The influence of parent-child conflict and stressful experiences on the health of youth with asthma.

摘要

Attaining a clear picture of everyday family interactions is essential for understanding how family stress and conflict adversely affects children's health, especially in the context of chronic illness. Using a naturalistic observation sampling method called the Electronically Activated Recorder (EAR), we sought to investigate the effects of daily interpersonal conflicts and parental stress on pediatric asthma outcomes. We collected data from 81 children, aged 10 to 17 (M age = 12.88), and their primary caregiver as part of a larger study. Each child completed a pulmonary function test and self-report questionnaires of asthma symptoms. Asthma-related medical information was abstracted from their medical records. The Adult and Parent UCLA Life Stress Interview (LSI) assessed acute stress as the number of acutely stressful events in the past 6 months. Of these 81 participants, 45 children wore the EAR for 4 days. Trained research assistants coded the EAR files using the Everyday Child Home Observations (ECHO) Coding System for instances of interpersonal conflict (e.g., arguing, fighting, yelling) and asthma symptoms (e.g., coughing, wheezing). EAR-observed parent-child conflict (r = .36, p < .05) and EAR-observed family environment conflict (r = .32, p < .05) was positively associated with youth reported asthma symptoms. Further, EAR-observed wheezing coded was positively associated with EAR-observed family environment conflict (r = .34, p < .05), conflict with fathers (r = .43, p < .01), and general conflict in the youth's life (r = .35, p < .05). Additionally, we found positive associations between recently experienced stressful events in the lives of parents and multiple measures of asthma morbidity, including Emergency Department use for asthma related symptoms (r = 0.28, p < 0.05), youth-BMI (r = 0.24, p < 0.05), youth-reported asthma symptoms (r = 0.36, p = 0.02) and asthma severity (r = 0.27, p < 0.05). We also found parental stress to negatively associated with pulmonary functioning (r = -0.29; p = 0.02) and with asthma clinic visits (r = -0.36; p < 0.01). These findings show that greater conflict in everyday life within the family and broad measures of stress in parent's lives are associated with multiple markers of asthma morbidity. This research has important implications for asthma interventions tailored to the individual and their family system.