(032) Contribution of Caregiver and Child Anxiety and Depressive Symptoms to Child Asthma-related Quality of Life

Trainee Involvement: Yes

Background: Asthma is a common, chronic condition of the airways in the lungs affecting 8.4% of adults and 5.8% of children in the United States. When present, asthma is associated with decreases in asthma-related quality of life (QOL) in adults and children. Caregiver and child demographic and emotional factors may influence pediatric asthma-related QOL (Brown et al., 2006, Wood et al., 2018). We examined whether caregiver and child depression and anxiety uniquely predict pediatric asthma-related QOL above and beyond demographic characteristics and asthma control.


Method: Included were children ages 7-17 with persistent asthma and their caregivers (n = 205) who were experiencing a major depressive episode. Three-stage hierarchical linear regression analysis was conducted to assess the effects of demographics, asthma control, and depressive and anxiety symptoms on the Pediatric Asthma Quality of Life (PAQOL) scale – a 23-item self-report that assesses the impact of asthma on child QOL. Stage 1 predictors included child’s sex and age, and caregiver’s race, ethnicity, and education. Asthma control – assessed by the Asthma Control Test (cACT for ages 4-11; ACT for ages 12 and older) – was added in stage 2. In stage 3, caregiver depression (Hamilton Rating Scale for Depression [HRSD]) and anxiety (Spielberger State/Trait Anxiety Scale [STAI]), and child depression (Children’s Depression Inventory [CDI]) and anxiety (Screen for Child Anxiety Related Disorders [SCARED]) were added. The unique contribution of both caregiver and child depression and anxiety on the variance explained in asthma-related QOL was determined using squared structure coefficients (rs2).


Results: On average, children and caregivers were 11 and 39 years old, respectively, and were primarily female (54% and 98%, respectively). Fifty-seven percent of children identified as Black, 35% as White, and 32% as Hispanic/Latino. Demographic characteristics accounted for only 6% of the variance in PAQOL scores (p = .029). Adding asthma control (ACT/cACT) significantly increased the variance explained in PAQOL to 33% (p < .001). Adding caregiver and child depression and anxiety further significantly increased the variance explained to 47% (p < .001). Child anxiety (SCARED) was the only mood or anxiety measure that significantly predicted PAQOL scores (β = -0.332, p < .001).


Conclusion: After adjusting for demographic characteristics and asthma control, adding child and caregiver anxiety and depression significantly improved the explanatory power of the model regarding child asthma-related QOL. Child anxiety was the only significant anxiety and depression predictor of child QOL. The findings suggest that caregiver and child mood significantly influences child asthma-related QOL, particularly child anxiety, beyond the contribution of demographic characteristics and asthma control.

References

Brown, E. S., Gan, V., Jeffress, J., Mullen-Gingrich, K., Khan, D. A., Wood, B. L., Miller, B. D., Gruchalla, R., & Rush, A. J. (2006). Psychiatric symptomatology and disorders in caregivers of children with asthma. Pediatrics, 118(6), e1715-e1720

Wood, B. L., Brown, E. S., Lehman, H. K., Khan, D. A., Lee, M. J., & Miller, B. D. (2018). The effects of caregiver depression on childhood asthma: Pathways and mechanisms. Annals of Allergy, Asthma & Immunology, 121(4), 421-427. https://doi.org/10.1016/j.anai.2018.06.031