Contribution of caregiver and child anxiety and depressive symptoms to child asthma-related quality of life.

BACKGROUND: Depression and anxiety negatively affect asthma-related quality of life (QoL). Yet, little is known regarding mood and asthma-related factors that best uniquely explain asthma-related QoL in children. OBJECTIVE: This cross-sectional study evaluated the unique variance explained by caregiver and child depressive and anxiety symptom severity in child asthma-related QoL, apart from that explained by demographics and asthma control. METHODS: Children aged 7 to 17 years with asthma (n = 205) and their caregivers with major depressive disorder were included. A 3-stage hierarchical linear regression analysis was conducted with the Pediatric Asthma Quality of Life Questionnaire total scores considered as the outcome. Predictors included demographic characteristics (stage 1); asthma control assessed by the Asthma Control Test (stage 2); and caregiver depression and anxiety (Hamilton Rating Scale for Depression and the Spielberger State/Trait Anxiety Scale) and child depression and anxiety (Children's Depression Inventory and the Screen for Child Anxiety-Related Disorders) (stage 3). RESULTS: Demographic characteristics accounted for only 5.5% of the Pediatric Asthma Quality of Life Questionnaire scores. Asthma control significantly increased variance explained in QoL to 32.6%, whereas caregiver and child depression and anxiety symptoms significantly increased variance explained to 42.6%. Child anxiety was found to uniquely explain the largest proportion of variance in QoL (rs2 = 0.584). CONCLUSION: After adjusting variance in QoL for demographic characteristics and asthma control, caregiver and child depression and anxiety measures significantly increased the proportion of variance explained in a child's asthma-related QoL. In addition to better asthma control, child and caregiver depression and anxiety should be addressed to increase child asthma-related QoL. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02809677.

The biobehavioral family model and the family relational assessment protocol: Map and GPS for family systems training.

The Biobehavioral Family Model (BBFM) was developed and evolved as a heuristic research model to support the investigation of pathways by which family relational function impacts individual family member wellbeing and disorder. Recently, the BBFM and its related assessment approach, the Family Relational Process Assessment Protocol (FRAP), have emerged as tools for clinical practice and training. The BBFM model will be presented, along with definitions of the dimensions constructed in the model, and research evidence in support of the model. To illustrate how the BBFM and FRAP are used in training, instructions for conducting the FRAP will be presented. Then, transcripts from two contrasting families participating in one of the interaction tasks will illustrate how, in training, the FRAP is interpreted through the BBFM lens to illuminate how these patterns of family relationship impact the identified patient. Finally, three applications of this training approach will exemplify the use of the BBFM and FRAP in the context of a Child and Adolescent Psychiatry Fellowship, a Family Medicine Fellowship, and a Family Therapy Training Program in Istanbul, Turkey. Limitations and future directions for the application of the BBFM in the exploration of multicultural aspects of family function for clinical and training purposes will be discussed.

The Impact of Caregiver Depression on Child Asthma Outcomes: Pathways and Mechanisms.

BACKGROUND: Depression is common in caregivers of children with asthma and is associated with poor outcomes in their child. No prior studies have longitudinally examined caregiver depression remission as a predictor of improvement in child asthma control. OBJECTIVE: This 2-site study examined whether the proportion of time a caregiver was in depression remission predicted subsequent child asthma control at exit. METHOD: Caregivers (n = 205) with current major depressive disorder and their children, ages 7 to 17, with persistent asthma were observed every 4 weeks for 52 weeks. Caregiver depressive symptoms were measured using the 17-item Hamilton Rating Scale for Depression (HRSD). Child asthma was assessed with the (Childhood) Asthma Control Test (cACT/ACT) and spirometry, and depression with the Children's Depression Inventory (CDI). Linear regression analyses were conducted with change in cACT/ACT, CDI, and forced expiratory volume in 1 second (FEV1)% predicted as outcomes and proportion of time the caregiver was in remission (HRSD score ≤ 7) as the predictor. Multilevel mediation analyses examined the role of child depressive symptoms and asthma controller medication adherence. RESULTS: Children were, on average, 54.1% female and 11 years old. Caregiver proportion of time in HRSD-assessed remission of depression was a significant predictor of improvement in cACT/ACT, CDI, and FEV1% predicted. Child CDI score, but not medication adherence, mediated the relationship between caregiver HRSD scores and child asthma control scores. CONCLUSIONS: Improvement in caregiver depression positively influences child asthma outcomes partially through improvement in child depressive symptom severity. Caregiver depression screening and treatment might lead to improvement in child asthma outcomes.

An application of the Biobehavioral Family Model: Examining the impact of maternal depression on child asthma mediated by insecure attachment and child depression.

OBJECTIVE: Child asthma disparities are prevalent in socio-economically stressed single-parent families. Stress impacts childhood asthma mediated by immune and autonomic pathways, but specific family stress pathways are not well established. This study tests the hypothesis, derived from a version of the Biobehavioral Family Model, that single parent maternal depression impacts child asthma mediated by insecure attachment and child depression. METHODS: In a cross-sectional study, children with asthma (age 7-17 years old) from a socio-economically disadvantaged population and their single parent mothers (N = 202) were assessed for depression and attachment security. Child asthma disease activity was assessed by symptom report and lung function tests. Structural equation modeling (SEM) was used to test a model in which caregiver depression impacts child asthma disease activity mediated by insecure attachment and child depression. RESULTS: SEM results indicated that maternal depression statistically predicted child depression (ß = 0.21, p < 0.01) and insecure mother-child attachment (ß = 0.17, p < 0.05). In addition, insecure attachment statistically predicted child depression (ß = 0.50, p < 0.001). Child depression mediated the adverse effects of maternal depression and insecure attachment on child asthma disease activity (ß = 0.43, p < 0.01). There was no direct effect of insecure attachment on child asthma. CONCLUSION: In single-parent families, maternal depression may impact child asthma disease activity, mediated serially by insecure attachment and child depression. Longitudinal and/or intervention studies are needed to establish a causal effect. These findings suggest that caregiver depression and parent-child relationships may be important targets for family intervention. These interventions may help improve child asthma outcomes and reduce health disparities.

The Biobehavioral Family Model: An Evidence-Based Approach to Biopsychosocial Research, Residency Training, and Patient Care.

Engel's biopsychosocial model, based in systems theory, assumes the reciprocal influence of biological, psychological, and social factors on one another and on mental and physical health. However, the model's application to scientific study is limited by its lack of specificity, thus constraining its implementation in training and healthcare environments. The Biobehavioral Family Model (BBFM) is one model that can facilitate specification and integration of biopsychosocial conceptualization and treatment of illness. The model identifies specific pathways by which family relationships (i.e., family emotional climate) impact disease activity, through psychobiological mechanisms (i.e., biobehavioral reactivity). Furthermore, it is capable of identifying positive and negative effects of family process in the same model, and can be applied across cultural contexts. The BBFM has been applied to the study of child health outcomes, including pediatric asthma, and adult health, including for underserved primary care patients, minoritized samples, and persons with chronic pain, for example. The BBFM also serves as a guide for training and clinical practice; two such applications are presented, including the use of the BBFM in family medicine residency and child and adolescent psychiatry fellowship programs. Specific teaching and clinical approaches derived from the BBFM are described in both contexts, including the use of didactic lecture, patient interview guides, assessment protocol, and family-oriented care. Future directions for the application of the BBFM include incorporating temporal dynamics and developmental trajectories in the model, extending testable theory of family and individual resilience, examining causes of health disparities, and developing family-based prevention and intervention efforts to ameliorate contributing factors to disease. Ultimately, research and successful applications of the BBFM could inform policy to improve the lives of families, and provide additional support for the value of a biopsychosocial approach to medicine.

Multivariate Association of Child Depression and Anxiety with Asthma Outcomes.

BACKGROUND: Pediatric asthma is associated with increased health services utilization, missed school days, and diminished quality of life. Children with asthma also report more frequent depressive and anxiety symptoms than children without asthma, which may further worsen asthma outcomes. OBJECTIVE: The current study investigated the relationship between depressive and anxiety symptoms and 4 asthma outcomes (asthma control, asthma severity, lung function, and asthma-related quality of life) in children (N = 205) with moderate to severe persistent asthma. METHODS: The data were analyzed using a canonical correlation analysis, a multivariate framework that allows examination of all variables of interest in the same model. RESULTS: We found a statistically significant relationship between symptoms of depression and anxiety and asthma outcomes (1 - Λ = .372; P < .001). A large effect size suggests that 37.2% of variance is shared between depression and anxiety symptoms and 4 asthma outcomes (particularly asthma control and asthma-related quality of life) in the overall sample. Among girls (vs. boys), asthma control (measured by the Asthma Control Test) emerged as a stronger contributor to asthma outcomes compared with boys. CONCLUSIONS: These results suggest that psychiatric symptoms, especially anxiety, are associated with poor asthma-related quality of life, and more negative perception of asthma control in girls compared with boys (with no observed sex difference in physiological lung function). Clinicians should consider incorporating questions about psychiatric symptoms as part of routine asthma management, and focus patient education on unique differences in which boys and girls perceive their asthma symptoms.

Comorbid Obesity and Depressive Symptoms in Childhood Asthma: A Harmful Synergy.

BACKGROUND: Overweight/obesity (OV/OB) and depression have each been separately associated with worsened childhood asthma severity and control. Pathways by which these factors may jointly affect childhood asthma have not been elucidated. OBJECTIVE: To examine the interrelationship of OV/OB and depressive symptoms with childhood asthma and explore associated psychobiologic pathways. The present study investigated whether comorbid OV/OB and depressive symptoms are associated with impaired baseline lung function and increased airway resistance during emotional stress, and to assess whether such effects may be mediated by autonomic nervous system (ANS) dysregulation, specifically through predominance of vagal over sympathetic reactivity (vagal bias). METHODS: A total of 250 children with asthma, aged 7 to 17, were assessed for OV/OB using body mass index, depressive symptoms using the Children's Depression Inventory (CDI), and asthma severity using National Asthma Education and Prevention Program Expert Panel Report 3 criteria. Baseline pulmonary function (forced expiratory volume in 1 second [FEV1]) was assessed. The film "E.T. the Extra-Terrestrial" was used in a laboratory paradigm to evoke emotional stress/arousal. Airway resistance (Rint) was measured before and after the film to determine changes in airway function. ANS reactivity was assessed by measuring parasympathetic/vagal and sympathetic reactivity throughout the film. RESULTS: In OV/OB children with asthma, depressive symptoms predicted lower baseline FEV1 (ß = -0.67, standard error [SE] = 0.24, P = .008), CDI predicted vagal bias under emotion stress/arousal (ß = 0.27, SE = 0.09, P = .009), and vagal bias predicted increased Rint (ß = 3.55, SE = 1.54, P = .023). CONCLUSION: This study is the first to link OV/OB and depressive symptoms in their relationship to childhood asthma. In OV/OB children with asthma, depression may potentiate airway compromise, mediated by vagal bias. Use of antidepressant and anticholinergic therapies should be studied in this subgroup of patients.

The effects of caregiver depression on childhood asthma: Pathways and mechanisms.

OBJECTIVE: To review the literature regarding the effects of caregiver depression on childhood asthma and integrate the findings into a multilevel model of pathways by which these effects occur to further the understanding of the complex biopsychosocial nature of childhood asthma and the key role that is played by caregiver depression. DATA SOURCES: PubMed was searched for articles published from 2007 to the present (10-year search), and Google Scholar was searched for articles published in 2017 and 2018 to identify the most recent publications. STUDY SELECTIONS: Studies selected were recent, empirical, or meta-analytic, conducted in humans, and had specific relevance to one or more of the identified pathways. Articles published before 2007 were included if deemed essential because they addressed key pathways, for which there were no more recent articles. RESULTS: Review of the literature substantiates that caregiver depression plays a key role in the socioeconomic, familial, psychological, and biological cascade of effects on childhood asthma. Childhood asthma outcomes are affected indirectly by socioeconomic status and family stress mediated by caregiver depression, which affects disease management, and/or stress and depression in the child, which, in turn, affect asthma through alterations in immune modulation and autonomic regulation. CONCLUSION: Findings indicate that future research should concentrate on mediators and moderators to further clarify the complex interplay of these factors that affect childhood asthma. The findings also have substantial translational implications. Given that child stress and depression contribute to asthma disease activity and that treating caregiver depression improves child stress and depression, there is strong rationale for treating depressed caregivers of children with asthma as a component means of improving childhood asthma control.

Review of family relational stress and pediatric asthma: the value of biopsychosocial systemic models.

Asthma is the most common chronic disease in children. Despite dramatic advances in pharmacological treatments, asthma remains a leading public health problem, especially in socially disadvantaged minority populations. Some experts believe that this health gap is due to the failure to address the impact of stress on the disease. Asthma is a complex disease that is influenced by multilevel factors, but the nature of these factors and their interrelations are not well understood. This paper aims to integrate social, psychological, and biological literatures on relations between family/parental stress and pediatric asthma, and to illustrate the utility of multilevel systemic models for guiding treatment and stimulating future research. We used electronic database searches and conducted an integrated analysis of selected epidemiological, longitudinal, and empirical studies. Evidence is substantial for the effects of family/parental stress on asthma mediated by both disease management and psychobiological stress pathways. However, integrative models containing specific pathways are scarce. We present two multilevel models, with supporting data, as potential prototypes for other such models. We conclude that these multilevel systems models may be of substantial heuristic value in organizing investigations of, and clinical approaches to, the complex social-biological aspects of family stress in pediatric asthma. However, additional systemic models are needed, and the models presented herein could serve as prototypes for model development.

Effects of paternal and maternal depressive symptoms on child internalizing symptoms and asthma disease activity: mediation by interparental negativity and parenting.

This study tested a hypothesized model of the relationships among parental depressive symptoms, family process (interparental negativity and negative parenting behavior), child internalizing symptoms, and asthma disease activity. A total of 106 children with asthma, aged 7 to 17, participated with their fathers and mothers. Parental depressive symptoms were assessed by self-report. Interparental and parenting behaviors were observed and rated during family discussion tasks. Child internalizing symptoms were assessed by self-report and by clinician interview and rating. Asthma disease activity was assessed according to National Heart, Lung and Blood Institute guidelines. Results of structural equation modeling generally supported interparental negativity and negative parenting behavior as mediators linking parental depressive symptoms and child emotional and physical dysfunction. However, paternal and maternal depressive symptoms play their role through different pathways of negative family process. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Depressive symptoms in children with cystic fibrosis and parents and its effects on adherence to airway clearance.

BACKGROUND: Little is currently known about the co-morbidity of depression and cystic fibrosis (CF) and there is currently no empirical research on the effects of depressive symptoms on adherence in children and adolescents with CF. The primary aim of this study was to evaluate the extent of depressive symptoms in children and adolescents with CF and their parents, and determine whether depressive symptoms in the child and/or parent was associated with adherence to airway clearance. We also evaluated whether children's perceptions of relational security with a parent were associated with adherence to airway clearance. METHODS: Participants included 39 children with CF ages 7-17 years and their primary caregivers. Depressive symptoms were measured with the Children's Depression Inventory (CDI) and the Center for Epidemiological Studies-Depression Scale (CES-D). The Relatedness Questionnaire assessed the quality of parent-child relational security. Adherence to airway clearance was measured using the daily phone diary (DPD), an empirically validated adherence measure for youth with CF. RESULTS: Rates of depressive symptoms were elevated in children with CF and their parents (29% for children; 35% for mothers; 23% for fathers). Child depressive symptoms were significantly associated with lower rates of adherence to airway clearance, after controlling for demographic variables (r = -0.34, P = 0.02). Child depressive symptoms were associated with worse perceptions of parental relationships (t(35) = 3.2; P = 0.002) and the quality of this relationship was also related to worse adherence (r = 0.42, P = 0.005). CONCLUSIONS: A large percentage of youth with CF and their parents reported elevated symptoms of depression. Children scoring in the depressed range on a standardized screening measure and those with less secure parent-child relationships were at greatest risk for poor adherence. Thus, depressive symptoms and family relationships are appropriate targets for adherence promotion interventions, which may ultimately improve health outcomes.

Depressed children with asthma evidence increased airway resistance: "vagal bias" as a mechanism?

BACKGROUND: Depression is prevalent in pediatric asthma, and implicated in asthma morbidity and mortality. Pathways linking stress, depression, and asthma are unknown. OBJECTIVES: To examine, under controlled laboratory conditions, pathways by which depressive states affect airway function via autonomic dysregulation. METHODS: Participants were 171 children with asthma, age 7 to 17 years, presenting to an emergency department for asthma exacerbation. Forty-five children with asthma and high depressive symptoms (D) were contrasted with 45 with low/no depressive symptoms (ND). Depressive symptoms, asthma disease severity, vagal and sympathetic reactivity to film stressors, airflow (FEV1), and airway resistance were compared between the groups. A subgroup with greater airway reactivity (nonmedicated FEV1<80% predicted) was also studied. Correlations among variables were examined for the entire sample. RESULTS: Groups did not differ in demographics, disease severity, medications, or adherence. The D group with FEV1<80% predicted showed greater airway resistance throughout all conditions (P = .03), and vagal bias in the film stressors. The D group's vagal response was significant for the sad stimuli: family distress/loss (P = .03), dying (P = .003), and death (P = .03). The ND group showed sympathetic activation to sad stimuli: lonely (P = .04) and dying (P = .04). Depressive symptoms were correlated with respiratory resistance (r = .43; P = .001) and vagal bias in scene 3 (r = .24; P = .03), and vagal bias (scene 3) was correlated with postmovie airway resistance (r = 0.39; P = .004). CONCLUSIONS: Children with asthma and depressive symptoms manifest vagal bias when emotionally stressed. Those with depressive symptoms and FEV1<80% manifest greater airway resistance. Depression, vagal bias, and airway resistance were intercorrelated for the full sample.

Antidepressant treatment of caregivers of children with asthma.

BACKGROUND: Depression is common in caregivers of children with asthma and is associated with increased emergency service utilization for the child's asthma. OBJECTIVE: This pilot study examined the impact of antidepressant treatment of depressed caregivers on the caregiver's depression and the child's asthma. METHOD: Eight depressed caregivers of children with asthma were given up to 6 months of algorithm-based antidepressant therapy. RESULTS: Caregiver depressive symptoms and the child's asthma symptoms improved significantly. CONCLUSION: Unscheduled clinic visits showed a trend toward significant decrease. Larger trials are needed to confirm these findings and identify mechanisms linking improvement in caregiver depression with improvement in their child's asthma.

Testing the Biobehavioral Family Model in pediatric asthma: pathways of effect.

This study uses a laboratory-based multiinformant, multimethod approach to test the hypothesis that a negative family emotional climate (NFEC) contributes to asthma disease severity by way of child depressive symptoms, and that parent-child relational insecurity mediates the effect. Children with asthma (n = 199; aged 7-17; 55% male) reported parental conflict, parent-child relational security, and depressive symptoms. Parent(s) reported demographics, asthma history, and symptoms. Asthma diagnosis was confirmed by clinical evaluation and pulmonary function tests, with disease severity rated by an asthma clinician according to NHLBI guidelines. Family interactions were evoked using the Family Process Assessment Protocol, and rated using the Iowa Family Interaction Rating Scales. Path analysis indicated a good fit of data to the hypothesized model (chi2[1] = .11, p =.74, NFI = .99, RMSEA = .00). Observed NFEC predicted child depression (beta = .19, p < .01), which predicted asthma disease severity beta = .23, p < .01). Relational security inversely predicted depressive symptoms (p = -.40, p < .001), and was not a mediator as predicted, but rather an independent contributor. The findings are consistent with the Biobehavioral Family Model, which suggests a psychobiologic influence of specific family relational processes on asthma disease severity by way of child depressive symptoms.

Maternal depression and parenting in relation to child internalizing symptoms and asthma disease activity.

This study tested a hypothesized model of the relationship between maternal depression and child psychological and physical dysfunction mediated by parenting and medication adherence. A sample of 242 children with asthma, aged 7 to 17, participated with their mothers. Maternal depression was assessed by self-report, and parenting was observed during family interaction tasks. Internalizing symptoms were assessed by self- and clinician reports. Asthma disease activity was assessed according to National Heart Lung and Blood Institute guidelines, and medication adherence was evaluated with a 24-hr recall method. Structural equation modeling indicated that negative parenting partially mediated the relationship between maternal depression and child internalizing symptoms. Child internalizing symptoms, in turn, mediated the associations between both maternal depression and negative parenting and asthma disease activity. Medication adherence did not mediate the link from maternal depression to disease activity. Thus, maternal depression was linked to child psychological dysfunction both directly and indirectly via negative parenting but linked to physical dysfunction only indirectly through psychological dysfunction. These findings suggest that diagnosing and treating depression in mothers of children with asthma would enhance child well-being both psychologically and physically.

Psychological factors affecting disease activity in children and adolescents with cystic fibrosis: medical adherence as a mediator.

PURPOSE OF REVIEW: It is likely that nonadherence to treatment is one mediator of the effect of psychological factors on disease activity and course of cystic fibrosis. Nonadherence is a significant problem for patients with the disease. This review assesses adherence to multiple treatment components in cystic fibrosis and identifies factors associated with poor adherence. Based on this assessment, strategies aimed at enhancing adherence will be discussed. RECENT FINDINGS: Adherence to treatment occurs less than 50% of the time in patients with cystic fibrosis, indicating poor adherence, which is particularly common in adolescents. Factors associated with poor adherence include psychiatric, psychological and emotional factors; family issues; and treatment-related problems. Recently, more information is being gathered regarding processes related to poor adherence. SUMMARY: Psychological factors affecting physical conditions frequently occur in children with cystic fibrosis. Therefore, patients need to be routinely screened for coexisting psychosocial issues and treatment adherence problems. Adherence needs to be examined according to the specific treatment component, and with an understanding of factors that make adherence difficult for patients and families. This will enable healthcare teams to target individualized strategies to counteract nonadherence, with emphasis on the role of psychological and psychosocial factors.

Where to B in dZ/dt.

The B point on the impedance cardiograph waveform corresponds to the opening of the aortic valve and is an important parameter for calculating systolic time intervals, stroke volume, and cardiac output. Identifying the location of the B point is sometimes problematic because the characteristic upstroke that serves as a marker of this point is not always apparent. Here is presented a reliable method for B point identification, based on the consistent relationship between the R to B interval (RB) and the interval between the R-wave and the peak of the dZ/dt function (RZ). The polynomial function relating RB to RZ (RB = 1.233RZ - 0.0032RZ(2) - 31.59) accounts for 90%-95% of the variance in the B point location across ages and gender and across baseline and stress conditions. This relation affords a rapid approximation to B point measurement that, in noisy or degraded signals, is superior to visual B point identification and to a derivative-based estimate.

Reliability and validity of the Asthma Trigger Inventory applied to a pediatric population.

OBJECTIVE: To test the reliability and validity of the Asthma Trigger Inventory (ATI) applied to a pediatric population. METHOD: Children with asthma (N = 272, 56% male, age 7-17) and their primary caregivers answered together an asthma trigger inventory, ATI (Ritz, Steptoe, Bobb, Harris, & Edwards, 2006) developed for adults. Cronbach's alpha, principal component analysis (PCA), hierarchical regression, and correlations of the ATI subscales with skin prick tests, psychological questionnaires, and disease severity were used to assess the psychometric properties of the ATI. RESULTS: The ATI subscales demonstrated excellent reliability regardless of gender, race, socioeconomic status (SES), or age. PCA confirmed and replicated the theoretical structure of the ATI. Hierarchical multiple regressions illuminated the association of ATI subscales with demographics and asthma history. Evidence in support of construct validity was found in associations between ratings of triggering and disease severity and asthma-related quality of life (PAQLQ). Criterion validity for allergy triggering was partially supported by correlations between ATI animal allergens subscale and the cat dander skin prick test, and construct validity for emotional triggering by associations between the emotional trigger subscale score and the anxiety (STAIC) and depression (CDI, CDI-P, CDRS-R, and CBCL-I) scores. CONCLUSION: The ATI holds promise as a reliable, valid, and useful clinical and research tool to assess the type and degree of asthma triggering in a pediatric population (age 7-17) of varied gender, race, and SES.

Family emotional climate, depression, emotional triggering of asthma, and disease severity in pediatric asthma: examination of pathways of effect.

OBJECTIVES: (a) To assess emotional triggering of pediatric asthma and ascertain its contribution to disease morbidity and functional status; (b) to test whether negative family emotional climate (NFEQ) is associated with depressive and/or anxious symptoms and emotional triggering of asthma attacks in the child. METHOD: Children with asthma (N = 272, 56% male, age 7-17) and their primary caregivers answered together an Asthma Trigger Inventory (Ritz, Steptoe, Bobb, Harris, & Edwards, 2006). Children reported on anxious (STAIC) and depressive (CDI) symptoms and on asthma-related quality of life (PAQLQ). Parent(s) reported on their child's internalizing (CBCL-I) and depressive symptoms (CDI-P). A clinician also rated the child's depression using the structured CDRS-R. Asthma diagnosis was confirmed and disease severity rated according to NHLBI guidelines by an asthma clinician. RESULTS: Path analyses indicated that NFEQ was associated with depressive symptoms, which in turn were associated both directly and indirectly (by way of emotional triggering) with disease severity. Comparison of nested models indicated the possibility of differential roles and pathways for anxious versus depressive symptoms. CONCLUSION: Findings elucidate possible pathways of effect by which family emotional climate and child depressive symptoms may influence pediatric asthma disease severity by way of potentiating emotional triggering of asthma.

Psychiatric symptomatology and disorders in caregivers of children with asthma.

OBJECTIVE: The prevalence of asthma and asthma-related mortality has increased in recent years. Data suggest an association between psychiatric symptoms in the caregiver and asthma-related hospitalizations in the child. We examined the prevalence of psychiatric symptoms and disorders and their relationship to asthma-related service utilization in caregivers of children hospitalized for asthma. PATIENTS AND METHODS: Caregivers (n = 175) were assessed during the child's hospitalization. The number of asthma-related hospitalizations, emergency department visits, and unscheduled clinic visits in the past 12 months was obtained. The Brief Symptom Inventory, an assessment of psychiatric symptoms including somatic, anxiety, and depression subscales, and the Mini International Neuropsychiatric Interview, a structured clinical interview for psychiatric disorders, were administered. RESULTS: Mean age of the caregivers was 34.2 +/- 7.3 years; 96.0% were women; 15.4% were white, 57.7% were black, and 26.3% were Hispanic. A total of 47.9% had incomes less than 25,000 dollars/year. Caregivers with clinically significant elevations in 2 or more Brief Symptom Inventory subscales reported more asthma-related child hospitalizations in the past 12 months than did caregivers with lower Brief Symptom Inventory scores. Asthma-related hospitalizations correlated with Brief Symptom Inventory total, somatic, anxiety, and depression subscale scores. Caregiver diagnosis of an anxiety disorder (n = 36) was associated with more asthma-related hospitalizations in the child. Children of caregivers with current depression (n = 44) had more unscheduled clinic visits than children of caregivers without depression. CONCLUSION: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined psychiatric disorders, particularly depressive disorders, were common in caregivers and associated with a greater frequency of asthma-related hospitalizations in the child.