Depression and family dysfunction have been implicated as factors complicating childhood asthma. Direct psychobiologic links have been proposed, but previous studies were limited by lack of integrative models and research methods capable of investigating specific pathways and mechanisms. Wood's 3iobehavioral Family Model (BBFM) proposes specific family relational patterns and child psychological """"""""processes which interact so as to influence physiological processes affecting physical disease in the child. Miller's Autonomic Nervous System (ANS) Dysregulation Model of Emotional Influence in Asthma proposes vagal bias as mediating the effect of depression on airway function. A hypothalamic-pituitary-adrenal (HPA)-immune mechanism is also postulated. The proposed project integrates these two conceptual models to test a family-depression-airway pathway. ? ? A controlled laboratory protocol will be used to elicit family interaction in synchrony with physiological measures. Structural Equation Modeling will assess the primary hypotheses: 1)Negative family emotional climate, parental conflict, triangulation of child in conflict predict depression/hopelessness in the child; 2) The family-depression effect is moderated by parent-child relationship security; 3) Depression predicts airway compromise, which is mediated by vagal bias and/or hypo-HPA function. Children with asthma (N= 320, age 7-12; about 60% boys) and their families will be recruited from the Emergency Department at Children's Hospital of Buffalo. Four weeks later they will have a clinical asthma evaluation and participate in Wood's Family Problem Solving Interaction Tasks (FPSIT). Throughout the protocol, cardio-impedance methods will be used to measure sympathetic and vagal branches of ANS function to index vagal bias in the child. Salivary cortisol response will examine a possible (HPA) pathway. Pulmonary function tests will assess airway compromise. Family interactions will be rated using a reliable and valid instrument (SCIFF). ? Questionnaires and interview will provide convergent data. This work will lay the foundation for controlled intervention studies, ultimately leading to the reduction of morbidity and mortality in childhood asthma. It will also fill a gap in understanding relationships between family patterns of relationship and the co-morbid conditions of emotional disorder and physical disease. ? ? ?
