175 - Social needs, caregiver depression, and child asthma control

Publication Number: 175.6647

Rachel H.F.. Margolis, Children's National Health System, Washington, DC, United States; Emma Straton, Children's National Hospital, Washington, DC, United States; Samuel Indresano, Children's National Health System, Washington, DC, United States; Shayla Stringfield, IMPACT DC, Children’s National Hospital, Washington, DC, United States; Shilpa J.. Patel, Children's National Health System, Washington, DC, United States

Background: Asthma prevalence and morbidity disproportionately affect children living in urban and disinvested communities, where limited resources and caregiver mental health problems contribute to health inequities. Social needs and caregiver depressive symptoms are prevalent and independently associated with poor child asthma outcomes; however, little is known about their combined effects.

Objective: To evaluate the added effect of caregiver depression on asthma control among children aged 4-17 years in the context of social needs.

Design/Methods: We conducted a retrospective, cross-sectional analysis of children evaluated between 6/1/23 and 4/15/24 at an urban asthma clinic providing care to children with frequent emergency department visits for asthma. Children and caregiver dyads were included if the caregiver completed the clinic’s social needs and PHQ depression screening tools. Social needs were dichotomized (0 vs. ≥1). Caregivers with PHQ-2 scores ≥2 completed the PHQ-9 which were dichotomized into clinically significant depressive symptoms (PHQ-9 ≥10 vs. < 10). Dyads were then categorized into three groups: 1) No social needs, no caregiver depression; 2) social needs, no caregiver depression; 3) social needs and caregiver depression. Kruskal Wallis and post-hoc Mann-Whitney U tests (adjusted for multiple comparisons using the Bonferroni correction) were used to compare Asthma Control Test (ACT) scores by group.

Results: Of 390 caregivers completing both tools, 7 (1.9%) reported depression without social needs, leaving 383 dyads for analysis. Most children (Mean age=8.0±3.4 years; 55.3% male) had persistent asthma (86.3%). Caregivers (Mean age=36.8±8.9 years) were primarily female (92.5%), self-identified as Black (87%), and reported an annual household income of <$30,000 (52.8%). 61.1% requested assistance with ≥1 social need, and 7.3% screened positive for clinically significant depressive symptoms. There was a significant difference in ACT scores across the three groups (χ2(2)=19.35, p< 0.001; Figure 1). Post-hoc tests indicated that ACT scores were significantly higher in Groups 1 than 2 (U=10504.0, p< 0.001) and in Groups 1 than 3 (U=1212.5, p=0.002; see Figure 1).

Conclusion(s): Social needs alone and combined with caregiver depression were associated with lower ACT scores than children with neither. Addressing social needs and caregiver mental health in the context of pediatric asthma care may improve outcomes and promote health equity.

Figure 1. Child Asthma Control by Group
IQR=Interquartile range; ACT=Asthma Control Test