A chaotic household is a household in which there is a lot of disorderly behaviour and noise. This makes relaxation impossible and often leads to stress and anxiety. Studies have associated chaotic households with anxiety and depressive disorders in children and adults.
A new study has shown that children in minority groups living in urban areas often experience worsening asthma symptoms when living in chaotic households. The study, entitled “Family Chaos and Asthma Control”, was published in the latest issue of Pediatrics.
Sally Weinstein, Associate Professor of Clinical Psychiatry at the University of Illinois at Chicago College of Medicine and Associate Director of the University of Illinois Center on Depression and Resilience, led the study. She explained: “Higher levels of chaos – including lack of organization or fixed routines – seem to be a way to combine parental depression and poorer asthma control in children.
The team found that urban minority youth are more likely to suffer from asthma and also have poorer asthma control and an increased risk of dying from asthma than the general population. The researchers add that there are several studies that link environmental factors and drugs to asthma. This study combines psychosocial environmental factors and asthma.
Depression and anxiety disorders in children are associated with worse asthma outcomes and also with more use of life-saving appliances due to exacerbations. Parental depression and family conflicts have also been associated with worsening asthma in children, the team wrote.
This study focused on the interaction between the child and its family members and how they functioned, and attempted to assess its association with the worsening of asthma. Their study was aimed at urban children and minority adolescents with uncontrolled asthma. The team defined uncontrolled asthma as asthma with excessive symptoms and frequent exacerbations requiring the use of life-saving equipment.
The team included 223 children between the ages of 5 and 16 years and assessed whether they or one or both of their parents suffered from depression and post-traumatic stress disorder or PTSD symptoms. They also reviewed asthma control in these participants. This was part of a longitudinal study (called the Erie study) in which asthma control was improved by asthma action, which was educational measures for asthma control.
Each of the participants was contacted to diagnose depression or PTSD or family chaos in the children before beginning the study. Asthma control was monitored over the duration of the study using the asthma control test. This test is a standardized evaluation technique for detecting asthma severity and symptoms in children. Each family was asked to indicate the number of days on which a child was incapable of asthma symptoms in the last two weeks. The team evaluated the family chaos using a 15 point questionnaire. There were questions like “No matter how hard we try, we always seem to be late”, “We can usually find things when we need them”, “We always seem to be in a hurry”, or “Our home is a good place to relax”, etc.
The results showed that both the depressive symptoms of the parents and the children were associated with a worsening of asthma control. However, the symptoms of PTSD were not associated with poorer asthma control. Larger levels of family chaos were associated with poorer asthma control, the researchers found. Parental and child depression factors were controlled and then the effects of family chaos in children were assessed. The link between family chaos and asthma worsening persisted even after such adjustment.
The authors write: “Emotional triggers of asthma have also mediated the relationship between parents and depression and asthma”.
Weinstein said: “If one parent is depressed, it is more difficult to keep the family routine running smoothly, and it is also more difficult to cope with the daily demands of caring for their child’s asthma, which may require multiple medications and avoiding triggers”. She added: “We have seen that in families with greater household chaos the control of asthma in children tended to be worse. The authors of the letter conclude: “The treatment of depression in parents and children, family routines and predictability can optimize asthma outcomes”.
Principal investigator of the study, Dr. Molly Martin, Associate Professor of Pediatrics at UIC College of Medicine, in a statement said: “Our results show the role of family chaos in poorer asthma outcomes for children in these families. Pediatricians and asthma specialists should consider and treat parents and children for depression and help optimize household routines to improve asthma control in children.
This study was supported by the National Heart, Lung, and Blood Institute.