Maternal Depressive Symptoms, Lung Function, and Severe Asthma Exacerbations in Puerto Rican Children.

ABSTRACT Background Maternal depression has been linked to healthcare use for asthma in cross-sectional or short-term follow-up studies of school-aged children. Objective To examine whether increased or persistent maternal depressive symptoms over ∼5 years are associated with severe asthma exacerbations or worse lung function in youth. Methods Prospective study of 386 youth living in Puerto Rico, aged 6-14 years at a baseline visit and 9-20 years at a second visit. Our exposure of interest was change in or persistence of maternal depressive symptoms, assessed at both visits using the Center for Epidemiologic Studies Depression Scale (CESD-D). Our outcomes of interest were change in percent predicted FEV1 and FEV1/FVC between the first and second visits in all subjects, and ≥1 severe asthma exacerbation in the year prior to the second visit in subjects with asthma. Results In a multivariable analysis, each one-point increment in the CESD score was associated with decrements of 0.15% in percent predicted FEV1 (95% CI=-0.28% to -0.01%; P= 0.03) and 0.10% in percent predicted FEV1/FVC (95% CI=-0.20% to 0.001%; P= 0.05) between visits, as well as with 1.03 times increased odds of ≥1 severe asthma exacerbation at the second visit (95% CI for odds ratio=0.99 to 1.06, P= 0.09). In a multivariable analysis, the presence of maternal depressive symptoms (a CESD score ≥21 points) at the second visit or at both visits was significantly associated with 3.17 to 3.52 times increased odds of ≥1 severe asthma exacerbation in the year prior to the second visit. Conclusions Increasing or persistent maternal depressive symptoms over ∼5 years are associated with worse lung function measures and severe asthma exacerbations among Puerto Rican youth, a high-risk population.