Psychological factors may play a role in asthma. In particular, emotional upsets have been correlated with fatal asthma attacks, and an abnormal personality attitude is considered to be a risk factor in fatal asthma. Moreover, some authors have recently reported favourable asthma outcome in patients with severe asthma and psychiatric abnormalities, when psychoactive treatment was initiated. On the understanding that people with fatal and "near fatal asthma" (NFA) are components of the same subset of the asthmatic population, we undertook a study aimed at assessing the importance of personality and psychiatric factors in asthma mortality. Between June 1991 and December 1993, a sample of 17 patients with asthma who had experienced one or more near fatal asthma attacks (respiratory arrest, or need for respiratory assistance, or altered conscious state, or arterial carbon dioxide tension (Pa,CO2) > 6.7 kPa (50 mmHg)), and 17 control patients with asthma who had never experienced such an attack (control group) were enrolled. All patients underwent: 1) an interview concerning their personal and family psychiatric history; 2) a psychodiagnostic investigation by a battery of four of the most widely used psychiatric tools: Hamilton scales for anxiety and depression; Zung scales for anxiety and depression; and Minnesota Multiphasic Personality Inventory. No statistical difference was found in psychodiagnostic tests between study and control groups. The psychiatric history was similar in the two groups. Our results suggest that personality characteristics and psychiatric history are not related to asthma outcome, and that the psychiatric approach is not expected to be useful in preventing mortality in asthma.