Mental, social health of caregivers associated with wheeze outcomes in preschoolers
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Key takeaways:
- The children of caregivers with the lowest mental and social health had more frequent wheeze.
- These caregivers also had the poorest quality of life and marked disparities in social determinants of health.
Poor mental and social health among caregivers of preschoolers with wheeze was associated with more symptoms and wheezing among those children, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
Routine assessment of the mental and social health of these caregivers may improve outcomes among their children, Anne M. Fitzpatrick, PhD, professor, department of pediatrics, Emory University, and colleagues wrote in the study.
The study enrolled 129 female caregivers aged 18 to 50 years and their children, who were aged 12 to 59 months and had recurrent wheeze.
The researchers assessed each child via the Child Symptom Questionnaire and the Test for Respiratory and Asthma Control in Kids (TRACK) at baseline and at 6 months. Total serum IgE and blood eosinophil counts were assessed as well.
The caregivers completed demographic and medical history questionnaires and validated patient-reported outcome measures of social and mental health, also at baseline and at 6 months. Caregivers were then categorized into three clusters.
The low-risk group had the highest life satisfaction, meaning and purpose, and emotional support as well as the lowest social isolation, depression, anger and perceived stress.
The group with moderate risk had intermediate scores for each of these measures except for perceived stress and anxiety, which were higher than those found in the low-risk group.
The high-risk group had the lowest life satisfaction, meaning and purpose, and emotional support and the highest social isolation, depression, anger, perceived stress and anxiety.
Racial distributions, medical histories, educational attainment, household incomes and other household features were similar between the low-risk and moderate-risk caregivers at baseline, although caregivers in the moderate-risk group were more likely to be Hispanic.
The high-risk group had more Hispanic caregivers and fewer white caregivers compared with the other groups, as well as lower educational attainment, more children in the home, greater household tobacco smoke exposure, and poorer quality of life related to their child’s asthma.
The demographic characteristics, medical histories, controller medications, daycare attendance and allergic features were similar among the children of the low-risk and moderate-risk groups at baseline.
However, the risks for previous ICU admission for wheeze and for sensitization to more aeroallergens were significantly higher among the high-risk group, who had more respiratory symptoms triggered by tobacco smoke or allergens as well.
Specifically, 7.9% of the low-risk group, 16.1% of the intermediate-risk group and 30.3% of the high-risk group were allergic to dog dander (P = .043). Similarly, percentages included 2.6%, 5.4% and 30.3% for cat dander (P < .001) and 2.6%, 7.1% and 30.3% for cockroach (P < .001) among the low-, intermediate- and high-risk groups.
Numbers of respiratory symptoms in the previous week included 2.68 ± 3.96 for the low-risk group, 2.84 ± 4.49 for the intermediate group and 4.2 ± 4.28 for the high-risk group (P = .041). However, the researchers said that respiratory and asthma control scores did not differ significantly between the groups.
At 6 months, the high-risk caregivers continued to experience worse life satisfaction, meaning and purpose, and emotional support as well as higher social isolation, depression, anger, perceived stress and anxiety.
By repeating the cluster analysis, the researchers found that 80% of the low-risk group and 75% of both the intermediate-risk and high-risk groups were correctly reassigned to their groups, confirming the stability of the original clusters.
The follow-up at 6 months additionally found that the caregivers who originally were in the high-risk group continued to report significantly poorer quality of life related to their child’s asthma, which in turn was associated with lower general life satisfaction, higher social isolation and higher perceived stress.
Meanwhile, the children in the high-risk group continued to have more frequent respiratory symptoms, which were associated with poorer quality of life among their caregivers as well.
Lower scores on the TRACK questionnaire indicating worse asthma control were associated with higher scores on the Child Symptom Questionnaire, also indicating worse asthma (r = –0.492; P < .001) and lower quality of life among caregivers (r = 0.465; P < .001) as well.
At 6 months, approximately 53% of the preschoolers had experienced one significant wheezing episode, with a significantly higher percentage of children with a wheezing episode in the high-risk group. The preschoolers in the high-risk cluster also were significantly less likely to see an outpatient physician to manage this wheezing.
Based on these findings, the researchers concluded that there were associations between differences in measures of mental and social health among caregivers and the quality of life among those caregivers and wheezing outcomes among their preschool-age children.
The researchers also suggested that these findings indicate opportunities to provide interventions for caregivers that will improve their quality of life as well as respiratory-related outcomes among the children while eliminating health inequities.
More effective tools, strategies and procedures, the researchers continued, are needed to educate families about wheezing in this age group.
Perspective
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As a marriage and family therapist, I have been clinically trained to utilize a systems perspective in patient care. Therefore, as I read through this study, I focused on various systems and factors impacting the outcomes.
First, I focused on the parent-child subsystem. The developmental stage of the children in this study is significant to its findings, since during this stage of life, children rely on their caregivers to effectively manage their overall well-being.
Therefore, it makes sense that children of caregivers who are not able to adequately manage their own mental health and well-being, either by choice or due to lack of support or accessibility, might experience worse asthma and respiratory-related outcomes.
Next, I explored the findings through a biopsychosocial lens. Determinants of health — specifically genetics, behavior, environmental and physical influences, medical care, and social factors — impacted these results. The fact that caregivers in the high-risk category were found to have the lowest life satisfaction, meaning, purpose and emotional support, and the highest rates of social isolation, perceived stress and anxiety, illustrates the importance of curiously exploring patients’ biological, psychological and social systems, as information about all these systems helps providers develop workable asthma management plans.
Finally, I explored these findings while considering Maslow’s Hierarchy of Needs. Developed by psychologist Abraham Maslow, this psychological theory explains how human behavior is based on human needs and the importance of each need in relation to human functioning.
Maslow asserts that until one’s basic needs are met, specifically having access to food, water, shelter, rest, safety and security, one will not be able to satisfy their other needs, including the ability to love, belong, experience healthy positive self-regard, and reach their highest potential.
While these needs do not have to be met in a particular order, if someone’s basic needs are not met, much of their energy will be spent meeting them, as they are foundational factors of quality-of-life perceptions.
Exploring this study’s findings using Maslow’s theory helps further explain why children of caregivers in the high-risk category had poorer respiratory outcomes. When caregivers are focused on satisfying their family’s basic needs, especially if they lack accessibility to accurate health information, medical care, and affordable interventions and treatments, caregiver burden levels will be higher.
Therefore, basic needs-related stressors are important for health care providers to understand and address to help high-risk patients find workable approaches to effective asthma management.
The data from this study offers a compelling argument for utilizing a biopsychosocial approach to patient care and incorporating caregiver check-ins during pediatric appointments to proactively identify needs and interventions.
Additionally, asthma and respiratory-related education must be made easily accessible to caregivers, and it must be written for various health literacy levels so it can be effectively digested and utilized.
Finally, licensed mental health professionals can help high-risk patients learn effective coping skills, as well as stress and anxiety management strategies such as mindfulness and breathwork, all of which have positive impacts on mental health and asthma management.
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