Neglect, Adherence and Depression in Asthmatic Children

低收入的城市哮喘儿童容易受到忽视的不利影响，因为他们的发病率增加和哮喘的复杂长期治疗方案。忽视可能通过治疗不依从直接导致哮喘控制不良，或者通过忽视对儿童适应的影响间接导致哮喘控制不良。本研究的主要目的是研究忽视，特别是在家庭系统属性方面的定义，是如何横向和纵向地与哮喘儿童治疗不依从性相关的。第二个目的是调查忽视和儿童感知的与主要照顾者的关系是如何横向和纵向与儿童抑郁症状相关的。样本将是160名患有持续性哮喘的低收入儿童（6 -11岁）及其主要护理人员，他们从公立城市医院的初级保健和紧急免预约诊所招募。依从性行为（使用吸入抗炎药、MDI/间隔技术、暴露于烟草烟雾）将通过观察、电子监测或实验室测试直接评估。抑郁症状将由儿童和照顾者报告评估。根据生物行为家庭模型（BBFM），忽视被概念化为低照顾者接近度、低照顾者反应性和松散/不一致的照顾者纪律。参与者将在入组时（T1）和一年后（T2）进行家访和实验室访问。基于改编自BBFM的概念模型，假设表明：(1)低依从性将被预测为哮喘知识水平低，忽视程度高，儿童抑郁症状程度高，以及与主要照顾者感知的不安全模式，忽视对上述方差的贡献显著增加，这是由知识所解释的；(2)高水平的忽视和不安全的关系模式会预测抑郁症状，而相关性会调节忽视与抑郁症状之间的关系。

Low-income, urban children with asthma are vulnerable to the adverse impact of neglect, given their increased morbidity and the complex, long-term treatment regimens for asthma. Neglect may lead to poor asthma control directly via treatment nonadherence, or indirectly, via the effect of neglect on children's adjustment. The primary aim of this study is to examine how neglect, defined specifically in terms of family systems properties, is related cross-sectionally and longitudinally to treatment nonadherence for children with asthma. The secondary aim is to investigate how neglect and children's perceived relatedness with the primary caregiver are cross-sectionally and longitudinally related to children's depressive symptoms. The sample will be 160 low-income children (ages 6 -11) with persistent asthma and their primary caregivers, recruited from primary care and emergency walk-in clinics in a public, urban hospital. Adherence behaviors (use of inhaled anti-inflammatory agents, MDI/spacer technique, exposure to tobacco smoke) will be assessed directly via observation, electronic monitoring, or lab test. Depressive symptoms will be assessed by child and caregiver report. Neglect is conceptualized, according to the Biobehavioral Family Model (BBFM), as low caregiver proximity, low caregiver responsivity, and lax/inconsistent caregiver discipline. Participants will be administered measures during a home visit and a lab visit at enrollment (T1) and one year later (T2). Based on a conceptual model adapted from the BBFM, hypotheses state that: (1) poor adherence will be predicted by low levels of knowledge about asthma, high levels of neglect, greater levels of child depressive symptoms, and an insecure pattern of perceived relatedness with the primary caregiver, with neglect contributing a significant increment in the variance above that accounted for by knowledge; and (2) depressive symptoms will be predicted by high levels of neglect and an insecure pattern of relatedness, with relatedness moderating the relationship between neglect and depressive symptoms.