Improvements in caregiver depression positively affected symptoms of asthma among their children, according to study results published in the Journal of Allery and Clinical Immunology: In Practice.
Patients (N=205) with persistent asthma who had a caregiver with major depressive disorder (MDD) were recruited from Parkland Health & Hospital System facilities and SUNY-Buffalo Medical Center in the United States in 2016 and were followed until 2020. The primary outcome of this study was the change in child 7-item Asthma Control Test (ACT) scores on the basis of improvement in caregiver depressive symptoms using 17-item Hamilton Rating Scale for Depression (HRSD).
The patient cohort comprised 54.1% girls (mean age, 11.31 [SD, 2.89] years), of whom 56.6% were Black, 51.6% used corticosteroids, 48.4% used inhaled corticosteroids plus long-acting β-agonists, self-rated Children’s Depression Inventory (CDI) t score was 49.14 (SD, 9.10) points, forced expiratory volume in 1 second (FEV1%) was 97.64% (SD, 17.69%), and total ACT score was 17.78 (SD, 4.89) points. The caregiver cohort comprised 98.0% women (mean age, 38.62 [SD, 7.95] years), of whom 52.2% were Black, and total HRSD score was 17.95 (SD, 4.79) points.
Overall, children with a caregiver who presented with MDD remission at 1 or more follow-up visits had superior improvement in CDI scores (P =.027) and FEV1% (P =.049) compared with children who did not have a caregiver in remission throughout the study.
In the multivariate linear regression analysis, the change in ACT score was associated with baseline ACT score (β, -0.475; P <.001), child age (β, 0.397; P <.001), and the proportion of follow-ups where the caregiver was in HRSD remission (β, 1.775; P =.025). Predictors for the change in CDI t score included child CDI t score at baseline (β, -0.555; P <.001) and the proportion of follow-ups where the caregiver was in HRSD remission (β, -5.522; P =.015). Significant predictors for improvement in FEV1%, child age (β, -1.087; P =.008), FEV1% at baseline (β, -0.421; P <.001), the proportion of follow-ups where the caregiver was in HRSD remission (β, 9.412; P =.023), and caregiver age (β, 0.318; P =.030).
In the mediation analysis, caregiver HRSD score had direct effects on child ACT score (β, -0.035; P =.004) and CDI score (β, 0.070; P =.009), which had a direct effect on child ACT score (β, -0.028; P =.014). Medication adherence also had a significant mediation effect between HRSD and ACT scores (β, 0.048; P <.001).
This study may have been limited by self-reported medication adherence.
Study authors concluded, “The results indicate that caregiver depression contributes to worsening child asthma control partially through child depression. These observations have important clinical implications, suggesting both caregiver depression and child depression are potential targets for adjunct intervention to improve child asthma outcomes.”
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Brown ES, Palka JM, Lehman HK, et al. The impact of caregiver depression on child asthma outcomes: pathways and mechanisms. J Allergy Clin Immunol Pract. Published online October 24, 2022. doi:10.1016/j.jaip.2022.09.016