November 30, 2009

Mom’s depression a risk factor in childhood asthma symptoms

Mothers’ depression can worsen asthma symptoms in their children, according to research from Johns Hopkins Children’s Center published online in the Journal of Pediatric Psychology.

Analyzing data from interviews with 262 mothers of African-American children with asthma—a population disproportionately affected by this inflammatory airway disorder—the Johns Hopkins investigators found that children whose mothers had more depressive symptoms had more frequent asthma symptoms during the six months of the study. Conversely, children whose mothers reported fewer depressive symptoms had less frequent asthma symptoms.

Researchers tracked ups and downs in maternal depression as related to the frequency of symptoms among children.

“Even though our research was not set up to measure just how much a mom’s depression increased the frequency of her child’s symptoms, a clear pattern emerged in which the latter followed the earlier,” said senior investigator Kristin Riekert, a pediatric psychologist and co-director of the Johns Hopkins Adherence Research Center.

But while maternal depression appeared to aggravate a child’s asthma, the opposite was not true: How often a child had symptoms did not seem to affect the mother’s depressive symptoms, an important finding that suggests maternal depression is an independent risk factor that can portend a child’s symptoms, the researchers said.

Past studies have shown that children with chronic health conditions fare worse if their primary caregiver is depressed, but none have teased out the exact interplay between the two.

“Intuitively, it may seem that we’re dealing with a chicken-egg situation, but our study suggests otherwise,” said Riekert , an assistant professor in the School of Medicine. “The fact that Mom’s depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first.”

Researchers did not study why and how a mother’s depression affects a child’s asthma status, but because depression often involves fatigue, memory lapses and difficulty concentrating, it can affect a parent’s ability to manage the child’s chronic condition, which can involve daily, and sometimes complex, drug regimens and frequent visits to the doctor.

“Mom is the one who must implement the doctor’s recommendations for treatment and follow-up, and if she is depressed, she can’t do it well, so the child will suffer,” said lead investigator Michiko Otsuki, a behavioral medicine fellow at Johns Hopkins at the time of the study and now at the University of South Florida, St. Petersburg.

Investigators said that their findings should prompt pediatricians who treat children with asthma to pay close attention to the child’s primary caregiver—whether or not it is the mother—and screen and refer him or her for treatment if needed.

“We ask these parents if they are smokers all the time, so maybe it’s time to start asking them if they are coping well emotionally,” said co-investigator Arlene Butz, a pediatric asthma specialist at the Johns Hopkins Children’s Center and a professor in the School of Medicine. “Doctors are trained to pick up on subtle clues, so if they see a red flag in Mom, they should follow up with a depression screener and referral if needed.”

Treating depressed mothers whose children are at high risk for asthma complications will likely benefit both mother and child, while providing a clear treatment target to help reduce the burden of asthma in the United States, the researchers said. Asthma is the country’s leading pediatric chronic illness, affecting 6.5 million children under the age of 18, according to the Centers for Disease Control and Prevention.

The Johns Hopkins study included only mothers, but investigators said they believe that a similar pattern would emerge regardless of who the primary caregiver is.

Researchers caution that the mothers in their study were screened for depression with a standard questionnaire, which is a reliable detector of symptoms but not a firm diagnosis.

The Johns Hopkins findings came from a high-risk, inner-city population and thus cannot be statistically extended to other ethnic and socioeconomic groups, but researchers said that the effect of caregiver depression on a child’s asthma likely transcends demographics.

The research was funded by the National Heart, Lung and Blood Institute.

Other Johns Hopkins researchers involved in the study are Michelle Eakin, Lisa Arceneaux and Cynthia Rand.