Relationship Between Caregiver Social Support, Depressive Symptoms, and Child Asthma Outcomes in Low-Income, Urban, African American Families

Abstract

Caregiver depressive symptoms are prevalent and put low-income, urban, African American children with asthma at risk for poor asthma medication adherence and control. Caregiver social support may improve medication adherence and asthma control directly or buffer against the negative effects of caregiver depressive symptoms. In Paper 1, I systematically reviewed the literature and identified nine studies examining the relationship between caregiver social support and child asthma outcomes. Most studies measured informal social support using self-report instruments and evaluated clinical indicators of asthma morbidity in ethnically diverse school-age children. Studies were limited by referral and recall bias. A pattern of significant results suggested that more caregiver social support is associated with better child asthma outcomes; however, due to the variety in asthma outcomes and the heterogeneity in their measurement, further research is needed to draw more definitive conclusions. In Paper 2, I examined the factor structure of the five-item Medication Adherence Report Scale (MARS), in a sample of caregivers of low-income, urban, African American children with uncontrolled asthma. Confirmatory factor analysis indicated that a five-item one-factor model marginally fit the data. The MARS demonstrated acceptable internal reliability. MARS was associated with caregiver-reported inhaled steroid adherence, but not with Asthma Medication Ratio, asthma control, or caregiver perception of asthma control in the regression model. These results suggest it may be more productive for clinicians to engage in consistent, non-judgmental communication with families about asthma medication rather than using the MARS. In Paper 3, I used generalized estimating equations and ordered logistic regression to investigate the longitudinal relationships among caregiver social support and depressive symptoms and two asthma outcomes: (a) medication adherence and (b) asthma control in the above sample. The analyses revealed that caregiver social support did not have an effect on either outcome, nor did it moderate the relationship with depressive symptoms in either model. Medication adherence and asthma control improved over time. Caregiver depressive symptoms predicted decreased medication adherence. Severe and moderate baseline asthma, very low income, and season (fall) were predictors of poorer asthma control. Clinicians should target depressive symptoms as a modifiable factor associated with child asthma outcomes.