title: Family relational factors in pediatric depression and asthma: pathways of effect.
abstract: OBJECTIVE
  This study tested a multilevel biobehavioral family model proposing that negative family emotional climate contributes to child depressive symptoms, which in turn contribute to asthma disease severity. Parent-child relational insecurity is proposed as a mediator.
  
  
  METHODS
  Children with asthma (N = 112; ages 7-18; 55% male) reported relational security, anxiety, and depressive symptoms. Parent(s) reported demographics, asthma history and symptoms, and family emotional expression. Asthma diagnosis was confirmed by medical history provided by parent and child together, clinical evaluation, pulmonary function tests, and methacholine challenge, with disease severity categorized by National Heart, Lung, and Blood Institute guidelines. Medication adherence was measured prospectively.
  
  
  RESULTS
  Path analysis indicated a good fit of data to the hypothesized model (chi2 = 0.072, p =.97, normal fit index = 0.998, root mean square error of approximation = 0.000). Negative family emotional climate predicted child depressive symptoms (beta =.21, p < .04), which predicted asthma disease severity (beta =.35, p < .001), with relational insecurity a partial mediator (beta = -.23, p < .05, beta =.46, p < .001, respectively). Depression was associated with disease severity even after controlling for adherence (r p = 0.38, p < .05).
  
  
  CONCLUSIONS
  Findings are consistent with the proposed family model, suggesting the clinical importance of assessing and intervening in these specific family relational processes when treating children with depression and asthma.
authors.affiliation: Division of Child and Adolescent Psychiatry, State University of New York at Buffalo, NY 14222-2006, USA. bwood@buffalo.edu
authors.forename: Beatrice L
authors.initials: BL
authors.lastname: Wood
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Miller
authors.forename: Jungha
authors.initials: J
authors.lastname: Lim
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lillis
authors.forename: Mark
authors.initials: M
authors.lastname: Ballow
authors.forename: Trudy
authors.initials: T
authors.lastname: Stern
authors.forename: Samuel
authors.initials: S
authors.lastname: Simmens
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D016085:Bronchoconstrictor Agents; D002648:Child; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D019260:Expressed Emotion; D005190:Family / Q000523:psychology; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D012720:Severity of Illness Index; D012931:Social Environment; D011795:Surveys and Questionnaires
chemical_list: D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride