Influence of Asthma Management on Depression and Stress in Puerto Rican Youth– Data from Project CURA

Puerto Rican youth experience higher asthma prevalence and worse morbidity than any other ethnic/racial group. They also have high rates of anxiety disorders and caregiver depression, both associated with their asthma. We will test if a Community Health Worker (CHW) intervention targeting asthma management skills influences depression and stress for youth and their caregivers.

A randomized controlled trial of 101 Puerto Rican youth ages 5-18 years old was conducted; participants received CHW home visits or mailed information. Data were collected in the home at baseline, five, and 12 months. Depression was measured in caregivers (n=101) and adolescents (n=50) using the PHQ-9. Caregiver stress was determined using the Perceived Stress Scale (n=101), while children and adolescents used the Life Events Checklist (n=101). Participants were offered four months of intervention on asthma self-management.

The cohort started with high asthma severity, poor asthma control, and suboptimal asthma management. At baseline, 59% of caregivers and 66% of adolescents had depression signs. Caregiver stress scores were high. Children and adolescents experienced an average of 4 (range 0-12) negative stressful life events in the past year. The CHW arm received an average of three home visits. By March of 2012, unblinding will occur and the final analyses will be conducted to test the stated hypothesis.

Mental health was not the target of this intervention but the high baseline rates in our cohort, experiences during the trial, and work of others informed the hypothesis. Implications for future interventions in similar high risk populations will be discussed.