The longitudinal relationship between parental reports of asthma and anxiety and depression symptoms among two groups of Puerto Rican youth☆
Introduction
Asthma is the most prevalent chronic illness in childhood [1]. As a chronic, life-threatening condition, asthma can affect youths' psychological adjustment. Cross-sectional associations between asthma and depression [2], [3], anxiety [3], [4], [5], [6], [7], [8], [9], [10], and combined measures of depression and anxiety [11], [12] have been reported in children and adults, with more severe asthma predicting more internalizing problems [11]. However, to our knowledge, no longitudinal examinations have examined the influence of asthma on trajectories of depression and anxiety in young adolescents. How asthma relates to change in depression and anxiety over time during early adolescence, a period characterized by increases in internalizing symptoms [13], [14], remains unknown.
Asthma is more prevalent among ethnic minorities, who are disproportionately affected by risk factors for asthma including poverty, limited access to health care, and exposure to hazardous environments [15]. Puerto Ricans in particular have the highest prevalence of asthma of all ethnic/racial groups in the US, with rates ranging from 22% to 30% on the mainland [16], [17], [18], [19], [20] and 32% to 41% on the island [21], [22], [23]. Among Puerto Ricans, having asthma has been consistently associated with depression, but inconsistently related to anxiety [24], [25], [26], [27].
In addition to having higher rates of asthma, Puerto Ricans tend to report higher rates of other chronic illnesses than other ethnic groups [27]. These chronic conditions, in turn, are related to internalizing disorders [27]. Whether having asthma represents a unique risk for Puerto Rican youths' anxiety and depression above and beyond the risks that other medical conditions represent is unknown. We address this question by adjusting for youths' comorbid medical conditions.
Even though it is known that asthma does not affect all ethnic/racial groups equally, only a few studies have examined how the sociocultural context in which individuals live and ethnic minority status affect asthma prevalence and morbidity [17], [28], [29]. Associations between asthma and trajectories of anxiety and depression might be different for youth living in contexts where they are part of the dominant group (i.e., children living in their country of origin) versus those living in contexts where they are not part of the dominant group and therefore represent a statistical minority (i.e., ethnic minorities). In this paper, we will refer to this concept of living in a context where your sociocultural conditions are not those of the statistical majority as being in a ‘minority context’. Youth living in minority contexts are likely to be exposed to different stressors and social environments than those living in a context where they represent the majority group. Specifically, children developing in minority contexts experience stressors associated with their relative social disadvantage such as neighborhood disadvantage, community violence, and discrimination [30]. Exposure to such stressors may in turn intensify the relationship between asthma and internalizing symptoms. To our knowledge, no studies have compared how the association between asthma and trajectories of internalizing symptoms might differ depending on the sociocultural context that defines minority vs. non-minority status for a given high-risk ethnic group, adjusting for socioeconomic status (SES).
We attempt to address this dearth of knowledge using data from a longitudinal study of Puerto Ricans in two contexts: one in which they are part of the dominant group, Puerto Rico (PR), and one in which they are the statistical minority, in New York (NY) [31]. We test associations between youths' asthma and their depression and anxiety symptoms over time, determine if these associations are independent of comorbid medical conditions, and examine if the associations vary depending on minority context, after adjusting for SES. We hypothesized (1) that parent-reported asthma would be related to higher overall levels of depression and anxiety symptoms, and to greater increases of depression and anxiety symptoms over time; (2) that these relationships would hold after adjusting for comorbid medical conditions; and (3) that these associations would be stronger among Puerto Rican youth living in a minority context (NY).
Section snippets
Sample
Data are from a longitudinal study of Puerto Rican youth living in the Standard Metropolitan Areas of San Juan and Caguas, Puerto Rico and in the South Bronx, New York. Both samples were multistage probability samples that represent the target areas based on the 1990 U.S. Census. Household eligibility criteria included the presence of a child aged 5 to 13 and both the child and a primary caregiver had to self-identify as Puerto Rican. Up to three randomly selected children were included per
Descriptive findings
Table 1 (bottom) shows the descriptive statistics for the main predictor and outcome variables. IA was more prevalent in PR (n = 209, weighted percent = 34%) than in NY (n = 112, weighted percent = 23%), but PA was higher in NY (n = 80, weighted percent = 16%) than in PR (n = 44, weighted percent = 7%). The mean levels of depression and anxiety decreased over time and were higher for youth in NY than in PR.
Depression
Table 2 shows the results from multilevel models of the association between parental reports of asthma
Discussion
Using three waves of data on two groups of Puerto Rican youth, one in Puerto Rico and one in New York, we found three main results: (1) rates of persistent asthma were higher in NY (16%) than in PR (7%), but rates of intermittent asthma were higher in PR (34%) compared to NY (23%); (2) both persistent and intermittent asthma were related to anxiety and depression in NY, but not in PR; and (3) associations between asthma and anxiety and depression in NY remained significant after adjusting for
Conflict of interest
The authors have no competing interests to report.
Acknowledgments
This study was supported by award number F31HD063473 from the National Institute of Child Health & Human Development to the first author and by the National Institute of Mental Health award number RO1 MH56401 to Dr. Bird. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health.
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This work was conducted at the Department of Psychology of New York University and the Child Study Center of the NYU Langone Medical Center.