ASTHMA: DIAGNOSIS AND MANAGEMENT |
Maternal Depressive Symptoms and Emergency Department Use Among Inner-City Children with Asthma
Boston, MA
Purpose of the Study. Inner-city minority children with asthma use emergency departments (EDs) frequently. This study examines whether maternal depressive symptoms are associated with this increased ED use.
Study Population. Children in kindergarten to fifth grade from inner-city schools in Baltimore and Washington, DC, were eligible for enrollment in the study. Children from these schools were eligible if they had an asthma diagnosis listed on their health records and their mothers reported that they had 1) asthma diagnosed by a physician, 2) day or night asthma symptoms, including wheezing, shortness of breath, and/or a cough at least once a week during the past 2 weeks, and/or 3) at least 1 visit for asthma to the ED in the previous 6 months or 1 overnight hospitalization for asthma in the previous year. Ninety-eight percent of the children were African American. One hundred fifty-eight of 338 respondents participated in both the baseline and follow-up surveys.
Methods. Telephone surveys were conducted at baseline and 6 months to evaluate ED use relative to child and maternal measures. The primary outcome measure was the number of ED visits (that did not result in hospitalization) reported by the mother between the baseline and 6-month follow-up interview. Independent variables evaluated included asthma morbidity, maternal age, maternal depressive symptoms (as measured by the Center for Epidemiologic Studies–Depression Scale), and other psychosocial data.
Results. Among mothers, nearly half reported significant levels of depressive symptoms. There were no demographic or asthma-related differences between the children of mothers with high and low depressive symptoms. However, in bivariate analyses, mothers with high depressive symptoms were 40% (prevalence ratio [PR]: 1.4; 95% confidence interval [CI]: 1.0–3.6; P = .04) more likely to report taking their child to the ED. Mothers aged 30 to 35 years were more than twice as likely (PR: 2.2; 95% CI: 1.9–9.3; P = .001) to report ED use, as were children with high morbidity (PR: 1.9; 95% CI: 1.4–7.1; P = .006). Child age and family income were not predictive of ED use. After controlling for asthma symptoms and mother’s age, mothers with depressive symptoms were still 30% more likely to report ED use.
Conclusions. Depression is common among inner-city mothers of children with asthma. Beyond asthma morbidity, maternal age and depressive symptoms are strong predictors of reports of ED visits. Identifying and addressing poor psychological adjustment in mothers may reduce unnecessary ED visits and optimize asthma management among inner-city children.
Reviewers’ Comments. As our understanding of the pathophysiology of asthma improves and as more maintenance medications for asthma become available, most children with asthma should be able to be managed in an outpatient setting with few hospital admissions and ED visits. However, as this study once again demonstrates, we must always evaluate children with chronic illnesses in the context of their social settings. At-risk children who are seen frequently in EDs must be identified, evaluated, and followed by multidisciplinary teams, including social workers and psychologists. Only by addressing those issues that decrease adherence with medication regimens and increase ED visits and morbidity will we be successful in providing the highest quality of care to these children and, in the long run, reducing costs.
REFERENCES
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Bartlett SJ, Kolodner K, Butz AM, Eggleston P, Malveaux FJ, Rand CS.
Arch Pediatr Adolesc Med.2001; 155
:347
–353
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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