title: Depression among caregivers of children with asthma and its impact on communication with health care providers.
abstract: BACKGROUND
  Caregiver depression is common, can negatively influence one's ability to communicate with health care providers, and may hinder appropriate care for children with asthma.
  
  
  OBJECTIVE
  To evaluate the impact of caregiver depression on communication and self-efficacy in interactions about asthma with their child's physician.
  
  
  METHODS
  Cross sectional analysis using data from the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers study.
  
  
  METHODS
  We enrolled caregivers of children (2-12 yrs) with persistent asthma prior to their health care visit. Caregivers were interviewed via telephone after the visit to assess depression, self-efficacy, and provider communication at the visit. Caregiver depression was measured using the Kessler Psychological Distress scale. We assessed caregiver self-efficacy using items from the Perceived Efficacy in Patient-Physician Interactions scale; caregivers rated their confidence for each item (range 0-10). We also inquired about how well the provider communicated regarding the child's asthma care. Bivariate and multivariate analyses were used.
  
  
  RESULTS
  We interviewed 195 caregivers (response rate 78%; 41% Black, 37% Hispanic), and 30% had depressive symptoms. Caregiver rating of provider communication did not differ by depression. Most caregivers reported high self-efficacy in their interactions with providers; however depressed caregivers had lower scores (8.7 vs. 9.4, p = .001) than non-depressed caregivers. Further, depressed caregivers were less likely to be satisfied with the visit (66% vs. 83%, p = .014), and to feel all of their needs were met (66% vs. 85%, p = .007). In multivariate analyses, depressed caregivers were >2× more likely to be unsatisfied with the visit and to have unmet needs compared to non-depressed caregivers.
  
  
  CONCLUSIONS
  Depressed caregivers of children with asthma report lower confidence in interactions with providers about asthma and are less likely to feel that their needs are met at a visit. Further study is needed to determine the best methods to communicate with and meet the needs of these caregivers.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. maria_fagnano@urmc.rochester.edu
authors.forename: M
authors.initials: M
authors.lastname: Fagnano
authors.forename: E
authors.initials: E
authors.lastname: Berkman
authors.forename: E
authors.initials: E
authors.lastname: Wiesenthal
authors.forename: A
authors.initials: A
authors.lastname: Butz
authors.forename: J S
authors.initials: JS
authors.lastname: Halterman
mesh_terms: D000328:Adult; D001249:Asthma / Q000628:therapy*; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D011368:Professional-Family Relations; D011569:Psychiatric Status Rating Scales; D036301:Qualitative Research; D020377:Self Efficacy