The Impact of Caregiver Depression on Child Asthma Outcomes: Pathways and Mechanisms

Edson S Brown, Jayme M. Palka, Heather K. Lehman, Alexandra Kulikova, David A Khan, Josseline Lopez, Anna Antony, Donna Persaud, Jasmin A Tiro, Elena I. Ivleva, Alyson K Nakamura, Zena Patel, Traci Holmes, Quratulain Humayun, Tressa Lloyd, Karen Allen, Savitoj Kaur, M. Seth Owitz, Ray J. Pak, Kevin G. ZablonskiMichael S. Adragna, Raymond Chankalal, Beatrice L. Wood, Bruce D. Miller

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Depression is common in caregivers of children with asthma and is associated with poor outcomes in their child. No prior studies have longitudinally examined caregiver depression remission as a predictor of improvement in child asthma control. Objective: This 2-site study examined whether the proportion of time a caregiver was in depression remission predicted subsequent child asthma control at exit. Method: Caregivers (n = 205) with current major depressive disorder and their children, ages 7 to 17, with persistent asthma were observed every 4 weeks for 52 weeks. Caregiver depressive symptoms were measured using the 17-item Hamilton Rating Scale for Depression (HRSD). Child asthma was assessed with the (Childhood) Asthma Control Test (cACT/ACT) and spirometry, and depression with the Children's Depression Inventory (CDI). Linear regression analyses were conducted with change in cACT/ACT, CDI, and forced expiratory volume in 1 second (FEV1)% predicted as outcomes and proportion of time the caregiver was in remission (HRSD score ≤ 7) as the predictor. Multilevel mediation analyses examined the role of child depressive symptoms and asthma controller medication adherence. Results: Children were, on average, 54.1% female and 11 years old. Caregiver proportion of time in HRSD-assessed remission of depression was a significant predictor of improvement in cACT/ACT, CDI, and FEV1% predicted. Child CDI score, but not medication adherence, mediated the relationship between caregiver HRSD scores and child asthma control scores. Conclusions: Improvement in caregiver depression positively influences child asthma outcomes partially through improvement in child depressive symptom severity. Caregiver depression screening and treatment might lead to improvement in child asthma outcomes.

Original languageEnglish (US)
Pages (from-to)200-209
Number of pages10
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number1
StatePublished - Jan 2023


  • Adherence
  • Asthma
  • Caregiver
  • Depression
  • Longitudinal
  • Mediators
  • Mood

ASJC Scopus subject areas

  • Immunology and Allergy


Dive into the research topics of 'The Impact of Caregiver Depression on Child Asthma Outcomes: Pathways and Mechanisms'. Together they form a unique fingerprint.

Cite this