Neglect, Adherence and Depression in Asthmatic Children

低收入的城市哮喘儿童由于发病率增加和哮喘治疗方案复杂、长期，容易受到忽视的不利影响。哮喘控制不佳可能直接通过治疗不依从性，或间接通过忽视儿童的适应影响。 本研究的主要目的是探讨如何忽视，特别是在家庭系统的属性，是相关的横截面和纵向治疗不依从性的儿童哮喘。 次要目的是调查如何忽视和儿童的感知与主要照顾者的相关性是横截面和纵向相关的儿童的抑郁症状。 样本将是160名患有持续性哮喘的低收入儿童（6 - 11岁）及其主要照顾者，从公立城市医院的初级保健和急诊诊所招募。 将通过观察、电子监测或实验室检查直接评估依从性行为（使用吸入性抗炎药、MDI/垫片技术、暴露于烟草烟雾）。 抑郁症状将通过儿童和看护者报告进行评估。 根据生物行为家庭模型（BBFM），Needless被概念化为低护理人员接近度，低护理人员响应度和松懈/不一致的护理人员纪律。 将在入组时（T1）和一年后（T2）的家庭访视和实验室访视期间对受试者进行测量。 基于BBFM的概念模型，假设：（1）对哮喘的知识水平低，忽视水平高，儿童抑郁症状水平高，与主要照顾者的关系不安全，忽视在知识解释的方差中贡献显著增加，将预测依从性差;（2）高水平的忽视和不安全的关系模式可以预测抑郁症状，关系调节忽视和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.