Abstract: Stress and Quality of Life in Urban Caregivers of Young Children with Poorly Controlled Asthma: A Longitudinal Analysis (Society for Social Work and Research 20th Annual Conference - Grand Challenges for Social Work: Setting a Research Agenda for the Future)

Schedule:

Saturday, January 16, 2016: 9:45 AM

Meeting Room Level-Meeting Room 12 (Renaissance Washington, DC Downtown Hotel)

* noted as presenting author

Melissa H. Bellin, PhD, Associate Professor, University of Maryland at Baltimore, Baltimore, MD

Philip Osteen, PhD, Assistant Professor, Florida State University, Tallahassee, FL

Joan Kub, PhD, Associate Professor, Johns Hopkins University, Baltimore, MD

Mary Bollinger, DO, Associate Professor, University of Maryland at Baltimore, Baltimore, MD

Mona Tsoukleris, PharmD, Associate Professor, University of Maryland at Baltimore, Baltimore, MD

Laurie Chaikind, MSW, Clinician, Center for Autism Research and Development, Baltimore, MD

Arlene Butz, ScD, Professor, Johns Hopkins University, Baltimore, MD

Purpose: Asthma is one of the most common chronic diseases in children and may result in profound social, physical, and functional impairments if not well controlled (Wildhaber, Carroll & Brand, 2012). Quality of life (QOL) is an important marker of the impact of health conditions on children and their families (Chow, Morrow, Robbins, & Leask, 2013). It is also proposed to influence health self-management behaviors such as treatment adherence and decisions about seeking healthcare However, few studies have explored the collective impact of disease-specific and contextual risk factors such as daily stress on caregiver QOL over time. Even less is known about whether protective processes such as social support may moderate the effects of these risks on QOL.

Methods: Three hundred urban, low-income caregivers of young children with asthma completed self-report measures of daily life stress, asthma caregiving stress, child asthma characteristics and asthma-related healthcare utilization, social support (SS), and QOL at baseline, and 6 and 12-months follow-up. A series of nested latent growth curve models (LGCM) was used to test the hypothesis that SS would be a significant moderator of the relationships between life stress, asthma caregiving stress, and QOL over time.

Results: Caregivers were primarily the biological mother (92%), single (70%), and unemployed (55%). The children (Mean age=5.5years) were African American (96%), Medicaid eligible (92%), and most (93%) were categorized as having poorly controlled asthma based on symptom frequency and emergency room/urgent visit rates. The LGCM analysis indicated that the covariates model was the best fitting model and demonstrated acceptable overall fit as evidenced by a RMSEA of 0.06, CFI of 0.83 and SRMR of .03. Greater life stress predicted lower QOL at baseline (b=-.26, se=.12,p=.03), six-month (b=-.19, se=.09,p=.03), and 12-month data points (b=-.21, se=.10,p=.03). Higher scores for asthma stress predicted lower scores for QOL at baseline (b=-.65, se=.12,p<.001), six-months (b=-.73, se=.10,p<.001), and twelve-months (b=-.71, se=.11,p<.001). Poorer asthma control was likewise associated with lower QOL scores at all three time points; at baseline b=-2.75(se=1.02,p=.007), at six-month b=-1.82 (se=.40,p<.001), and at twelve-month b=-2.05 (se=.35,p<.001). However, SS did not predict QOL, and the interaction terms for life stress and SS and for asthma caregiving stress and SS were non-significant at all time points (p>.10).

Implications: Findings underscore the importance of capturing objective and subjective measures of asthma burden. Integrating questions about daily life stress in social work assessments with this population is likewise indicated. The study further highlights vulnerability to lower QOL among inner-city caregivers of young children with high-risk asthma when just one stressor is present (asthma caregiving stress, life stress).

Chow, M. Y. K., Morrow, A. M., Robbins, S. C. C., & Leask, J. (2013). Condition-specific quality of life questionnaires for caregivers of children with pediatric conditions: a systematic review. Quality of Life Research, 22(8), 2183-2200.

Wildhaber, J., Carroll, W. D., & Brand, P. L. (2012). Global impact of asthma on children and adolescents' daily lives: The room to breathe survey. Pediatric Pulmonology, 47(4), 346-357.