Researchers Funded to Study Links Between Depression and Asthma

Results of this study could revolutionize the treatment of child asthma, leading to comprehensive, family-based and more effective treatment modalities. 

Studies have shown that children with asthma are at higher risk for depression, and research also has shown an association between a parent or caregiver’s depression and worsening symptoms in an asthmatic child.

Bruce D. Miller, MD, and Beatrice L. Wood, PhD, both professors of psychiatry and pediatrics, are principal investigators on the grant and note “we are hypothesizing that an improvement in the caregiver’s depression will lead to a subsequent improvement in the child’s asthma.”

Miller and Wood have been working together on factors that affect asthma in children for more than 20 years.

“We have continuously found associations between emotional stress and worsening asthma and that family relational stress plays a key role,” Wood says.

Early in his career, Miller developed a model for how depression affects the autonomic nervous system, which is responsible for involuntary neural processes affecting the airways.

He found that depression in asthmatic children alters their autonomic nervous system function, causing their already reactive airways to become even more dysregulated, resulting in worse airway function under stressful conditions. These seminal findings were published in the Journal of Allergy and Clinical Immunology in 2009.

Wood’s research has demonstrated how family relationship patterns impact physical and emotional illness in children. A 2011 research paper co-authored by Wood and Miller showed that depression among parents of children with asthma was associated with negative parenting and also predicted child depression and worsening asthma.

The new research translates findings from their previous NIH-funded child asthma research into a two-site treatment intervention study.

Two hundred families will be recruited for the study through Women and Children’s Hospital of Buffalo (WCHOB) and University of Texas Southwestern Medical Center in Dallas.

The study will involve screening caregivers of children with asthma for depression. Those who meet criteria for clinical depression will be offered antidepressant medication. The child’s asthma treatment plan will not be altered in order to determine the effect of treating caregiver depression to benefit the child’s asthma.

Both caregiver and child will be followed monthly for a year to see if improvements in the caregiver’s depression are followed by improvement in the child’s asthma.

The new study also builds on a previous pilot study conducted by E. Sherwood Brown, MD, PhD, professor of psychiatry at UT Southwestern Medical Center, that suggested a connection between caregiver depression and worsening asthma in children.

Brown, who is also principal investigator on the current study, found children who had been hospitalized with asthma improved when their parents, who screened positive for depression, were treated with antidepressants, even though the child’s asthma treatment was not changed.

“When the parents’ depression got better, the children’s asthma got better,” Miller says.

The purpose of the current study is to confirm those findings and better understand the underlying mechanisms.

“If a caregiver is depressed he or she may be less able to carry out the care of a child, especially a fragile child who is vulnerable with illness,” Miller explains. “They may not be able to manage the child’s medications or get the child to the doctor when necessary.”

“At the same time,” says Wood, “our previous studies have shown that depression in the parent cascades into negative parent-child relationships, child depression and worse asthma.” She notes that Miller’s 2009 study showed that depression in the child has a direct physiological effect on the child’s asthma.

The researchers say the findings may also eventually reduce health disparities in child asthma because there is a higher percentage of depressed caregivers among children with asthma from minority and socio-economically disadvantaged groups.

Heather K. Lehman, MD, clinical associate professor of pediatrics in the Division of Allergy/Immunology and Rheumatology, is a co-investigator on the grant. She has been working with Miller and Wood for several years and is developing a collaborative research program to continue studies examining the interplay between depression and child asthma.

The current study is being funded through the National Heart, Lung and Blood Institute; National Institute of Mental Health; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Miller and Wood are founders and co-directors of the Center for Child and Family Asthma Studies at WCHOB. Miller sees patients through UBMD Psychiatry. Lehman sees patients through UBMD Pediatrics.