Asthma is the most common chronic condition affecting children in the United States. The disease is responsible for both considerable morbidity in children and high levels of medical care resource consumption. For example, estimates show that asthma affects approximately 4.4 million children and accounts for 2.9 million visits to pediatricians each year. While asthma is a prevalent pediatric disease, it imposes a disproportionate burden on minority children, particularly Puerto Rican children. Studies have demonstrated that Latino children have worse asthma morbidity, poorer medication management, and more unnecessary emergency care use compared to majority children.


The literature points to several possible explanations for Latino children’s excess asthma burden. These factors include genetic, environmental, family health beliefs and disparities in health care use. Importantly, the literature has also suggested that co morbid psychiatric problems, particularly anxiety and depression in caregivers and anxiety in children, could be responsible for a significant portion of the excess asthma morbidity.


Unfortunately, the associations between asthma and psychiatric problems are relatively understudied. Some clinical studies have observed associations between anxiety and depression in both youth and caregivers and asthma in youth, but little is known about these associations. The studies that have examined these relationships have been limited in a variety of ways including reliance on clinical samples, cross-sectional studies (limiting conclusions about directionality), non-standardized measures of psychiatric disorders, non-rigorous methods for determining asthma morbidity or severity, and little attention to risk and protective factors of the relationships. This study uses standardized, valid measures of asthma and psychiatric disorders and symptoms and examines certain risk and protective factors for the associations. Moreover, this study builds upon two waves of recently collected data as part of an island-wide study of the prevalence of psychiatric disorders and mental health utilization patterns of Puerto Rican youth (U01 MH5482701).


  • Aim 1: The prevalence of anxiety and depression as well as their co-occurrence with asthma and asthma severity in Puerto Rican youth.
  • Aim 2: The relationship between caregivers’ anxiety and depression and their perceptions of the presence and severity of asthma in their children/adolescents.
  • Aim 3: The relationship of caregiver and child/adolescent anxiety and depression to the perceived self-efficacy of managing asthma and actual management and prevention strategies.
  • Aim 4: The effects of psychosocial stressors, parental worry and child/adolescent’s psychopathology on caregivers’ and youths’ perceived self-efficacy to manage asthma.
  • Aim 5: The association of child/adolescent psychosocial stressors and caregiver psychosocial stress to the longitudinal development of threshold and sub-threshold anxiety and depressive disorders in youth with asthma.


Funding Acknowledgement

NIH: 5R01MH69849-3



  • Alexander Ortega, Ph.D – Principal Investigator
  • Glorisa Canino, Ph.D. – Co-Principal Investigator



  • Ortega AN, Goodwin RD, McQuaid EL, Canino G (2004) Parental mental health, childhood psychiatric disorders, and asthma attacks in island Puerto Rican youth. Ambulatory Pediatrics 4(4):55-62.
  • Ortega AN, McQuaid EL, Canino G, Goodwin R, Fritz GK (2004) Comorbidity of asthma and anxiety and depression in Puerto Rican children. Psychosomatics 45:93-99.



  • Diagnostic Interview Schedule for Children (DISC) parental report and child self report
  • Diagnostic Interview Schedule for Young Adult (DISC-IV) parental report and youth self report
  • Composite International Diagnostic Interview (CIDI).
  • Parent Interviewer Children’s Global Assessment Scale (PIS-GAS)
  • Child Behavior Checklist (CBCL)
  • Traumatic Experiences Questionnaire (TEQ))
  • Family functioning (APGAR)
  • Body Mass Index
  • Physical activity
  • Childhood Asthma Severity Scale (CHAS)
  • Asthma Assessment Form
  • Parent Asthma Self-Efficacy Scale
  • Child Asthma Self-Efficacy Scale
  • Asthma Quality of life


Other Measures

  • Pulmonary function testing and tests for broncho-reversibility
  • Allergy skin testing