Impact of caregiver depression on child asthma outcomes in Mexicans and Puerto Ricans

Abstract

Objective

Examine whether caregiver depressive symptoms at baseline predict longitudinal child asthma outcomes in the two populations with the largest asthma disparities: Mexicans and Puerto Ricans.

Methods

Two hundred and sixty-seven Hispanic caregiver–child dyads (Mexican = 188, Puerto Rican = 79; children 5–12 years) were recruited from clinics and hospitals in Phoenix, AZ and the Bronx, NY. The Center for Epidemiological Studies Depression Scale assessed caregiver depressive symptoms; higher scores indicate greater depressive symptomology. Medical records verified child asthma diagnosis. Assessments for outcome variables occurred at baseline, 3, 6, 9, and 12-month follow-ups. Pulmonary function was measured by spirometry, asthma control was measured by the Asthma Control Test, steroid bursts and acute healthcare utilization were assessed by caregiver report and medical records, and adherence was measured by doser devices on controller medications. Structural equation modeling analyzed baseline caregiver depressive symptoms as a predictor of longitudinal child asthma outcomes, and differences between subgroups.

Results

Higher caregiver depressive symptoms predicted better pulmonary function (β = .02, p = .001) in Mexican children, and fewer steroid bursts (β = −.41, p = .01) and better medication adherence (β = .02, p = .07) in Puerto Rican children. Caregiver depressive symptoms did not predict pediatric asthma control or acute healthcare utilization in either subgroup.

Conclusions

Caregiver depressive symptomology had unexpected effects on child asthma outcomes. Results may be explained by the Hispanic paradox, caregiver resilience, acculturation, and the study’s longitudinal nature. Further research is needed on social determinants of health that may influence differences in child asthma outcomes in heterogeneous Hispanic communities.

Keywords:

• Caregiver depression
• asthma management
• pulmonary function
• adherence
• acculturation

Acknowledgements

We would like to thank all of the families who participated in our study, and generously shared their time and experiences with us. We would also like to thank our clinical colleagues and research staff at both of our locations, for their dedication and hard work.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. The intent of this policy is not to prevent authors with these relationships from publishing work, but rather to adopt transparency such that readers can make objective judgments on conclusions drawn.

Additional information

Funding

This work was supported by funding from the National Center for Complementary & Alternative Medicine (grant number 1R01AT005216 to KJA) and the National Institutes of Health Clinical and Translational Science Award (1UL1 TR001073).