The Psychosomatic Pattern of Anxiety in Children with Asthma: A Mixed-Methods Study Using Latent Dirichlet Allocation

Abstract BACKGROUND: Anxiety disorders are common psychosomatic comorbidities in children with asthma, negatively affecting both disease control and emotional well-being. OBJECTIVE: This study aimed to estimate the prevalence of anxiety disorders and develop a psychosomatic conceptual model integrating psychological, biological, and environmental determinants. METHODS: A mixed-methods design was adopted. Quantitatively, 200 children aged 5–12 years with mild-to-moderate asthma attending a national tertiary care and referral center for pulmonary and allergic diseases in Tehran, Iran, were assessed using the Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition checklist for anxiety disorders. Descriptive and inferential analyses were conducted in SPSS 27. Qualitatively, topic modeling was performed using the Latent Dirichlet Allocation (LDA) method on full-text articles extracted from PubMed, Scopus, and Web of Science databases to identify key psychosomatic dimensions. RESULTS: Quantitative findings showed that “specific phobia” (75%) and “separation anxiety” disorder (41.5%) were the most prevalent, followed by “social anxiety” (34.5%) and “agoraphobia” (26%). “Selective mutism” (19%) and “panic disorder” (21.9%) were less frequent. The LDA analysis yielded five major domains: psychological, clinical, bio-environmental, neuroimmune-genetic, and social, with good model fit (mean coherence = 0.083, perplexity = 2240.30). The integrated model revealed that children exposed to high family stress and low emotional support exhibited significantly higher anxiety levels. CONCLUSION: The findings demonstrate that anxiety in asthmatic children emerges from complex interactions among cognitive, familial, and environmental factors. The proposed psychosomatic model emphasizes the importance of multidimensional interventions – combining psychotherapy, parental education, and clinical management – to enhance psychological resilience and quality of life in pediatric asthma.