Caregiver Depressive Symptoms and Observed Family Interaction in Low‐Income Children with Persistent Asthma

Abstract

This study examined the relationship between caregiver depressive symptoms and observed parenting behaviors and family processes during interactions among 101 urban, low-income Africtan American families with children with persistent asthma. Caregivers (primarily female) were assessed on four dimensions (i.e., warmth/ involvement, hostility, consistent discipline, relationship quality) in three videotaped interaction tasks (loss, conflict, cohesion). The results indicated that increased depressive symptoms were significantly associated with lower warmth/involvement and synchrony scores and greater hostility scores during the loss and conflict tasks. In the total sample, the highest levels of hostility and the lowest levels of warmth/involvement were found for the conflict task; nevertheless, caregivers with moderate/severe depressive symptoms showed a significantly greater increase in hostility from the loss to the conflict task than caregivers with minimal/mild depressive symptoms. The findings highlight the salience of considering task content in family observational process research to expand our understanding of depressed and nondepressed caregivers abilities to modulate appropriately their behaviors and affect across various family interactions. Implications for improving asthma management for low-income children with persistent asthma are discussed, including the utility of multidisciplinary interventions that combine asthma education with family therapy.

Medication Use in Children with Asthma: Not a Child Size Problem

“…One of the key themes to emerge from our review was that parental knowledge, attitudes, beliefs, socioeconomic characteristics, and family interaction patterns can all contribute to inappropriate use of medications (29,45,62,63). Parental fear of ICS ("steroid phobia") is reported extensively as a major barrier to the use of and adherence to asthma medications ( 45,48,(64)(65)(66)(67)(68).…”

“…Probing, identifying, and addressing parental/carer fears at the start of treatment can help to allay doubts and improve adherence to therapy (44,45,72). Intervention research should concentrate on family-focused interventions designed to promote asthma control by integrating psychosocial factors (62). Health-care professionals and parents should involve children in the medical consultation and in the formulation of their own asthma management plan (81).…”

“…Evidence supporting alternative treatments also needs to be explored (52). A less commonly identified issue in the extant research is the association between the parent's or caregiver's own QOL and their management behaviors which affect how medications are used in children (62).…”

The unbearable cost of severe asthma in underprivileged populations

“…In low-income settings such as in inner city environment in the US, asthma in children is inducing depression in the mothers (24). Children of low socioeconomic status are more likely to require higher resources because of their asthma (25).…”

Family processes in pediatric asthma

“…In a recent study of low-income, urban, African-American children with persistent asthma, higher levels of depressive symptoms among female caregivers were significantly associated with lower observed warmth/involvement and synchrony with the child, and greater observed hostility during a multitask family interaction assessment [17].…”