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Maternal Depressive Symptoms and Emergency Department Use Among Inner-city Children With Asthma
Susan J. Bartlett, PhD;
Kenneth Kolodner, ScD;
Arlene M. Butz, ScD;
Peyton Eggleston, MD;
Floyd J. Malveaux, MD, PhD;
Cynthia S. Rand, PhD
Arch Pediatr Adolesc Med. 2001;155:347-353.
Context Inner-city minority children with asthma use emergency departments (ED)
frequently.
Objective To examine whether maternal depressive symptoms are associated with
ED use.
Design, Setting, and Patients Baseline and 6-month surveys were administered to mothers of children
with asthma in inner-city Baltimore, Md, and Washington, DC.
Main Outcome Measures Use of the ED at 6-month follow-up was examined. Independent variables
included asthma morbidity, age, depressive symptoms, and other psychosocial
data.
Results Among mothers, nearly half reported significant levels of depressive
symptoms. There were no demographic or asthma-related differences between
the children of mothers with high and low depressive symptoms. However, in
bivariate analyses, mothers with high depressive symptoms were 40% (prevalence
ratio [PR], 1.4; 95% confidence interval [CI], 1.0-3.6; P = .04) more likely to report taking their child to the ED. Mothers
aged 30 to 35 years were more than twice as likely (PR, 2.2; 95% CI, 1.9-9.3; P = .001) to report ED use, as were children with high
morbidity (PR, 1.9; 95% CI, 1.4-7.1; P = .006). Child
age and family income were not predictive of ED use. After controlling for
asthma symptoms and mother's age, mothers with depressive symptoms were still
30% more likely to report ED use.
Conclusions Depression is common among inner-city mothers of children with asthma.
Beyond asthma morbidity, maternal age and depressive symptoms are strong predictors
of reports of ED visits. Identifying and addressing poor psychological adjustment
in mothers may reduce unnecessary ED visits and optimize asthma management
among inner-city children.
From the Departments of Medicine (Drs Bartlett, Kolodner, and Rand),
Pediatrics (Dr Butz) and Pediatric Allergy and Immunology (Dr Eggleston),
The Johns Hopkins University, Baltimore, Md; and College of Medicine, Howard
University, Washington, DC (Dr Malveaux).
Corresponding author and reprints: Susan J. Bartlett, PhD, The Johns
Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Cir, Suite 4B.32,
Baltimore, MD 21224 (e-mail: bartlett{at}jhmi.edu).
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