Family Chaos and Asthma Control

Abstract

Objectives: Asthma is a highly prevalent childhood chronic disease, with particularly high rates among poor and minority youth. Psychosocial factors have been linked to asthma severity but remain poorly understood. This study examined (1) relationships between parent and child depression and posttraumatic stress disorder (PTSD) symptoms, family functioning, and child asthma control in a sample of urban minority youth with uncontrolled asthma and (2) family functioning as a pathway linking parent depression and asthma outcomes.

Methods: Data were drawn from the baseline cohort of a randomized trial testing community interventions for children aged 5 to 16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was defined by using the Asthma Control Test and Childhood Asthma Control Test, activity limitation, and previous-12-month asthma severity. Psychosocial measures included parent and child depression and PTSD symptoms, family chaos, and parent social support.

Results: Parent and child depression symptoms, but not PTSD, were associated with worse asthma control (β = -.20 [SE = 0.06] and β = -.12 [SE = -.03]; P < .001). Family chaos corresponded to worse asthma control, even when controlling for parent and child depression (β = -.33; [SE = 0.15]; P < .05), and was a mediator of the parent depression-asthma path. Emotional triggers of asthma also mediated the parent depression-asthma relationship.

Conclusions: Findings highlight family chaos as a mechanism underlying the relationship between parent depression and child asthma control. Addressing parent and child depression, family routines, and predictability may optimize asthma outcomes.

Trial registration: ClinicalTrials.gov NCT02481986.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Mosnaim receives research grant support from GlaxoSmithKline and Propeller Health, owns stock options in electroCore, and serves as a consultant and/or member of a scientific advisory board for electroCore, GlaxoSmithKline, Teva, Novartis, AstraZeneca, Boehringer Ingelheim, and Propeller Health; the other authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2019 by the American Academy of Pediatrics.

Figures

FIGURE 1

Mediation model of the effect of parent depression on ACT scores via family chaos and emotional triggers. Solid lines are significant paths (P < .05); dashed lines are nonsignificant paths. Findings reveal full mediation, with the effect of parent depression on ACT scores being mediated separately through family chaos and emotional triggers.