011; 45: 788-95.
  • 5. Meltzer EO, Blaiss MS, Derebery MJ, Mahr TA, Gordon BR, Sheth KK, et al. Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol 2009; 124: 43-70.
  • 6. Wu WC, Chang HY, Kuo KN, Chen CY, Tu YC, Yang YH. Psychosocial problems in children with allergic diseases: a population study in Taiwan. Child Care Health Dev. 2011; 37: 662-70.
  • 7. Lv X, Xi L, Han D, Zhang L. Evaluation of the psychological status in seasonal allergic rhinitis patients. ORL J Otorhinolaryngol Relat Spec 2010; 72: 84-90.
  • 8. Katon W, Lozano P, Russo J, McCauley E, Richardson L, Bush. The prevalence of DSM-IV anxiety and depressive disorders in youth with asthma compared with controls. J Adolesc Health 2007; 41: 455-63.
  • 9. Xi L, Zhang Y, Han D, Zhang L. Effect of asthma, aeroallergen category, and gender on the psychological status of patients with allergic rhinitis. J Investig Allergol Clin Immunol 2012; 22: 264-9.
  • 10. Szabo A, Mezei G, Kovari E, Cserháti E. Depressive symptoms amongst asthmatic children’s caregivers. Pediatr Allergy Immunol 2010; 21: 667-73.
  • 11. Yuksel H, Sogut A, Yilmaz O,Demet M, Ergin D, Kirmaz C. Evaluation of sleep quality and anxiety-depression parameters in asthmatic children and their mothers. Respir Med 2007; 101: 2550-4.
  • 12. Brown ES, Gan V, Jeffress J, Mullen-Gingrich K, Khan DA, Wood BL, et al. Psychiatric symptomatology and disorders in caregivers of children with asthma. Pediatrics 2006; 118: 1715-20.
  • 13. Bitsko MJ, Everhart RS, Rubin BK. The adolescent with asthma. Paediatr Respir Rev 2014; 15: 146-53.
  • 14. Timonen M, Viilo K, Hakko H, Särkioja T, Meyer-Rochow VB, Väisänen E, et al. Is seasonality of suicides stronger in victims with hospital treated atopic disorders? Psychiatry Res 2004; 126: 167-75.
  • 15. Marshall PS, O’Hara C, Steinberg P. Effects of seasonal allergic rhinitis on fatigue levels. Psychosom Med 2002; 64: 684-91.
  • 16. Dreborg S, Frew A. Allergen standardization and skin tests. EAACI Position paper. Allergy 1993; 48: 49-54.
  • 17. Tezcan D, Uzuner N, Sule Turgut C, Karaman O, Köse S. Retrospective evaluation of epidermal skin prick tests in patients living in Aegean region. Allergol Immunopathol (Madr) 2003; 31: 226-30.
  • 18. Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention: Revised 2014.
  • 19. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004; 113: 59- 65.
  • 20. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319-38.
  • 21. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. World Health Organization; GA(2)LEN; AllerGen. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63: 8-160.
  • 22. Spector SL, Nicklas RA, Chapman JA, Bernstein IL, Berger WE, Blessing-Moore J, et al. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; Joint Council of Allergy, Asthma, and Immunology. Symptom severity assessment of allergic rhinitis: part 1. Ann Allergy Asthma Immunol 2003; 91: 105-14.
  • 23. Bousquet PJ, Combescure C, Neukirch F, Klossek JM, Méchin H, Daures JP, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy 2007; 62: 367-72.
  • 24. Kovacs M. The Children Depression Inventory (CDI). Psychopharmacol Bull 1985; 21: 995-8.
  • 25. Öy B. Children’s Depression Inventory: depression scale for children: study of validity and reliability. Turk Psikiyatri Derg 1991; 2: 132-6.
  • 26. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 1999; 38: 1230-6.
  • 27. Karaceylan CF. The screen for child anxiety related emotional disorders: A study of reliability and validity. Unpublished Master’s Thesis, Kocaeli University, Turkey, 2004.
  • 28. Hamilton A. Diagnosis and rating of anxiety. Br J Psychiatry 1969; 3: 76-9.
  • 29. Yazıcı MK, Demir B, Tanrıverdi N. Hamilton Anksiyete Degerlendirme Ölceği; Degerlendiriciler Arası Güvenirlik ve Geçerlik Çalısması. Turk Psikiyatri Derg 1998; 9: 114-7.
  • 30. Akdemir A, Örsel S, Dağ İ, Türkçapar H, İşcan N, Özbay H. Hamilton depresyon derecelendirme ölçeği (HDDÖ)’nin geçerliği, güvenirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi 1996; 4: 251-9.
  • 31. Cohen P, Pine D, Must A, Kasen S, Brook J. Prospective associations between somatic illness and mental illness from childhood to adulthood. Am J Epidemiol 1998; 147: 232-9.
  • 32. de Marco R, Locatelli F, Sunyer J, Burney P, the European Community Respiratory Health Survey Study Group. Differences in incidence of reported asthma related to age in men and women. Am J Respir Crit Care Med 2000; 162: 68-74.
  • 33. Bavbek S, Kumbasar H, Tuğcu H, Misirligil Z. Psychological status of patients with seasonal and perennial allergic rhinitis. J Investig Allergol Clin Immunol 2002; 12: 204-10.
  • 34. Katon WJ, Richardson L, Lozano P, McCauley E. The relationship of asthma and anxiety disorders. Psychosom Med 2004; 66: 349-55.
  • 35. Wong KO, Hunter Rowe B, Douwes J, Senthilselvan A. Asthma and wheezing are associated with depression and anxiety in adults: an analysis from 54 countries. Pulm Med 2013; 2013: 929028.
  • 36. McQuaid EL, Kopel SJ, Nassau JH. Behavioral adjustment in children with asthma: a meta-analysis. J Dev Behav Pediatr 2001; 22: 430-9.
  • 37. Bender BG, Annett RD, Iklé D, DuHamel TR, Rand C, Strunk RC. Relationship between disease and psychological adaptation in children in the Childhood Asthma Management Program and their families. CAMP Research Group. Arch Pediatr Adolesc Med 2000; 154: 706-13.
  • 38. Letitre SL, de Groot EP, Draaisma E, Brand PL. Anxiety, depression and self-esteem in children with well-controlled asthma: casecontrol study. Arch Dis Child 2014; 99: 744-8.
  • 39. Di Marco F, Verga M, Santus P, Giovannelli F, Busatto P, Neri M, et al. Close correlation between anxiety, depression, and asthma control. Respir Med 2010; 104: 22-8.
  • 40. Liu S, Wu R, Li L, Liu L, Li G, Zhang X, et al. The prevalence of anxiety and depression in Chinese asthma patients. PLoS One 2014; 9: 103014.
  • 41. Trzcińska H, Przybylski G, Kozłowski B, Derdowski S. Analysis of the relation between level of asthma control and depression and anxiety. Med Sci Monit 2012; 18: 190-4.
  • 42. Vieira AA, Santoro IL, Dracoulakis S, Caetano LB, Fernandes AL. Anxiety and depression in asthma patients: impact on asthma control. J Bras Pneumol 2011; 37: 13-8.
  • 43. Pietras T, Panek M, Witusik A, Wujcik R, Szemraj J, Górski P, et al. Analysis of the correlation between level of anxiety, intensity of depression and bronchial asthma control. Post Dermatol Alergol 2011; 28: 15-22.
  • 44. Krommydas GC, Gourgoulianis KI, Angelopoulos NV, Kotrotsiou E, Raftopoulos V, Molyvdas PA. Depression and pulmonary function in outpatients with asthma. Respir Med 2004; 98: 220-4.
  • 45. Rimington LD, Davies DH, Lowe D, Pearson MG. Relationship between anxiety, depression, and morbidity in adult asthma patients. Thorax 2001; 56: 266-71.
  • 46. Richardson LP, Lozano P, Russo J, McCauley E, Bush T, Katon W. Asthma symptom burden: relationship to asthma severity and anxiety and depression symptoms. Pediatrics 2006; 118: 1042-51.
  • 47. McCauley E, Katon W, Russo J, Richardson L, Lozano P. Impact of anxiety and depression on functional impairment in adolescents with asthma. Gen Hosp Psychiatry 2007; 29: 214-22.

Psychological Status of Adolescents with Respiratory Allergic Diseases and Their Caregivers

Year 2016, Volume: 17 Issue: 3, 120 - 128, 01.12.2016

Abstract

Objective: The aim of the study was to evaluate the psychological status of adolescents with respiratory allergies and their caregivers. Materials and Methods: Child and adolescent psychiatrists evaluated the adolescents’ psychological status using the Children’s Depression Inventory (CDI) and Screen for Child Anxiety-Related Emotional Disorders (SCARED). Psychiatrist evaluated the psychological status of their caregivers using the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A). Results: Anxiety symptoms were found in 21 of 63 patients. CDI scores were higher in controls than in patients (p=0.03). HAM-D scores were higher in the caregivers of adolescents with allergic rhinitis and comorbid asthma than in those of controls (p=0.025). None of the scores were affected by the severity of asthma and allergic rhinitis, asthma control levels, presence of an asthma attack in the preceding year as well as by pulmonary function tests (p>0.05). Moderate and strong positive correlations were found between SCARED and CDI (r=0.644, p<0.001) and HAM-A and HAM-D scores (r=0.860, p<0.001). Conclusion: Anxiety symptoms were found in one-third of the patients. HAM-D scores were higher in the caregivers of adolescents with allergic rhinitis and comorbid asthma than in those of controls.

References

  • 1. Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004; 59: 469-78.
  • 2. Cruz AA, Popov T, Pawankar R, Annesi-Maesano I, Fokkens W, Kemp J, et al. ARIA Initiative Scientific Committee. Common characteristics of upper and lower airways in rhinitis and asthma: ARIA update, in collaboration with GA(2)LEN. Allergy 2007; 62: 1-41.
  • 3. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733-43.
  • 4. Slattery MJ, Essex MJ. Specificity in the association of anxiety, depression, and atopic disorders in a community sample of adolescents. J Psychiatr Res 2011; 45: 788-95.
  • 5. Meltzer EO, Blaiss MS, Derebery MJ, Mahr TA, Gordon BR, Sheth KK, et al. Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol 2009; 124: 43-70.
  • 6. Wu WC, Chang HY, Kuo KN, Chen CY, Tu YC, Yang YH. Psychosocial problems in children with allergic diseases: a population study in Taiwan. Child Care Health Dev. 2011; 37: 662-70.
  • 7. Lv X, Xi L, Han D, Zhang L. Evaluation of the psychological status in seasonal allergic rhinitis patients. ORL J Otorhinolaryngol Relat Spec 2010; 72: 84-90.
  • 8. Katon W, Lozano P, Russo J, McCauley E, Richardson L, Bush. The prevalence of DSM-IV anxiety and depressive disorders in youth with asthma compared with controls. J Adolesc Health 2007; 41: 455-63.
  • 9. Xi L, Zhang Y, Han D, Zhang L. Effect of asthma, aeroallergen category, and gender on the psychological status of patients with allergic rhinitis. J Investig Allergol Clin Immunol 2012; 22: 264-9.
  • 10. Szabo A, Mezei G, Kovari E, Cserháti E. Depressive symptoms amongst asthmatic children’s caregivers. Pediatr Allergy Immunol 2010; 21: 667-73.
  • 11. Yuksel H, Sogut A, Yilmaz O,Demet M, Ergin D, Kirmaz C. Evaluation of sleep quality and anxiety-depression parameters in asthmatic children and their mothers. Respir Med 2007; 101: 2550-4.
  • 12. Brown ES, Gan V, Jeffress J, Mullen-Gingrich K, Khan DA, Wood BL, et al. Psychiatric symptomatology and disorders in caregivers of children with asthma. Pediatrics 2006; 118: 1715-20.
  • 13. Bitsko MJ, Everhart RS, Rubin BK. The adolescent with asthma. Paediatr Respir Rev 2014; 15: 146-53.
  • 14. Timonen M, Viilo K, Hakko H, Särkioja T, Meyer-Rochow VB, Väisänen E, et al. Is seasonality of suicides stronger in victims with hospital treated atopic disorders? Psychiatry Res 2004; 126: 167-75.
  • 15. Marshall PS, O’Hara C, Steinberg P. Effects of seasonal allergic rhinitis on fatigue levels. Psychosom Med 2002; 64: 684-91.
  • 16. Dreborg S, Frew A. Allergen standardization and skin tests. EAACI Position paper. Allergy 1993; 48: 49-54.
  • 17. Tezcan D, Uzuner N, Sule Turgut C, Karaman O, Köse S. Retrospective evaluation of epidermal skin prick tests in patients living in Aegean region. Allergol Immunopathol (Madr) 2003; 31: 226-30.
  • 18. Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention: Revised 2014.
  • 19. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004; 113: 59- 65.
  • 20. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319-38.
  • 21. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. World Health Organization; GA(2)LEN; AllerGen. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63: 8-160.
  • 22. Spector SL, Nicklas RA, Chapman JA, Bernstein IL, Berger WE, Blessing-Moore J, et al. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; Joint Council of Allergy, Asthma, and Immunology. Symptom severity assessment of allergic rhinitis: part 1. Ann Allergy Asthma Immunol 2003; 91: 105-14.
  • 23. Bousquet PJ, Combescure C, Neukirch F, Klossek JM, Méchin H, Daures JP, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy 2007; 62: 367-72.
  • 24. Kovacs M. The Children Depression Inventory (CDI). Psychopharmacol Bull 1985; 21: 995-8.
  • 25. Öy B. Children’s Depression Inventory: depression scale for children: study of validity and reliability. Turk Psikiyatri Derg 1991; 2: 132-6.
  • 26. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 1999; 38: 1230-6.
  • 27. Karaceylan CF. The screen for child anxiety related emotional disorders: A study of reliability and validity. Unpublished Master’s Thesis, Kocaeli University, Turkey, 2004.
  • 28. Hamilton A. Diagnosis and rating of anxiety. Br J Psychiatry 1969; 3: 76-9.
  • 29. Yazıcı MK, Demir B, Tanrıverdi N. Hamilton Anksiyete Degerlendirme Ölceği; Degerlendiriciler Arası Güvenirlik ve Geçerlik Çalısması. Turk Psikiyatri Derg 1998; 9: 114-7.
  • 30. Akdemir A, Örsel S, Dağ İ, Türkçapar H, İşcan N, Özbay H. Hamilton depresyon derecelendirme ölçeği (HDDÖ)’nin geçerliği, güvenirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi 1996; 4: 251-9.
  • 31. Cohen P, Pine D, Must A, Kasen S, Brook J. Prospective associations between somatic illness and mental illness from childhood to adulthood. Am J Epidemiol 1998; 147: 232-9.
  • 32. de Marco R, Locatelli F, Sunyer J, Burney P, the European Community Respiratory Health Survey Study Group. Differences in incidence of reported asthma related to age in men and women. Am J Respir Crit Care Med 2000; 162: 68-74.
  • 33. Bavbek S, Kumbasar H, Tuğcu H, Misirligil Z. Psychological status of patients with seasonal and perennial allergic rhinitis. J Investig Allergol Clin Immunol 2002; 12: 204-10.
  • 34. Katon WJ, Richardson L, Lozano P, McCauley E. The relationship of asthma and anxiety disorders. Psychosom Med 2004; 66: 349-55.
  • 35. Wong KO, Hunter Rowe B, Douwes J, Senthilselvan A. Asthma and wheezing are associated with depression and anxiety in adults: an analysis from 54 countries. Pulm Med 2013; 2013: 929028.
  • 36. McQuaid EL, Kopel SJ, Nassau JH. Behavioral adjustment in children with asthma: a meta-analysis. J Dev Behav Pediatr 2001; 22: 430-9.
  • 37. Bender BG, Annett RD, Iklé D, DuHamel TR, Rand C, Strunk RC. Relationship between disease and psychological adaptation in children in the Childhood Asthma Management Program and their families. CAMP Research Group. Arch Pediatr Adolesc Med 2000; 154: 706-13.
  • 38. Letitre SL, de Groot EP, Draaisma E, Brand PL. Anxiety, depression and self-esteem in children with well-controlled asthma: casecontrol study. Arch Dis Child 2014; 99: 744-8.
  • 39. Di Marco F, Verga M, Santus P, Giovannelli F, Busatto P, Neri M, et al. Close correlation between anxiety, depression, and asthma control. Respir Med 2010; 104: 22-8.
  • 40. Liu S, Wu R, Li L, Liu L, Li G, Zhang X, et al. The prevalence of anxiety and depression in Chinese asthma patients. PLoS One 2014; 9: 103014.
  • 41. Trzcińska H, Przybylski G, Kozłowski B, Derdowski S. Analysis of the relation between level of asthma control and depression and anxiety. Med Sci Monit 2012; 18: 190-4.
  • 42. Vieira AA, Santoro IL, Dracoulakis S, Caetano LB, Fernandes AL. Anxiety and depression in asthma patients: impact on asthma control. J Bras Pneumol 2011; 37: 13-8.
  • 43. Pietras T, Panek M, Witusik A, Wujcik R, Szemraj J, Górski P, et al. Analysis of the correlation between level of anxiety, intensity of depression and bronchial asthma control. Post Dermatol Alergol 2011; 28: 15-22.
  • 44. Krommydas GC, Gourgoulianis KI, Angelopoulos NV, Kotrotsiou E, Raftopoulos V, Molyvdas PA. Depression and pulmonary function in outpatients with asthma. Respir Med 2004; 98: 220-4.
  • 45. Rimington LD, Davies DH, Lowe D, Pearson MG. Relationship between anxiety, depression, and morbidity in adult asthma patients. Thorax 2001; 56: 266-71.
  • 46. Richardson LP, Lozano P, Russo J, McCauley E, Bush T, Katon W. Asthma symptom burden: relationship to asthma severity and anxiety and depression symptoms. Pediatrics 2006; 118: 1042-51.
  • 47. McCauley E, Katon W, Russo J, Richardson L, Lozano P. Impact of anxiety and depression on functional impairment in adolescents with asthma. Gen Hosp Psychiatry 2007; 29: 214-22.
There are 47 citations in total.

Details

Other ID JA54FJ23MA
Journal Section Research Article
Authors

Duygu Erge This is me

Pınar Uysal This is me

Hatice Aksu This is me

Sibelnur Avcil This is me

Börte Gürbüz Özgür This is me

Faruk Demir This is me

İmran Kurt Ömürlü This is me

Şahap Dede This is me

Publication Date December 1, 2016
Published in Issue Year 2016 Volume: 17 Issue: 3

Cite

EndNote Erge D, Uysal P, Aksu H, Avcil S, Özgür BG, Demir F, Ömürlü İK, Dede Ş (December 1, 2016) Psychological Status of Adolescents with Respiratory Allergic Diseases and Their Caregivers. Meandros Medical And Dental Journal 17 3 120–128.