母親的憂鬱惡化孩童的氣喘

作者：Janis C. Kelly  
出處：WebMD醫學新聞

　　November 24, 2009 — 首次有研究完整檢視母親憂鬱與其小孩氣喘之間的關係，結果發現母親的憂鬱會惡化其小孩的氣喘，而不是因為孩童氣喘而造成她們憂鬱。
　　
　　這項研究由南佛羅里達大學聖彼得堡分校的Michiko Otsuki博士在任職於約翰霍普金斯兒童中心之行為醫學研究員時，與約翰霍普金斯的同僚一同進行，研究結果線上發表於10月22日的兒科心理學期刊(Journal of Pediatric Psychology)。
　　
　　資深研究者、約翰霍普金斯順從性研究中心肺部與重症照護醫學組的Kristin A. Riekert博士向Medscape Psychiatry表示，他們對氣喘症狀無法預測母親的憂鬱症狀感到驚訝。
　　
　　Riekert博士指出，由於我們納入急診室症狀嚴重的孩童，前述結果在氣喘較不嚴重的孩童可能有所不同，不過，經常急診的孩童有較嚴重氣喘且使用較多健康照護資源，因此，注意這類孩童其母親的憂鬱症會有很大的影響。
　　
　　為Medscape Psychiatry回顧此篇研究的德州大學西南醫學中心精神科副教授E. Sherwood Brown博士表示同意。
　　
　　他表示，我發現資料相當有趣。研究者感到掙扎的問題是，母親憂鬱與孩童氣喘症狀和/或資源運用之間的影響方向，直覺上認為，氣喘惡化孩童的母親，可能因為疾病造成的壓力和照護上的負擔而發生憂鬱。
　　
　　Brown博士指出，不過，該研究認為此關係可能相當複雜，母親的憂鬱可能可以預測孩童氣喘症狀的嚴重度。這些發現認為，有效地介入處置母親的憂鬱可以改善孩童的氣喘症狀。
　　
　　【相互影響】
　　約翰霍普金斯研究者分析的資料來自一個隨機控制試驗的一部份，該試驗介入方式的目標是減少有氣喘高風險之貧民區孩童的急診使用率。研究者藉由每週回顧急診室紀錄來納入研究對象。
　　
　　研究者接著分析有氣喘小孩的262名非裔美國籍母親的訪問資料，檢驗以下4個假設：(1)相互影響模式：時間點1的母親憂鬱症狀和孩童氣喘發病率，可以同步預測後續的孩童氣喘發病率和母親的憂鬱症狀；(2)憂鬱症狀影響模式：母親的憂鬱症狀可以預測後續的孩童氣喘發病率；(3)氣喘發病率影響模式：孩童氣喘發病率可以預測後續的母親憂鬱症狀；(4) 虛無假設。
　　
　　在電話訪談中，使用刪節版、有11個問題的「Center for Epidemiological Studies Scale」量表來評估母親的憂鬱症狀。
　　
　　分析顯示，在這6個月的研究期間，憂鬱症狀比較頻繁母親的小孩，發生氣喘症狀的頻率較高，而憂鬱症狀較少母親的小孩，發生氣喘的頻率較少。不過，兒童的氣喘嚴重度未能預測母親的憂鬱症狀。這項發現認為，母親的憂鬱是孩童氣喘嚴重度的一個獨立風險因素。
　　
　　Riekert博士表示，即便我們的研究並非設定要測量母親的憂鬱程度多少才會增加其小孩的氣喘症狀，但出現的模式清楚顯示，後者(小孩的氣喘症狀)在前者(母親的憂鬱)之後發生。直覺地，我們面臨的似乎是「雞生蛋、蛋生雞」的問題，我們的研究認為不是，母親的憂鬱未受孩童氣喘症狀程度影響這個事實令我們措手不及，但是提出了哪個因素先發生的論點。
　　
　　【警訊】
　　研究者並未探討母親的憂鬱為何，以及如何影響孩童的氣喘狀態，但是因為憂鬱一般會出現疲倦、健忘、不容易專心，他們認為，這會影響父母親處理小孩慢性疾病的能力。
　　
　　Otsuki博士表示，母親必須執行醫師的治療和追蹤建議，如果她有憂鬱，可能就會做得沒那麼好，使得她的小孩比較會發病。
　　
　　研究者表示，他們的發現將促使小兒科醫師在治療氣喘孩童時，注意這些小孩的主要照護者、不論是否為母親，並在必要時為這些照護者提供轉診服務。
　　
　　共同研究者、約翰霍普金斯兒童中心的小兒氣喘專家Arlene Butz醫師表示，我們總是會問這些父母親是否有抽菸，現在或許是時候問他們有無情緒上的問題了。醫師被訓練要注意細微的線索，所以如果看到母親有警訊，必要時應為其轉診進行憂鬱篩檢。
　　
　　國家心臟、肺臟與血液研究中心資助本研究。Otsuki博士、Riekert博士、Brown博士與 Butz醫師皆宣告沒有相關財務關係。
　　
　　J Pediatr Psychol. 線上發表於2009年10月22日。


Maternal Depression Worsens Child's Asthma

By Janis C. Kelly
Medscape Medical News

November 24, 2009 — The first study to thoroughly examine the relationship between depression in mothers and asthma in their children found that a mother's depression can worsen, and is not the result of, her child's asthma.

The study, by Michiko Otsuki, PhD, from the University of South Florida in St. Petersburg, who was a behavioral medicine fellow at Johns Hopkins Children's Center in Baltimore, Maryland, at the time of the study, and colleagues from Johns Hopkins, was published online October 22 in the Journal of Pediatric Psychology.

Senior investigator Kristin A. Riekert, PhD, assistant professor and codirector of the Johns Hopkins Adherence Research Center, Division of Pulmonary Critical Care Medicine, told Medscape Psychiatry, they were surprised that asthma symptoms did not predict maternal depressive symptoms.

"Since we recruited children at a point of high symptoms during an emergency department visit, the results might have been different in children with less severe asthma," Dr. Riekert noted. "However, children with frequent emergency department visits have more severe asthma and use more healthcare, so paying attention to maternal depression with this population could make a big difference."

E. Sherwood Brown, MD, PhD, associate professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas, who reviewed the study for Medscape Psychiatry, agreed.

"I find the data very interesting," he said. "A question researchers struggle with is the direction of the relationship between maternal depression and childhood asthma symptoms and/or service utilization. It is intuitive to suggest that mothers of children with worsening asthma might get depressed due to stress from the illness and burden of care," he noted.

However, "this study suggests that the relationship may be more complex and that maternal depressive symptoms may predict the severity of the child's asthma symptoms," Dr. Brown added. "These findings suggest that effective interventions for the mother's depression could result in improvement in the child's asthma symptoms."

Reciprocal Effects

The Hopkins researchers analyzed data gathered as part of a randomized controlled trial of an intervention aimed at reducing emergency department use among high-risk inner-city children with asthma. Participants were recruited by weekly review of emergency department records.

The investigators then analyzed data from interviews with 262 mothers of African American children with asthma to test 4 hypotheses: (1) a "reciprocal effects" model in which maternal depressive symptoms and child asthma morbidity at time 1 would simultaneously predict subsequent child asthma morbidity and maternal depressive symptoms; (2) a "depressive symptoms effect model" in which maternal depressive symptoms would predict subsequent child asthma morbidity; (3) an "asthma morbidity effects model" in which child asthma morbidity would predict subsequent maternal depressive symptoms; and (4) the null hypothesis.

Maternal depressive symptoms were assessed by telephone using an abridged, 11-item version of the Center for Epidemiological Studies Scale.

The analysis showed that children whose mothers had more depressive symptoms had more frequent asthma symptoms during the 6 months of the study and that children whose mothers reported fewer depressive symptoms had less frequent asthma symptoms. The child's asthma severity did not predict later maternal depressive symptoms, however. This finding suggests that maternal depression is an independent risk factor for children's asthma severity.

"Even though our research was not set up to measure just how much a mom's depression increased the frequency of her child's symptoms, a clear pattern emerged in which the latter followed the earlier," Dr. Riekert said. "Intuitively, it may seem that we're dealing with a chicken-egg situation, but our study suggests otherwise. The fact that mom's depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first."

A Red Flag

The researchers did not study why and how a mother's depression affects a child's asthma status, but because depression often involves fatigue, memory lapses, and difficulty concentrating, they suggest that it might affect a parent's ability to manage the child's chronic condition.

"Mom is the one who must implement the doctor's recommendations for treatment and follow-up, and if she is depressed she can't do it well, so the child will suffer," said Dr. Otsuki.

The investigators say their findings should prompt pediatricians who treat children with asthma to pay close attention to the child's primary caregiver — whether or not it is the mother — and screen and refer them for treatment if needed.

"We ask these parents if they are smokers all the time, so maybe it's time to start asking them if they are coping well emotionally," said coinvestigator Arlene Butz, ScD, a pediatric asthma specialist at Johns Hopkins Children's Center. "Doctors are trained to pick up on subtle clues, so if they see a red flag in mom, they should follow up with a depression screener and referral if needed."

This study was funded by the National Heart, Lung, and Blood Institute. Dr. Otsuki, Dr. Riekert, Dr. Brown, and Dr. Butz have disclosed no relevant financial relationships.

J Pediatr Psychol. Published online October 22, 2009.