Neglect, Adherence and Depression in Asthmatic Children

哮喘儿童的忽视、依从和抑郁

• 批准号: 6881356
• 负责人: MARIANNE CELANO
• 金额: $ 25.82万
• 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 2007-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6881356
• 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.

鉴于他们的发病率增加以及对哮喘的复杂，长期治疗方案，低收入的城市儿童遭受了忽视的不利影响。通过忽视儿童调整的影响，忽视可能直接通过治疗不遵守或间接导致哮喘控制不良。 这项研究的主要目的是研究如何在家庭系统特性方面具体定义的忽视与横截面和纵向与哮喘儿童的不依从性有关。 第二个目的是研究忽视和儿童与初级护理人员的相关性与儿童抑郁症状的横截面和纵向相关。 该样本将是160名低收入儿童（6-11岁），持续的哮喘及其主要护理人员是在城市医院公立医院的初级保健和紧急步入式诊所招募的。 将直接通过观察，电子监测或实验室测试直接评估粘附行为（使用吸入的抗炎药，MDI/间隔技术，暴露于烟草烟雾）。 抑郁症状将由儿童和照顾者报告评估。 根据生物行为家庭模型（BBFM）的概念化，因为低照顾者接近，看护者的反应性低以及宽松/不一致的护理人员纪律。 参与者将在家庭访问期间和一年后（T2）进行实验室访问期间进行措施。 基于由BBFM改编的概念模型，假设指出：（1）依从性差会通过对哮喘，高度忽视，更高水平的儿童抑郁症状的知识水平较低来预测，以及与初级护理人员的感知相关性的不安全模式，而忽视会导致忽视的显着增长。 （2）抑郁症状将通过高水平的忽视和相关性的不安全模式来预测，相关性调节了忽视与抑郁症状之间的关系。