Caregiver depression, child asthma severity, and preventive care among urban children with persistent asthma

Introduction: Depression is prevalent among caregivers of urban children with asthma.  We compared preventive asthma care delivery at the time of an office visit for children of caregivers with and without depression, and assessed persistence of symptoms in longitudinal follow-up. 

Methods: We analyzed data for children (2-12yrs) with persistent asthma in 6 control primary care practices of the PAIR-UP trial in urban Rochester, NY. We assessed asthma care actions occurring at an office visit, and symptoms and healthcare utilization at 2-month follow-up. Bivariate and multivariate analyses assessed associations for caregivers with and without depression, as measured by the Kessler Psychological Distress scale.

Results:292 caregivers enrolled (participation rate 80%; 77% Minority); 38% were depressed.  More children of depressed caregivers had moderate/severe persistent asthma (70% vs 54%,p=.007) and a caregiver who smoked (44% vs 28%,p=.003) compared to children of caregivers without depression.  At the visit, providers were no more likely to ask about symptoms (59% vs 58%,p=.90) or prescribe preventive medications (24% vs 23%,p=.78) for children with vs. without depressed caregivers.  At 2 months, children of depressed caregivers continued to have fewer symptom-free days/2 weeks (8.2 vs 10.4,p<.001), more days needing rescue medications (4.1 vs 2.2,p<.001), and more healthcare visits (.78 vs .47,p=.008). These findings persisted in multivariate analyses. 

Conclusions: Despite greater severity, children of caregivers with depression are no more likely to receive guideline-based preventive care at healthcare visits.  At follow-up, these children remained more symptomatic, highlighting a critical need to reform practice to promote health equity in this urban population.