Caregiver's depressive symptoms and asthma control in children from an underserved community

摘要

Caregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries. Objective: To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children. Methods: Case-control study of 87 asthmatic children (aged 4-11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] 20 points) and controls were children with adequate asthma control (cACT = 20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers' depression and family health vulnerability. Serum from participating children was assayed for IFN-gamma, IL-4, IL-13, TGF-beta, cortisol, and total IgE. Results: The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p=0.003; 41.3% vs. 24.8%, p=0.07; and 39.1% vs. 19.5%, p=0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR=3.56 [1.34-9.48], p=0.01). Conclusions: Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.