Contribution of Caregiver and Child Anxiety and Depressive Symptoms to Child Asthma-Related Quality of Life

To assess the contribution of caregiver and child depressive and anxiety symptoms severity to child asthma-related quality of life (QoL), apart from explanation by demographics and asthma control to QoL.The study population consisted of 205 caregiver-child pairs from Dallas, Texas, and Buffalo, New York, from June 2016 to December 2020. The study included children aged 7 to 17 years with a diagnosis of persistent asthma (classified by either of the following criteria: [1] requirement for treatment with daily controller medication or [2] symptoms of persistent asthma in children not on a daily controller medication with any of the following: [1] daytime symptoms 2 or more days per week; [2] rescue bronchodilator use 2 or more times per week; [3] nocturnal symptoms 2 or more nights per month; or [4] 2 or more oral steroid bursts in the past year). The study also included primary caregivers of the children under study. All caregivers met the criteria for major depressive disorder (MDD) based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and diagnosed using a structured clinical interview.Participants of the study were observed every 4 weeks for a year. Child asthma-related quality of life was assessed with Pediatric Asthma Quality of Life Questionnaire (PAQLQ) total scores. Asthma control was measured with Asthma Control Test (ACT) or Childhood ACT (cACT). Caregiver depressive symptoms were measured by Hamilton Rating Scale for Depression (HRSD); caregiver anxiety symptoms were measured by State-Trait Anxiety Inventory (STAI). Child depressive symptoms were measured with Children’s Depression Inventory (CDI); child anxiety symptoms were measured with Screen for Child Anxiety Related Emotional Disorders Inventory (SCARED). A 3-stage hierarchical linear regression analysis was performed with PAQLQ total scores as the outcome of child asthma-related QoL. The following predictors were included for the 3 stages of linear regression: demographic characteristics for stage 1; asthma control (ACT, cACT) for stage 2; and caregiver depression (HRSD), caregiver anxiety (STAI), child depression (CDI), child anxiety (SCARED) for stage 3.The study analyzed data from a total of 205 child-caregiver pairs. The average age for children was 11 (±3) years, and 38 (±8) years for caregivers. Most participants were female (caregiver 98%, child 54.1%) and of Black race (caregiver 52.2%, child 56.6%). For the first stage of the hierarchical linear regression, demographic variables (child sex, age, caregiver educational level, caregiver race, caregiver ethnicity) contributed to 5.5% of variance in QoL. It was found that only child sex had a significant association with QoL, where males reported a higher QoL. For the second stage, asthma control (ACT/cACT) was included in the regression, which significantly increased explained variance to 32.6%. Asthma control was thus found to be a strong predictor of QoL, with better asthma control indicating a better QoL. For the third stage, the inclusion of child and caregiver anxiety and depression scores significantly increased explained variance to 42.6%. Child anxiety (SCARED scores) was found to be the only statistically significant mood-related predictor (P < .001, β = −0.332). This finding indicated that higher child anxiety scores were associated with lower asthma-related QoL. Asthma control had the most significant contribution to QoL variance as it was seen by a squared structure coefficients (rs2) score of 0.702, then child anxiety (rs2 score = 0.584), and lastly child depression (rs2 score = 0.343).Child and caregiver depression and anxiety have a pertinent influence on child asthma-related QoL after adjusting for demographic characteristics and asthma control. Specifically, child anxiety scores were found to be statistically significant predictors of diminished QoL.The study addresses the contribution of caregiver and child mood symptoms, specifically depression and anxiety, to pediatric asthma-related QoL. The finding of a significant and unique contribution of child anxiety to asthma-related quality of life adds to the necessity of addressing mental well-being in addition to physical health in pediatric asthma management. This study adds to the literature supporting the need for integrated medical and behavioral models of asthma management to improve asthma-related QoL in the pediatric population with asthma. This can include the addition of routine screening and treatment of anxiety and depression in both children with asthma and their primary caregivers into asthma management guidance. Further study should also focus on the implementation of integrated medical-psychological models for pediatric asthma management and explore barriers to application, access, and quality of model implementation, especially in high-risk, underserved, and underresourced populations.