Childhood Asthma and Parental Antidepressant Use Seem Linked
—A nationwide cohort study from Denmark found that having a child with asthma increased the prevalence of antidepressant use by parents and caregivers—and that this antidepressant use was associated with poor asthma control independent of socioeconomic status.
Previous studies have shown that mothers of children with asthma are more likely to have symptoms of anxiety and depression than moms of healthy children.1
Conversely, a nationwide cohort study of families in Denmark found that children of parents with mental health conditions were more likely to have asthma than children of parents without these conditions.2 In this analysis, disadvantaged socioeconomic status (SES) was associated with an additional increase in the incidence of asthma in children of a mother with mental health conditions, particularly if the condition was severe.
“However, the extent to which lower SES and parental mental health independently contribute to children’s asthma burden, particularly in universal healthcare systems, has not yet been well elucidated,” Cabrera Guerrero and colleagues wrote in a new report published in the Journal of Asthma and Allergy.3 In the new study, the investigators analyzed the association of parental antidepressant use with childhood asthma outcomes and potential predictors, including SES factors. This study, too, was conducted in a nationwide cohort in Denmark.
How the study was designed
The study cohort data was obtained from Statistics Denmark, the National Patient Registry, and the Danish National Prescription Database.3 Asthma was defined as the redemption of 2 or more canisters of inhaled corticosteroids (ICS) in 2015. Children ages 2 to 17 years old with actively treated asthma were identified from the nationwide REASSESS Youth cohort. Caregivers were adults residing with children on the redemption date. Data collection began with the first ICS redemption and continued for 730 days.
Families were matched 1:1 based on the number of biological and nonbiological siblings, maternal age, disposable income, highest family education level, and size of their city of residence.
Asthma severity was determined using medication redemption data in relation to the Global Initiative for Asthma 2020 treatment steps.4 Uncontrolled asthma was defined as twice the acceptable frequency of short-acting β2 agonist use based on the number of redemptions in 2015.4 In the new study, a redemption of ≥37.5 mg of prednisolone for 5 days defined a moderate exacerbation, while hospitalization defined a severe exacerbation.3
Caregivers were classified as having depression if they redeemed more than 1 prescription antidepressant after the child’s birth. SES variables were work status, receipt of welfare, residence location, disposable income estimate, and highest family education level.
Asthma factors and caregiver antidepressant use
The investigators identified 28,595 children with asthma and their families, matched 1:1 to control children and families. A total of 59% of each group were boys. Of the children with asthma, 4.8% had possible severe asthma, 16% had uncontrolled asthma, 6% had at least 1 severe exacerbation, and 2% had at least 1 moderate exacerbation.
Caregiver antidepressant use was significantly higher in families with a child with asthma. In 17% of these families, 1 or both parents had an antidepressant prescription, compared with 14% of control families (P < .001). The odds ratio (OR) of caregiver antidepressant use was 1.29 (95% confidence interval [CI] 1.23 to 1.35) compared with that of control families and included both maternal and paternal antidepressant use. Twelve percent of mothers in asthma case families used antidepressants, compared with 9.3% of mothers of control families (P < .001). For fathers, 6.2% used antidepressants in asthma case families, versus 5.3% in control families (P < .001).
Relative to control families, families with a child with uncontrolled asthma had higher odds of caregiver antidepressant use (OR 1.43, 95% CI 1.31 to 1.56). However, families with a child with controlled asthma also had higher odds of caregiver antidepressant use (OR 1.26, 95% CI 1.20 to 1.33).
Mild-to-moderate asthma was associated with higher odds of caregiver antidepressant use (OR 1.30, 95% CI 1.24 to 1.37) relative to control families. Possible severe asthma, however, was not associated with increased antidepressant use among caregivers (OR 0.99, 95% CI 0.84 to 1.16).
What effect do socioeconomic factors have?
SES factors were associated with caregiver antidepressant use among families with a child with asthma. Compared with high school education, vocational education (OR 0.92, 95% CI 0.85 to 0.99; P = .036) and higher education (OR 0.85, 95% CI 0.78 to 0.92; P < .001) were associated with reduced odds of caregiver antidepressant use.
Higher disposable income was also protective. The third quartile (OR 0.62, 95% CI 0.57 to 0.67; P < .001) and fourth quartile (OR 0.43, 95% CI 0.39 to 0.47; P < .001) of disposable income was also associated with lower odds of caregiver antidepressant use relative to the first and second quartiles. On the other hand, receiving welfare payments nearly doubled the odds of caregiver antidepressant use relative to being employed (OR 1.90, 95% CI 1.73 to 2.08; P < .001).
The investigators also analyzed asthma outcomes after controlling for SES factors to assess whether outcomes were independent of SES. This analysis showed that the odds of poor asthma control were higher in children of caregivers who used antidepressants relative to children of caregivers who did not (OR 1.10, 95% CI 1.01 to 1.20).
Surprisingly, after controlling for SES, the odds of possible severe asthma were lower in families with a caregiver who used antidepressants compared with those who did not use antidepressants (OR 0.76, 95% CI 0.65 to 0.89).
Limitations and conclusions
The results of this large cohort study support those of previous studies showing an increased prevalence of depressive symptoms in parents of children with asthma. In addition, “this is the first study to show a positive association between caregiver depression and childhood actively treated asthma, using medication retrieval rather than symptom questionnaires, independent of socioeconomic status in a large nationwide cohort,” Cabrera Guerrero and colleagues wrote.3
Limitations of the study were its observational design, possible missing asthma cases for patients who were not treated with ICS, exclusion of parental depression cases treated with nonpharmacologic therapies, and data collection of only 2 years.
Nevertheless, could treating caregiver depression affect asthma control in children? Yes, say the results of another recent study, which reported a positive association between the length of remission of caregiver depression and child asthma control.5
As such, Cabrera Guerrero and colleagues suggested that their results and those of previous studies “identify the necessity of addressing parental needs in the clinical management of childhood asthma, which is likely not addressed during caregivers’ medical visits.”3
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