Family relational factors in pediatric depression and asthma: pathways of effect.
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.
Wood
Beatrice L
BL
Division of Child and Adolescent Psychiatry, State University of New York at Buffalo, NY 14222-2006, USA. bwood@buffalo.edu
Miller
Bruce D
BD
Lim
Jungha
J
Lillis
Kathleen
K
Ballow
Mark
M
Stern
Trudy
T
Simmens
Samuel
S
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
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride