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

 描述(由申请人提供)：儿童哮喘是一种常见的、代价高昂的、潜在威胁生命的疾病，近年来患病率、发病率和死亡率都有所增加。迫切需要改进哮喘控制和减少对紧急护理的需求的战略。抑郁是哮喘儿童照顾者的常见情况(定义为对儿童的哮喘需求负有主要责任的人，通常是家庭成员)，并与儿童哮喘的负面后果有关，包括与哮喘相关的服务利用率增加。我们的初步研究表明，照顾者抑郁和儿童哮喘之间的联系可能部分归因于糟糕的哮喘管理和育儿压力。在一项初步研究中，我们用抗抑郁药物治疗抑郁的哮喘照顾者。在抗抑郁治疗期间，照顾者抑郁症状和儿童哮喘症状都有所改善，儿童哮喘相关服务利用率下降。观察到照顾者抑郁的改善与儿童呼吸功能和哮喘控制的改善之间存在很强的相关性。基于这些数据，我们建议一种改善哮喘结果和减少哮喘儿童服务利用率的方法是解决照顾者中未经治疗的抑郁问题。在目前的申请中，我们建议招募196名被诊断为严重抑郁障碍的哮喘儿童及其儿童哮喘的主要照顾者。目前抑郁的照顾者将接受由研究小组精神病学家提供的为期52周的基于算法的抗抑郁治疗。52周的治疗期将提供所需的时间来观察照顾者抑郁症状的变化和儿童哮喘控制的变化，并允许在所有四季进行哮喘评估。这项研究的目的是确定照顾者抑郁的改善是否预示着儿童哮喘控制和服务利用的改善。照顾者的抑郁症状和生活质量，以及儿童的哮喘控制、服务利用和哮喘相关的生活质量，将在每四周的随访中进行量化。我们将检查哮喘药物依从性和儿童情绪(抑郁和焦虑)，作为照顾者抑郁变化对儿童哮喘控制和服务利用影响的两个可能的中介。如果这项研究的结果表明照顾者抑郁的变化与儿童哮喘控制之间的关系，那么未来的一项试验将探索一种多模式方法，不仅针对照顾者抑郁，而且同时针对依从性和儿童抑郁/焦虑。一个研究小组将在儿童哮喘、哮喘患者和哮喘患者照顾者的情绪障碍、抑郁药物治疗、生物统计学、压力和抑郁以及影响儿童哮喘的家庭关系因素方面拥有专业知识，将开展该项目。

 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.