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The Relationship of Life Stressors and Maternal Depression to Pediatric Asthma Morbidity in a Subspecialty Practice

  • Madeleine U. Shalowitz
    Correspondence
    Address correspondence to Madeleine U. Shalowitz, MD, MBA, Department of Pediatrics, Evanston Northwestern Healthcare Research Institute 450, 2650 Ridge Ave, Evanston, IL 60201
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  • Carolyn A. Berry
    Affiliations
    From the Department of Pediatrics, Northwestern University Medical School, Chicago, Ill (Dr Shalowitz); Center for Health and Public Service Research, Robert F. Wagner Graduate School of Public Service, New York University, New York, NY (Dr Berry); Evanston Northwestern Healthcare Research Institute, Evanston, Ill (Dr Shalowitz and Ms Quinn); and Department of Clinical Pediatrics, University of Chicago, Pritzker School of Medicine, and Department of Pediatric Allergy and Immunology, La Rabida Children's Hospital and Research Center, Chicago, Ill (Dr Wolf).
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  • Kelly A. Quinn
    Affiliations
    From the Department of Pediatrics, Northwestern University Medical School, Chicago, Ill (Dr Shalowitz); Center for Health and Public Service Research, Robert F. Wagner Graduate School of Public Service, New York University, New York, NY (Dr Berry); Evanston Northwestern Healthcare Research Institute, Evanston, Ill (Dr Shalowitz and Ms Quinn); and Department of Clinical Pediatrics, University of Chicago, Pritzker School of Medicine, and Department of Pediatric Allergy and Immunology, La Rabida Children's Hospital and Research Center, Chicago, Ill (Dr Wolf).
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  • Raoul L. Wolf
    Affiliations
    From the Department of Pediatrics, Northwestern University Medical School, Chicago, Ill (Dr Shalowitz); Center for Health and Public Service Research, Robert F. Wagner Graduate School of Public Service, New York University, New York, NY (Dr Berry); Evanston Northwestern Healthcare Research Institute, Evanston, Ill (Dr Shalowitz and Ms Quinn); and Department of Clinical Pediatrics, University of Chicago, Pritzker School of Medicine, and Department of Pediatric Allergy and Immunology, La Rabida Children's Hospital and Research Center, Chicago, Ill (Dr Wolf).
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      Objective.—To examine the relationships among demographic characteristics, caregiver life stressors, and depressive symptoms of mothers and their children's asthma morbidity.
      Setting.—Three pediatric asthma subspecialty programs, 2 in the inner city and 1 in the suburbs.
      Design.—Cross-sectional census sample of caregivers of children with asthma: interviews mostly with mothers (N = 123) regarding their children's asthma symptoms and health care utilization. Information collected on demographics and caregivers' own recent life stressors and depressive symptoms.
      Subjects.—Caregivers of children ages 18 months to 12 years with asthma at their subspecialty visit.
      Measures.—Structured interviews: a survey instrument prepared for this study and standardized instruments for depression (Center for Epidemiologic Studies–Depression) and life stressors (Crisis in Family Systems).
      Results.—A total of 32% of respondents' children had high asthma morbidity, 28% intermediate, and 40% low. Caregiver life stressors and depression and the children's sex showed the strongest relationships to asthma morbidity in a model that also included race, residence, and Medicaid status. Children were more likely to have high morbidity if they had caregivers with more depressive symptoms and negative life stressors and if they were female.
      Conclusions.—Respondents experienced many life stressors and symptoms of depression while managing their children's illness. Caregivers' lives may affect their children's asthma morbidity, offering empirical evidence for the potential value of targeted case management for children in subspecialty care.

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