Maternal depressive symptoms and adherence to therapy in inner-city children with asthma.
BACKGROUND
Little is known about how depressive symptoms in mothers affects illness management in inner-city children with asthma.


OBJECTIVE
Our goal was to determine how maternal depressive symptoms influence child medication adherence, impact of the child's asthma on the mother, and maternal attitudes and beliefs.


METHODS
Baseline and 6-month surveys were administered to 177 mothers of young minority children with asthma in inner-city Baltimore, MD and Washington, DC. Medication adherence, disruptiveness of asthma, and select attitudes toward illness and asthma therapy were measured. Six-month data (N = 158) were used to prospectively evaluate long-term symptom control and emergency department use. Independent variables included asthma morbidity, age, depressive symptoms, and other psychosocial data.


RESULTS
No difference in child asthma morbidity was observed between mothers high and low in depressive symptoms. However, mothers with high depressive symptoms reported significantly more problems with their child using inhalers properly (odds ratio [OR]: 5.0; 95% confidence interval [CI]: 1.3-18.9) and forgetting doses (OR: 4.2; 95% CI: 1.4-12.4). Depressive symptoms were also associated with greater emotional distress and interference with daily activities caused by the child's asthma, along with less confidence in asthma medications, ability to control asthma symptoms, and self-efficacy to cope with acute asthma episodes. In addition, depressed mothers reported less understanding about their child's medications and use (OR: 7.7; 95% CI: 1.7-35.9). Baseline asthma morbidity, maternal depression scores, and family income were independently associated with asthma symptoms 6 months later, whereas medication adherence was not predictive of subsequent asthma morbidity or emergency department use.


CONCLUSIONS
Maternal depressive symptoms were not associated with child asthma morbidity but were associated with a constellation of beliefs and attitudes that may significantly influence adherence to asthma medications and illness management. Identifying and addressing poor psychological adjustment in mothers is important when developing a child's asthma treatment and may facilitate parent-provider communication, medication adherence, and asthma management among inner-city children.
Bartlett
Susan J
SJ
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. bartlett@jhmi.edu
Krishnan
Jerry A
JA
Riekert
Kristin A
KA
Butz
Arlene M
AM
Malveaux
Floyd J
FJ
Rand
Cynthia S
CS
D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000523:psychology / Q000628:therapy*; D001294:Attitude to Health; D015142:Baltimore; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D003863:Depression; D003866:Depressive Disorder; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers / Q000523:psychology*; D009330:Nebulizers and Vaporizers; D011204:Poverty Areas; D011795:Surveys and Questionnaires; D014504:Urban Health; D014861:Washington
D018927:Anti-Asthmatic Agents