Depression, perception of poverty and social connections among primary caregivers with asthma in an urban setting

Abstract

Background. Asthma is a chronic illness and a health concern for parents and health care providers in New York. Children with asthma of depressed caregivers may be at risk for worse asthma morbidity. Low socioeconomic status (SES) and fewer social connections have also been linked with greater childhood asthma morbidity. Perceived poverty represents an under-studied area within the context of childhood asthma. It is also unclear how perceptions of poverty and social connections may be impacted by maternal depression within an inner-city population. Understanding how these psychosocial variables impact child asthma morbidity may further research into assessment and intervention for caregivers of children who suffer from asthma.;Objective. The purpose of this study was to examine the impact of caregiver depression, negative perceptions of poverty and available social connections on childhood asthma morbidity in an inner-city population.;Methods. A total of 249 primary caregiver-child dyads of Puerto Rican, Mexican, African-American, Afro-Caribbean and Anglo-American descent were recruited from two Bronx, NY community hospitals and a primary care clinic. Primary caregivers were interviewed for current mood disorder and they and their children answered questionnaires on asthma morbidity perceived poverty, perceived stress (PSS) and social connections (SC); including family support and social cohesion. Child pulmonary function as defined by forced expiratory volume (%FEV1), asthma severity and family income (federal poverty line) were controlled as covariates in the analyses.;Results. Depressed caregivers were more likely to endorse greater functional morbidity due to asthma in their children versus those who were not depressed, F(1, 72) = 5.86, p = .018. Increased family support predicted a reduction in current mood disorder for the caregiver (OR = .771, 95% CI [.638, .932]). Results suggest that caregiver level of social cohesion (neighborhood support) was not a significant predictor of child functional morbidity, F (1,163) = 1.07, p = .303. Social cohesion did account for a significant proportion of variance (4%) in child pulmonary function. Children of parents who reported greater social cohesion had better pulmonary function (FEV1) on the day of testing, F (1,160) = 6.09, p = .015. Mothers who reported "living poor" did not endorse greater functional morbidity on the AFSS than those who reported "living well/check-to-check," F(1, 148) = 8.57, p = .429. The PoPS was validated by the PSS within our present sample. As caregiver perceived stress increased, so did the likelihood that the caregiver would report "not living well" on the PoPS (OR = 1.43, 95% CI [1.24-1.64]).;Discussion. This study adds to a growing body of literature that supports a relationship between caregiver mood disorder and child asthma morbidity. The results of the present study suggest that caregiver depression may influence childhood asthma morbidity. In addition, the availability of family and neighborhood support might also be important to understanding how asthma morbidity and caregiver depression affect children with asthma and those who care for them. Effective treatment of maternal depression may help to reduce childhood asthma morbidity and lower health care costs. Health-care screening and community outreach may be potential targets for intervention.