Treating Caregiver Depression to Improve Childhood Asthma: Impact and Mediators -

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 DESCRIPTION (provided by applicant): Childhood asthma is a common, costly, and potentially life-threatening illness with increased prevalence, morbidity, and mortality in recent years. Strategies to improve asthma control and decrease the need for emergency care are badly needed. Depression is a common condition in caregivers of children with asthma (defined as the person, generally a family member, who is primarily responsible for the asthma needs of the child) and is associated with negative asthma outcomes in their children, including increased asthma- related service utilization. Our preliminary studies show that this association between caregiver depression and the child's asthma may be due, in part, to both poor asthma management and parenting stress. In a pilot study, we treated depressed asthma caregivers with antidepressants. During antidepressant therapy, both caregiver depressive symptoms and the child's asthma symptoms improved, and the child's asthma-related service utilization decreased. Strong associations were observed between improvement in caregiver depression and improvement in the child's respiratory function and asthma control. Based on these data, we suggest that an approach to improving asthma outcomes and decreasing service utilization by children with asthma is to address untreated depression in their caregivers. In the current application, we propose to enroll 196 primary caregivers of children with asthma who are diagnosed with major depressive disorder and their child with asthma. Currently depressed caregivers will receive 52 weeks of algorithm-based antidepressant therapy provided by research team psychiatrists. A 52- week treatment period will provide the time needed to observe both changes in depressive symptoms in the caregiver and in asthma control in the child, as well as allowing for asthma assessments across all four seasons. The aim of the study is to determine if improvement in caregiver depression predicts improvement in the child's asthma control and service utilization. Caregiver depressive symptoms and quality of life, and the child's asthma control, service utilization, and asthma-related quality of life will be quantifed at follow-up visits every four weeks. We will examine asthma medication adherence and the child's emotions (depression and anxiety) as two possible mediators of the effect of changes in caregiver depression on the child's asthma control and service utilization. If the results of this study suggest a relationship between changes in caregiver depression and the child's asthma control, then a future trial will explore a multimodal approach targeting not only caregiver depression, but also adherence and child depression/anxiety concurrently. A research team with expertise in childhood asthma, mood disorders in asthma patients and in caregivers of asthma patients, depression pharmacotherapy, biostatistics, stress and depression, and family relational factors affecting child asthma will conduct the project.