Rioseco Andrea, Serrano Carolina, Celedón Juan C, Padilla Oslando, Puschel Klaus, Castro-Rodriguez Jose A
a Department of Family Medicine, School of Medicine , Pontificia Universidad Católica de Chile , Santiago , Chile.
b Department of Pediatric Gastroenterology and Nutrition , School of Medicine, Universidad de Chile , Santiago , Chile.
J Asthma. 2017 Dec;54(10):1059-1064. doi: 10.1080/02770903.2017.1292281. Epub 2017 Feb 13.
Caregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries.
To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children.
Case-control study of 87 asthmatic children (aged 4-11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] <20 points) and controls were children with adequate asthma control (cACT ≥20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers' depression and family health vulnerability. Serum from participating children was assayed for IFN-γ, IL-4, IL-13, TGF-β, cortisol, and total IgE.
The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p = 0.003; 41.3% vs. 24.8%, p = 0.07; and 39.1% vs. 19.5%, p = 0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR = 3.56 [1.34-9.48], p = 0.01).
Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.
在富裕国家，照顾者或母亲的抑郁与儿童哮喘发病率增加有关，但在低收入和中等收入国家，对此关联了解甚少。
探讨照顾者的抑郁症状是否与学龄儿童哮喘控制不佳及异常免疫反应有关。
对智利圣地亚哥一个服务不足地区的初级保健诊所的87名哮喘儿童（4至11岁）进行病例对照研究。病例为哮喘控制不佳的儿童（儿童哮喘控制测试[cACT]<20分），对照为哮喘控制良好的儿童（cACT≥20分）。使用贝克抑郁量表第二版（BDI）和经过本地验证的家庭健康脆弱性测试（SALUFAM）来评估照顾者的抑郁和家庭健康脆弱性。对参与研究的儿童血清进行干扰素-γ、白细胞介素-4、白细胞介素-13、转化生长因子-β、皮质醇和总免疫球蛋白E检测。
研究参与者的平均（标准差）年龄为8.23（2.15岁），55.2%为女性。使用吸入性糖皮质激素（ICS）、家庭健康脆弱性和照顾者的抑郁症状在病例组中显著比对照组更常见（分别为65.4%对34.6%，p = 0.003；41.3%对24.8%，p = 0.07；39.1%对19.5%，p = 0.04）。两组之间任何血清生物标志物水平均无显著差异。在多变量分析中，只有使用ICS与更好的哮喘控制显著相关（比值比 = 3.56 [1.34 - 9.48]，p = 0.01）。
在一个服务不足社区的儿童中，照顾者抑郁症状的存在与哮喘控制不佳有关，但在考虑ICS使用情况后，这种关联不再显著。
