title: Caregiver depression and perceptions of primary care predict clinic attendance in head start children with asthma.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the mediating role of perceptions of primary care (PC) on the association between depression and PC clinic attendance among caregivers of children with asthma. In adults, depression is associated with lower PC clinic attendance and ∼25% of mothers presenting to a pediatric PC clinic will screen positive for depression. Adults' perceptions about their medical care mediate the depression-clinic attendance relation, but this has not been tested in children or in an asthma population.
  
  
  METHODS
  This is a secondary prospective data analysis of 141 caregivers of Head Start children diagnosed with asthma, offered an intervention to reduce barriers to PC. Caregivers rated their depressive symptoms and perceptions of PC (access, provider contextual knowledge, and continuity of care) at baseline. PC clinic attendance was tracked prospectively for 6-months.
  
  
  RESULTS
  At baseline, 26% of caregivers screened positive for depression. Within 6-months, 66% of children attended a PC appointment. A positive depression screen was not associated with PC attendance (p = 0.07) or continuity of care (p = 0.98) but was inversely associated with perceptions of both access (p = 0.03) and provider contextual knowledge (p = 0.02). Though the total indirect effect was not significant, the specific indirect effect of depression on PC attendance through access was significant (95% CI: 0.01, 0.68).
  
  
  CONCLUSIONS
  Providing tangible resources to reduce barriers to PC without addressing perceptions of access may not sufficiently improve PC clinic attendance in pediatric asthma. Screening caregivers for depression may identify families requiring targeted interventions to improve their perceptions of access.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine , Baltimore, MD , USA , and.
authors.forename: Josie S
authors.initials: JS
authors.lastname: Welkom
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Hilliard
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Eakin
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Riekert
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000628:therapy*; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010465:Perception; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D012959:Socioeconomic Factors
keywords: Pediatrics; prevention; quality of life