Caregiver Depressive Symptoms and Asthma Control in an Urban Asthma Clinic Serving Under-Resourced Children

Background: Asthma prevalence and morbidity disproportionately affect under-resourced children living in urban environments. Evidence demonstrates that interconnected environmental, economic, social, and psychological risk factors drive these disparities. Depressive symptoms, which affect 30-47% of caregivers of under-resourced children with asthma, are a prevalent and modifiable risk factor for child asthma morbidity. The purpose of this study was to examine the relationship between caregiver depressive symptoms and asthma control among children with persistent asthma

Methods: We conducted a retrospective, cross-sectional analysis of children evaluated between 9/2/2021 and 9/22/22 at a community-based asthma clinic providing NIH guidelines-based care to predominately under-resourced children with frequent ED visits for asthma. Children were included in the analysis if they were 4-17 years of age, had persistent asthma, and their caregiver completed the depression screening tool (2-item Patient Health Questionnaire; PHQ-2) that is routinely administered to caregivers at the beginning of each clinic visit (N=234). Caregivers with PHQ-2 scores ≥ 3 completed the PHQ-9. Binary logistic regression was used to examine the relationship between clinically significant caregiver depressive symptoms (PHQ-9 ≥ 10) and child asthma control (Asthma Control Test ≥ 20). Covariates included child asthma severity and age; caregiver relationship, language, and self-reported race; self-reported annual household income; and unmet social needs that were associated with asthma control in the bivariate analysis.

Results: The 234 children had a mean age of 8.1 years (SD=3.4) and most had mild persistent asthma (58.1%) that was uncontrolled (66.2%). Caregivers were predominately mothers (83%) and ranged in age from 22-70 years with a mean age of 35.7 (SD=8.5). 83% of caregivers self-identified as Black, and nearly 96% completed the PHQ-2 in English. Over half the caregivers (54.7%) reported an annual household income less than $40,000, and 27.4% requested housing assistance (finding housing, foreclosure assistance, utility bill payment). Only 8.1% of caregivers reported clinically significant depressive symptoms (PHQ-9 ≥ 10). In the unadjusted analysis, children whose caregivers had clinically significant depressive symptoms had a lower odds of controlled asthma (OR: 0.13; 95% CI: 0.02-0.98). In the adjusted analysis, caregiver depressive symptoms were not associated with child asthma control (aOR: 0.23; 95% CI: 0.03-1.93). Children with moderate persistent asthma (compared to mild or severe) had lower odds of asthma control (aOR: 0.28, 95% 0.10-0.79) as did children whose caregivers requested housing assistance (aOR: 0.27; 95% CI: 0.09-0.81).

Conclusions: The rate of clinically significant caregiver depressive symptoms was much lower than previously reported in the literature. Caregiver depressive symptoms were not associated with child asthma control in a sample of under-resourced children with persistent asthma evaluated at a community-based asthma clinic. Requesting assistance with housing, including finding housing, help with foreclosure, and/or help paying utility bills, was associated with lower odds of controlled asthma. Future work will examine the direct and indirect relationships among caregiver depressive symptoms, housing needs, and child asthma control in a larger cohort of children and families from the community-based asthma clinic.