IMPACT DC Asthma, Center for Translational Science, Children's National Research Institute, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
University of Maryland School of Social Work, 525 W. Redwood Street, Baltimore, MD, 21201, USA.
J Racial Ethn Health Disparities. 2022 Aug;9(4):1234-1242. doi: 10.1007/s40615-021-01065-w. Epub 2021 May 26.
The purpose of this study was to examine relationships among caregiver social support, caregiver depressive symptoms, medication adherence, and asthma control in a sample of low-income, urban, Black children aged 3-12 years with uncontrolled asthma and their caregivers. Using longitudinal data from a randomized controlled trial (RCT) assessing the efficacy of an environmental control educational intervention, we used generalized estimating equations and ordered logistic regression models to evaluate the relationship between caregiver social support (Medical Outcomes Study Social Support Survey), depressive symptoms (Center for Epidemiologic Studies Depression scale), and two child asthma outcomes: (a) medication adherence (Asthma Medication Ratio) and (b) asthma control. At baseline, 45.7% of the 208 children had very poorly controlled asthma. Nearly a third of caregivers (97% female) had clinically significant depressive symptoms at each data collection point. Social support was not associated with either asthma outcome nor did it moderate the relationship between depressive symptoms and child asthma outcomes. Higher caregiver depressive symptoms predicted decreased medication adherence (b=-0.003, SE 0.002). Moderate asthma at baseline (OR: 0.305, SE: 0.251), severe asthma at baseline (OR: 0.142, SE: 0.299), household income < $20,000 per year (OR: 0.505, SE: 0.333), and fall season (OR: 0.643, SE: 0.215) were associated with poorer asthma control. Attending to the social context of low-income, urban, Black children with asthma is critical to reduce asthma morbidity. Maternal depressive symptoms are modifiable and should be targeted in interventions to improve child asthma outcomes in this vulnerable population. The RCT was registered with ClinicalTrials.gov (NCT01981564) in October 2013.
本研究旨在考察社会支持、抑郁症状、药物依从性与哮喘控制之间的关系，对象为患有未控制哮喘的、收入低、居住在城市的、年龄在 3-12 岁的黑人儿童及其照顾者。该研究使用了一项评估环境控制教育干预效果的随机对照试验（RCT）的纵向数据，通过广义估计方程和有序逻辑回归模型，评估照顾者社会支持（医疗结局研究社会支持量表）、抑郁症状（流行病学研究中心抑郁量表）与儿童哮喘两种结局的关系：（a）药物依从性（哮喘药物比值）和（b）哮喘控制。在基线时，208 名儿童中有 45.7%的哮喘控制非常差。几乎三分之一的照顾者（97%为女性）在每个数据收集点都有明显的抑郁症状。社会支持与哮喘结局均无关联，也不能调节抑郁症状与儿童哮喘结局之间的关系。较高的照顾者抑郁症状预示着药物依从性降低（b=-0.003，SE 0.002）。基线时中度哮喘（OR：0.305，SE：0.251）、基线时重度哮喘（OR：0.142，SE：0.299）、家庭收入<20000 美元/年（OR：0.505，SE：0.333）和秋季（OR：0.643，SE：0.215）与较差的哮喘控制有关。关注患有哮喘的低收入、城市、黑人儿童的社会环境对于降低哮喘发病率至关重要。母亲的抑郁症状是可以改变的，应该作为改善这一弱势群体儿童哮喘结局的干预措施的目标。该 RCT 于 2013 年 10 月在 ClinicalTrials.gov（NCT01981564）注册。
