The relationship of caretaker anxiety to children's asthma morbidity and acute care utilization

Objectives. This study examined self-reported psychological distress in caretakers of inner-city children with asthma and examined its association to disease severity, as measured by day and night symptoms, and to acute care utilization for asthma. Method. We enrolled 193 English and Spanish-speaking caretakers (86% were mothers) of 2- to 12-year-olds who had at least one asthma hospitalization at a large urban medical center. They completed an interview asking about children's asthma symptoms and acute care utilization ( provider visits, emergency department visits, hospitalizations for asthma) and a 29-item psychiatric symptom inventory. National guidelines criteria were used to classify asthma severity into three categories based on caretaker report of day and night symptoms in the past 4 weeks. These were: moderate-severe persistent (37%), mild persistent (27%), and mild intermittent (35%) asthma. Results. Caretakers of children who were reported as having moderate-severe persistent asthma symptoms exhibited higher anxiety than caretakers reporting milder symptoms in their children, but symptom severity was unrelated to depression, anger, cognitive disturbance, or overall distress in caretakers. Three measures of acute care utilization in the last 6 months increased with reported symptom severity, but they were not associated with caretaker distress. Conclusions. Providers treating children with asthma should consider the potential importance of caretaker reports of daily symptoms both for the child's physical functioning and for parental anxiety.