Neglect, Adherence and Depression in Asthmatic Children

哮喘儿童的忽视、依从和抑郁

• 批准号: 6539126
• 负责人: MARIANNE CELANO
• 金额: $ 28.71万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-05-20 至 2006-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6539126
• 关键词: African American; asthma; attention; behavior test; caregivers; child abuse; child behavior; clinical research; depression; disease /disorder prevention /control; dyadic interaction; family structure /dynamics; human subject; interview; longitudinal human study; low socioeconomic status; middle childhood (6-11); outcomes research; patient care management; pediatrics; psychometrics; respiratory disease /disorder therapy; respiratory disorder epidemiology; therapy compliance; urban area; urinalysis

Low-income, urban children with asthma are vulnerable to the adverse impact of neglect, given their increased morbidity and the complex, long-term treatment regimens for asthma. Neglect may lead to poor asthma control directly via treatment nonadherence, or indirectly, via the effect of neglect on children's adjustment. The primary aim of this study is to examine how neglect, defined specifically in terms of family systems properties, is related cross-sectionally and longitudinally to treatment nonadherence for children with asthma. The secondary aim is to investigate how neglect and children's perceived relatedness with the primary caregiver are cross-sectionally and longitudinally related to children's depressive symptoms. The sample will be 160 low-income children (ages 6 -11) with persistent asthma and their primary caregivers, recruited from primary care and emergency walk-in clinics in a public, urban hospital. Adherence behaviors (use of inhaled anti-inflammatory agents, MDI/spacer technique, exposure to tobacco smoke) will be assessed directly via observation, electronic monitoring, or lab test. Depressive symptoms will be assessed by child and caregiver report. Neglect is conceptualized, according to the Biobehavioral Family Model (BBFM), as low caregiver proximity, low caregiver responsivity, and lax/inconsistent caregiver discipline. Participants will be administered measures during a home visit and a lab visit at enrollment (T1) and one year later (T2). Based on a conceptual model adapted from the BBFM, hypotheses state that: (1) poor adherence will be predicted by low levels of knowledge about asthma, high levels of neglect, greater levels of child depressive symptoms, and an insecure pattern of perceived relatedness with the primary caregiver, with neglect contributing a significant increment in the variance above that accounted for by knowledge; and (2) depressive symptoms will be predicted by high levels of neglect and an insecure pattern of relatedness, with relatedness moderating the relationship between neglect and depressive symptoms.

低收入城市患有哮喘的儿童很容易受到忽视的不利影响，因为他们的发病率不断上升，而且哮喘的长期治疗方案也很复杂。忽视可能会通过治疗不依从直接导致哮喘控制不佳，或者通过忽视对儿童适应的影响而间接导致哮喘控制不佳。 本研究的主要目的是探讨忽视（根据家庭系统特性具体定义）与哮喘儿童治疗不依从性之间的横向和纵向关系。 第二个目的是调查忽视以及儿童与主要照顾者的感知关联性与儿童抑郁症状的横向和纵向关系。 样本将是 160 名患有持续性哮喘的低收入儿童（6 -11 岁）及其主要照顾者，这些儿童是从公立城市医院的初级保健和急诊诊所招募的。 依从行为（使用吸入抗炎剂、MDI/间隔技术、接触烟草烟雾）将通过观察、电子监测或实验室测试直接评估。 抑郁症状将根据儿童和看护者的报告进行评估。 根据生物行为家庭模型 (BBFM)，忽视被概念化为护理人员亲近度低、护理人员响应度低以及护理人员纪律松懈/不一致。 参与者将在入学时 (T1​​) 和一年后 (T2) 进行家访和实验室访问期间接受措施。 基于改编自 BBFM 的概念模型，假设指出：(1) 依从性差将由哮喘知识水平低、忽视程度高、儿童抑郁症状程度高以及感知到与哮喘相关的不安全模式来预测。主要照顾者，忽视导致方差显着增加，高于知识所解释的方差； （2）抑郁症状将通过高度忽视和不安全的关联模式来预测，而关联性会调节忽视和抑郁症状之间的关系。