Asthma is the leading chronic disease of childhood. Asthma attacks may be precipitated or maintained by psychosocial factors. Asthma also has a significant impact on the psychosocial adjustment of children and their families.
The specific aim of the proposed study is to examine changes in psychosocial morbidity over time in asthmatic children and their families who use the emergency department as the primary source of their health care. In addition, the study will provide unique information about the effect of a psychosocial intervention on multiple indicators of psychosocial morbidity in this high risk population. Improvement in disease-specific health and global function will also be evaluated, as well as the impact of the interventions on health services utilization. The proposed research is a prospective randomized, controlled study. Two hundred twenty subjects will be solicited from the population of children from 5 to 17 years of age inclusive who frequent the emergency department for acute care of asthma (two or more visits during the preceding twelve months). Informed consent will be obtained from eligible subjects who will be enrolled at the time of presentation to the emergency department for acute asthma care. Subjects will be randomly assigned to either the structured psychosocial intervention group (n = 110) or to the control group (n = 110). The psychosocial intervention incorporating two widely disseminated techniques, stress inoculation and patient activation, will be delivered in four sessions by trained patient family managers in the subjects' homes during the first two months following enrollment. The control group will receive usual care. Pre-intervention baseline data will be collected at the time of enrollment after randomization. The following major operational variables will be assessed at scheduled intervals during a two year follow-up: anxiety and depressive symptoms in child and parent, number of school absences, family dysfunction, health locus of control, peak expiratory flow rate (an index of control of the disease), number of asthma attacks and number of emergency department visits. Data on a variety of secondary outcome variables will be collected as well. The proposed intervention would be particularly appealing for rural areas where trained nurses or social workers could supplement scarce physician health care providers. In addition to improving mental health, disease-specific health and global function for the child and family, this intervention could result in improved health care coordination and a significant reduction in health care expenditures by increasing appropriate utilization of health services.
