Background
There is increasing evidence that maternal depressive symptoms are high among poor women who have children with chronic diseases such as asthma. The purpose of this pilot is to provide preliminary evidence on the extent to which pediatricians identify and refer depressed mothers of children with asthma to mental health treatment and the extent to which a screening and referral intervention for maternal depression increases the number of depressed mothers of children with persistent asthma to seek mental health care.
Pediatric asthma remains a significant public health problem. Puerto Ricans emerge as having high lifetime asthma prevalence, compared to other ethnic groups in the United States (Cohen et al., 2007; Loyo-Berrios et al., 2006). Epidemiological studies of mainland Latinos and island Puerto Ricans have demonstrated high rates of depressive symptoms among these populations (Alegría et al., 2008). Specifically, mothers of children with chronic diseases seem to have more risk depression symptoms as compared to the general population (Flynn et al., 2004; Silver, Warman & Stein, 2005). However, less than half of depressed Latina women self-identify as being depressed or are identified as such by their health professional precluding the possibility of referral for treatment (Chaudron et al., 2002; Olson, Kemper et al., 2002). The association between maternal mental health problems and poor asthma outcomes has been reported across different populations, including low income, inner-city families (Barlett et al., 2001), and Island Puerto Rican families (Ortega et al., 2004). Symptoms of maternal depression have been linked to higher levels of health care utilization for pediatric asthma patients, including higher rates of hospitalization (Weil et al., 1999), poor caregiver outcomes and poor asthma-related quality of life (Kaugart, Klinner & Bender, 2004; Shalowitz et al., 2006).
The use of short screening surveys for depression symptoms in clinics have shown to successfully result in depressed mothers being identified and referred to mental health treatment (Olson et al., 2005; 2006). The proposed screening and referral intervention (MIRAS) is designed to increase the identification and referral of depressed mothers of children with persistent asthma within primary care, pediatric clinics that serve mostly low-income Puerto Rican children. The MIRAS involves screening for depression using standardized screening scales, providing feedback to the pediatricians about the results of the screening, as well as facilitating the referral process for mothers with high symptoms of depression. The purpose of the study is to determine the extent to which pediatricians in two clinics identify, treat and refer depressed mothers of children with asthma for mental health treatment, as well as evaluate the feasibility and effectiveness of the MIRAS in significantly increasing the identification and mental health referral.
The MIRAS study will be implemented and tested in one large primary care clinic serving mostly poor children with asthma. Results of the intervention will be compared with a similar clinic in which the program will not be implemented. There will be a total of 70 subjects (35 subjects for the control clinic and 35 for the experimental clinic).