Family chaos, depression impact asthma control in children

A chaotic family life is detrimental to health outcomes for children with severe asthma, new research shows. These were the results of a new study led by Dr. Sally Weinstein, Associate Director of the UICDR and Associate Professor of Clinical Psychology, UIC College of Medicine, published in a recent issue of Pediatrics (click here for the study)

The first-of-its-kind study examined the connection between parent and children depression, post-traumatic stress disorder symptoms (PTSD), family functioning, and asthma control in urban minority youth with “uncontrolled asthma,” defined as excessive asthma symptoms that require use of rescue medications.

Parent, child, and family factors all play a role in the etiology and maintenance of child asthma control. Above and beyond the effects of parent and child depression, however, family chaos emerged as a robust influence on child asthma outcomes.

The study offers a fresh perspective of exploring the psychosocial risk factors of asthma, and can equip front line providers such as Pediatricians, Community Health Workers, parents and caregivers with guidance and a resource to develop and advance a collaborative system of care for asthma management.

Pediatric Asthma: Prevalence and Disparities

Asthma is highly prevalent in the U.S., and the most common chronic disease within the pediatric population. An estimated 7 million children in this country have asthma, resulting in $50 billion direct health care costs. The negative impact of asthma becomes profoundly evident when studying comparative outcomes along socio-economic measures, where health disparities in asthma reflect an alarming higher prevalence and morbidity among urban minority youth.

We cannot underestimate the contribution of socio-economic factors to “chaotic living”, those elements that impede balancing the stress of daily life, and are disruptive to family routines, structure, and organization, particularly around asthma management.

“We wanted to look at the interplay between parent, child and family functioning and child asthma control in urban minority youth with uncontrolled asthma,” said Dr. Weinstein.

The research discovered that, in families with greater household chaos, child asthma control tended to be worse. “This is a measure of family commotion, chaos, organization, routine, noise and disruption, just how things operate in the home on a day-to-day basis,” she said.

The link between family/psychosocial issues and asthma

“Much research has shown a link between psychosocial issues and child asthma control, but these links are not well-understood – we do not have great answers to the questions of “why” and “how” this relationship exists. Our study aimed to address some of these gaps in the literature and our understanding of the health disparities that exist in pediatric asthma, particularly in low-income minority populations, by focusing on family chaos as a potential pathway that could explain the link between parent/child mental health and child asthma control.  Our study is the first to suggest that family chaos was indeed a powerful mechanism linking parent depression and worse child asthma control in our high risk urban population,” said Dr. Weinstein.

Impacting clinical practice/patient outcomes

The research underscores the importance of looking beyond symptoms in children with uncontrolled asthma to address the health and well-being of the child, caregiver, and the family.  These findings suggest that assessing and addressing child and parent depression is critical for improving child asthma outcomes in high risk populations. Additionally, offering education and support on family structure, organizations, and routines in the household around asthma management may be particularly important tools for the healthcare provider. Integrating such interventions in the home via resources such as a Community Health Worker may be a key avenue for healthcare in the future.

Surprisingly few studies have examined the role of family chaos in pediatric chronic health conditions and these findings certainly point to the importance of future research exploring the role of family chaos in other pediatric chronic conditions that require daily management.