The Effects of Caregiver Social Support and Depressive Symptoms on Child Medication Adherence and Asthma Control.
The Effects of Caregiver Social Support and Depressive Symptoms on Child Medication Adherence and Asthma Control.
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DOI：
10.1007/s40615-021-01065-w
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发表时间：
2022-08
影响因子：
3.9
通讯作者：
Bellin MH
中科院分区：
文献类型：
--
作者：
Margolis RHF;Dababnah S;Sacco P;Jones-Harden B;Bollinger ME;Butz A;Bellin MH
本研究的目的是探讨照顾者的社会支持，照顾者抑郁症状，药物依从性，哮喘控制在低收入，城市，黑人儿童3-12岁的哮喘不受控制的样本和他们的照顾者之间的关系。利用一项评估环境控制教育干预效果的随机对照试验（RCT）的纵向数据，我们使用广义估计方程和有序logistic回归模型来评估照顾者社会支持与（医学结局研究社会支持调查），抑郁症状（流行病学研究中心抑郁量表），和两个儿童哮喘结果：（a）药物依从性（哮喘药物比例）和（B）哮喘控制。基线时，208名儿童中有45.7%的哮喘控制非常差。近三分之一的照顾者（97%为女性）在每个数据收集点都有临床显著的抑郁症状。社会支持与哮喘的结果无关，也没有缓和抑郁症状和儿童哮喘结果之间的关系。较高的照顾者抑郁症状预测药物依从性降低（B=-0.003，SE 0.002）。基线时中度哮喘（OR：0.305，SE：0.251）、基线时重度哮喘（OR：0.142，SE：0.299）、家庭年收入<20，000美元（OR：0.505，SE：0.333）和秋季（OR：0.643，SE：0.215）与哮喘控制较差相关。关注低收入、城市、黑人哮喘儿童的社会背景对降低哮喘发病率至关重要。母亲的抑郁症状是可以改变的，应该在干预措施中有针对性地改善这一弱势人群的儿童哮喘结局。该随机对照试验于2013年10月在ClinicalTrials.gov（NCT 01981564）上注册。
The purpose of this study was to examine relationships among caregiver social support, caregiver depressive symptoms, medication adherence, and asthma control in a sample of low-income, urban, Black children aged 3–12 years with uncontrolled asthma and their caregivers. Using longitudinal data from a randomized controlled trial (RCT) assessing the efficacy of an environmental control educational intervention, we used generalized estimating equations and ordered logistic regression models to evaluate the relationship between caregiver social support (Medical Outcomes Study Social Support Survey), depressive symptoms (Center for Epidemiologic Studies Depression scale), and two child asthma outcomes: (a) medication adherence (Asthma Medication Ratio) and (b) asthma control. At baseline, 45.7% of the 208 children had very poorly controlled asthma. Nearly a third of caregivers (97% female) had clinically significant depressive symptoms at each data collection point. Social support was not associated with either asthma outcome nor did it moderate the relationship between depressive symptoms and child asthma outcomes. Higher caregiver depressive symptoms predicted decreased medication adherence (b=−0.003, SE 0.002). Moderate asthma at baseline (OR: 0.305, SE: 0.251), severe asthma at baseline (OR: 0.142, SE: 0.299), household income < $20,000 per year (OR: 0.505, SE: 0.333), and fall season (OR: 0.643, SE: 0.215) were associated with poorer asthma control. Attending to the social context of low-income, urban, Black children with asthma is critical to reduce asthma morbidity. Maternal depressive symptoms are modifiable and should be targeted in interventions to improve child asthma outcomes in this vulnerable population. The RCT was registered with ClinicalTrials.gov (NCT01981564) in October 2013.
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