Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. e940-e948 (doi:10.1542/peds.2005-2446)
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Context Matters: A Community-Based Study of Maternal Mental Health, Life Stressors, Social Support, and Children's Asthma

Madeleine U. Shalowitz, MD, MBAa,b, Tod Mijanovich, MPAc, Carolyn A. Berry, PhDc, Elizabeth Clark-Kauffman, MHSa, Kelly A. Quinn, MPHa and Elizabeth L. Perez, BAa

a Section for Child and Family Health Studies, Evanston Northwestern Healthcare, Evanston, Illinois
b Northwestern University, Feinberg School of Medicine, Chicago, Illinois
c Center for Health and Public Service Research, Robert F. Wagner Graduate School Of Public Service, New York University, New York, New York

OBJECTIVE. Recent national survey data indicate an overall asthma prevalence of 12.2% for children who are younger than 18 years. Previous research in clinical samples of children with asthma suggests that their mothers are at greater risk for symptoms of depression. We describe the relationship between maternal symptoms of depression and having a child with asthma in a community-based sample.

METHODS. After a school-based ascertainment of asthma and asthma symptoms in 15 low-income, racially/ethnically diverse public elementary schools, 1149 eligible mothers agreed to participate in a longitudinal study. Mothers either had a child with previously diagnosed asthma or a child with symptoms consistent with possible asthma or were in the randomly selected comparison group in which no child in the household had asthma. During the first interview, mothers responded to questions about their own life stressors, supports and mental health, and their children's health.

RESULTS. In bivariate analyses of a community-based sample of children who share low-income neighborhoods, mothers of children with diagnosed or with possible undiagnosed asthma had more symptoms of depression than did mothers of children who have no asthma. Mothers of children with diagnosed or with possible undiagnosed asthma also experienced more life stressors than did mothers of children without asthma. Using nested linear regression, we estimated a model of maternal symptoms of depression. Most of the variation in Center for Epidemiologic Studies–Depression score was accounted for by life stressors and social support. There were no independent effects of either asthma status or asthma status–specific child health status on maternal symptoms of depression.

CONCLUSION. Children who are under care for chronic conditions such as asthma live and manage their illness outside the clinical setting. Their social context matters, and maternal mental health is related to their children's physical health. Although having a child with asthma may be "just" another stressor in the mother's social context, complex treatment plans must be followed despite the many other pressures of neighborhood and family lives.

Key Words: asthma • stress • social support • maternal depression

Abbreviations: CES-D— Center for Epidemiologic Studies–Depression • CRISYS-R—Crisis in Family Systems–Revised • BPAS+—Brief Pediatric Asthma Screen Plus

Accepted Nov 21, 2005.




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