Novel study connects family stress to asthma exacerbation

September 3, 2019
Rachael Zimlich, RN, BSN

Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

Children who are in difficult family situations may have a particularly difficult time managing their asthma, according to a recent report.

The connection between mind and body are well known, but a study is now tying family stress to chronic illness-specifically asthma.

In a study published in Pediatrics, researchers in the department of at University of Illinois Medical Center, Principal Investigator Molly Martin, MD, MAPP, associate professor of pediatrics in the University of Illinois at Chicago (UIC) College of Medicine, and her team reveal that family chaos corresponded to worse asthma control, even when accounting for parent and child depression.

Much research has shown a link between psychosocial issues and child asthma control, says Sally Weinstein, PhD, associate director of the University of Illinois Center on Depression and Resilience and associate professor of Clinical Psychology the UIC College of Medicine and lead author of the report, but these links are not well understood.

“We do not have great answers to the questions of ‘why’ and ‘how’ this relationship exists,” Weinstein says. “Our aim was to address some of these gaps in the literature and our understanding of the health disparities that exist in pediatric asthma, particularly in low-income minority populations, by examining family chaos as a potential pathway that could explain the link between parent/child mental health and child asthma control.”

The study shows that there are many factors to asthma manifestation and control, she adds.

“Parent, child, and family factors all play a role in the etiology and maintenance of child asthma control,” says Weinstein. “Above and beyond the effects of parent and child depression, family chaos emerged as a robust influence on child asthma outcomes in an urban, high-risk population.”

The study is the first to suggest that family chaos was indeed a powerful mechanism linking parent depression and worse child asthma control in our high risk urban population, Weinstein adds.  

“Because it’s a first-of-its-kind study, this study offers a fresh perspective of exploring the psychosocial risk factors of asthma, and opens up the opportunity to equip front line providers such as pediatricians, community health workers, and parents and caregivers with guidance and a resource to develop and advance a collaborative system of care for asthma management,” she says.

Still, Weinstein says knowing the problem is the first step in finding a solution.

“Our findings offer a much-needed resource to more effectively control pediatric asthma in high risk populations-integrating behavioral interventions that can improve family chaos through developing family routines, structure, and organization, particularly around asthma management,” she says.

Asthma is a difficult condition to control, and this research could point the way to more effective treatment methods, she adds. Weinstein says while the findings of the study are novel, they were not all that surprising.

“Despite all our advances in treatment, child asthma prevalence and morbidity remains high. What was most compelling about this study was that focusing on the family can be key to improving child asthma,” Weinstein says. “As a child psychologist, I suppose that I’m not surprised that family functioning plays such a key role in child asthma outcomes, yet this is the first study to document this relationship. Our study is unique in exploring the mechanisms underlying well-documented-but not well-understood-relationships between psychosocial factors and child asthma control.”

Weinstein says the study highlights the importance of caring for the whole child, as well as their families.

“Our research underscores the importance of looking beyond symptoms in children with uncontrolled asthma to address the health and well-being of the child, caregiver, and the family,” she says. “Our findings suggest that assessing and addressing child and parent depression is critical for improving child asthma outcomes in high risk populations. Additionally, offering education and support on family structure, organizations, and routines in the household around asthma management may be particularly important tools for the healthcare provider.”

Pediatricians are a vital front line provider for not only children but their caregivers, Weinstein adds, and should include parents in some way in their routine assessments. “Including brief, low-burden assessments of parental well-being in routine child visits, followed by providing mental health resources and referrals to parents identified as higher risk, can offer an important gateway for parents to access their own mental healthcare,” Weinstein says. “Having a list of local resources for mental health treatment, with a few guidance points on what to ask for and what information may be needed to schedule an appointment, readily available for parents may help break down some of the barriers associated with accessing mental health resources can also be helpful.”

While this study focused only on pediatric asthma, Weinstein couldn’t say for certain whether family chaos may contribute to other chronic conditions in the pediatric population, as well.

“However, family routines and structure are important for child and family well-being, and that relationship becomes even more important when the family is confronted with the multiple daily tasks and challenges involved in managing a chronic health condition,” Weinstein explains. “Surprisingly few studies have examined the role of family chaos in pediatric chronic health conditions-one notable exception is a study from 2016 on family chaos and diabetes-and our findings certainly point to the importance of future research exploring the role of family chaos in other pediatric chronic conditions that require daily management.”