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，而且哮喘的治疗方案复杂而长期。忽视可能直接通过治疗不依从性导致哮喘控制不良，也可能通过忽视对儿童适应的影响间接导致哮喘控制不良。这项研究的主要目的是研究忽视是如何从横向和纵向上与哮喘儿童的治疗不依从性有关的，具体是根据家庭系统的属性来定义的。第二个目的是调查忽视和儿童感觉到的与主要照顾者的关系如何在横向和纵向上与儿童的抑郁症状有关。样本将是160名患有持续性哮喘的低收入儿童(6-11岁)和他们的主要照顾者，他们是从一家公立城市医院的初级保健和紧急无预约诊所招募的。将通过观察、电子监测或实验室测试直接评估粘着行为(使用吸入消炎剂、MDI/SPACE技术、暴露在烟草烟雾中)。抑郁症状将通过儿童和照顾者报告进行评估。根据生物行为家庭模型(BBFM)，忽视被概念化为低照顾者亲近度、低照顾者责任感和松懈/不一致的照顾者纪律。参与者将在注册时(T1)和一年后(T2)进行家访和实验室访问时进行测量。根据BBFM提出的概念模型，假设：(1)低水平的哮喘知识、高水平的忽视、更高水平的儿童抑郁症状、以及不安全的与主要照顾者的关系模式将预测较差的依从性，其中忽视对抑郁症状的影响显著高于知识水平；以及(2)抑郁症状将通过高水平的忽视和不安全的关系模式来预测，关系在忽视和抑郁症状之间的关系中起调节作用。

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.