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Maternal Depressive Symptoms (maternal + depressive_symptom)
Selected AbstractsEffects of Maternal Depressive Symptoms and Infant Gender on the Interactions Between Mothers and Their Medically At-Risk InfantsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2008June Cho ABSTRACT Objective:, To examine the effects of maternal depressive symptoms and infant gender on interactions between mothers and medically at-risk infants. Design:, Longitudinal, descriptive secondary analysis. Setting:, Neonatal intensive care unit, intermediate care unit, and infectious disease clinic of the tertiary medical centers in the Southeast and East. Participants:, One hundred and eight preterm infants and their mothers, 67 medically fragile infants and their mothers, and 83 infants seropositive for HIV and their primary caregivers were studied in their homes between 6 and 24 months. Main Outcome Measures:, Observation and the Home Observation for Measurement of the Environment Inventory were used to assess the interactions of mothers and their medically at-risk infants. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results:, The level of depressive symptoms did not differ between the mothers of boys and mothers of girls in the three groups. Mothers of medically fragile infants had higher levels of depressive symptoms than mothers of preterm infants at 6 months corrected age and similar levels of depressive symptoms as HIV-positive mothers at 12 months. Mothers of medically fragile infants with elevated depressive symptoms were less attentive and more restrictive to their infants. HIV-positive mothers with elevated depressive symptoms were less attentive to their infants. The effects of gender on mother-infant interactions were not moderated by maternal depressive symptoms. Conclusion:, Maternal depressive symptoms had a somewhat negative effect on the interactions of mothers and medically at-risk infants. [source] Sustained withdrawal behavior in clinic-referred and nonreferred infantsINFANT MENTAL HEALTH JOURNAL, Issue 3 2006Daphna Dollberg To examine the relations between infants' sustained withdrawal behavior and children's mental health status and maternal and child relational behavior, 36 clinic-referred and 43 control infants were evaluated. Families were visited at home, mother-child free play and feeding interactions were videotaped, and mothers completed self-report measures. Interactions were coded for sustained withdrawal using the Alarm Distress Baby Scale (ADBB; Guedeney and Fermanian, 2001) and for global relational patterns with the Coding of Interactive Behavior (CIB; Feldman, 1998). Higher ADBB scores were found for the referred group, with many infants (38.9% ) scoring above the clinical cutoff (vs. 11.6% in the control group). More negative relational patterns were found for the withdrawn group in terms of higher maternal intrusiveness, lower reciprocity, and lower child involvement. Associations were found between maternal and child behavior during play and feeding and child sustained withdrawal behavior at play. Sustained withdrawal also was associated with unpredictable child temperament and lower sense of parental self-efficacy. Maternal depressive symptoms were higher in the referred group and correlated with maternal and child relational patterns. The findings contribute to the construct and discriminant validity of the CIB and the ADBB coding systems, and suggest that sustained withdrawal may serve as a risk indicator for early socioemotional disorders. [source] Effects of Maternal Depressive Symptoms and Infant Gender on the Interactions Between Mothers and Their Medically At-Risk InfantsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2008June Cho ABSTRACT Objective:, To examine the effects of maternal depressive symptoms and infant gender on interactions between mothers and medically at-risk infants. Design:, Longitudinal, descriptive secondary analysis. Setting:, Neonatal intensive care unit, intermediate care unit, and infectious disease clinic of the tertiary medical centers in the Southeast and East. Participants:, One hundred and eight preterm infants and their mothers, 67 medically fragile infants and their mothers, and 83 infants seropositive for HIV and their primary caregivers were studied in their homes between 6 and 24 months. Main Outcome Measures:, Observation and the Home Observation for Measurement of the Environment Inventory were used to assess the interactions of mothers and their medically at-risk infants. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results:, The level of depressive symptoms did not differ between the mothers of boys and mothers of girls in the three groups. Mothers of medically fragile infants had higher levels of depressive symptoms than mothers of preterm infants at 6 months corrected age and similar levels of depressive symptoms as HIV-positive mothers at 12 months. Mothers of medically fragile infants with elevated depressive symptoms were less attentive and more restrictive to their infants. HIV-positive mothers with elevated depressive symptoms were less attentive to their infants. The effects of gender on mother-infant interactions were not moderated by maternal depressive symptoms. Conclusion:, Maternal depressive symptoms had a somewhat negative effect on the interactions of mothers and medically at-risk infants. [source] Breastfeeding duration and postpartum psychological adjustment: Role of maternal attachment stylesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2008pek Akman Aim: Depressive and anxiety symptoms are common in new mothers. The aim of this study is to explore the link between postpartum psychological adjustment and feeding preferences of the mothers. Methods: Sixty mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened by the Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by the State-Trait Anxiety Inventory at 1 month postpartum. The Multidimensional Scale of Perceived Social Support was used for the assessment of maternal social support. The Adult Attachment Scale was used to determine the attachment style of the mother. Infants were examined and evaluated at 1 and 4 months of life. Results: All mothers started breastfeeding their infants postpartum; 91% and 68.1% continued exclusive breastfeeding at 1 and 4 months, respectively. The first-month median EPDS score of mothers who breastfeed at the fourth month was statistically significantly lower than those who were not breastfeeding (6 and 12, respectively) (P = 0001). The first-month median EPDS score of mothers with secure attachment was lower than the median score of mothers with insecure attachment (5 and 9, respectively) (P < 0001). Exclusive breastfeeding rate was not statistically different among mothers with secure and insecure attachment styles. The median state and trait anxiety scores and social support scores of mothers were not different between groups according to breastfeeding status. Conclusions: This study has shown an association between higher EPDS scores and breastfeeding cessation by 4 months after delivery. [source] Mothers' Violence Victimization and Child Behavior Problems: Examining the LinkAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2007Richard Thompson PhD The current study examined the link between parents' experience of violence victimization and child outcomes, in 197 mother-child dyads recruited from low-income urban neighborhoods. At recruitment (when children were between 6 and 18 months old), demographic factors, child behavioral outcomes, mother-child interactions, mothers' psychosocial functioning, and mothers' history of violence victimization were assessed. Child behavioral outcomes, mother-child interactions, and mothers' psychosocial functioning were assessed again at age 4. Mothers' history of victimization as children (but not as adults) uniquely predicted child behavior problems at age 4. Three classes of possible mediators were examined: demographics, maternal psychosocial functioning, and mother-child interactions. Of these, only mother psychological aggression toward child met preliminary criteria for mediation; it partially mediated the link between mother childhood victimization and child behavioral outcomes. Maternal depressive symptoms and young age at child's birth independently predicted child behavior problems, but did not act as mediators. Mothers' early experiences with violence victimization appear to exert an important influence on child behavioral outcomes; this influence appears to be mediated, in part, by mothers' psychological aggression toward their children. [source] Maternal depressive symptoms and adherence to therapy in inner-city children with AsthmaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2004Richard Reading Maternal depressive symptoms and adherence to therapy in inner-city children with Asthma . Bartlet, S.J., Krishnan, J.A., Riekert, K.A., Butz, A.M., Malveaux, F.J. & Rand, C.S. ( 2004 ) Pediatrics113 , 229 , 237 . Context Little is known about how depressive symptoms in mothers affects illness management in inner-city children with asthma. Objective The goal was to determine how maternal depressive symptoms influence child medication adherence, impact of the child's asthma on the mother, and maternal attitudes and beliefs. Methods Baseline and 6-month surveys were administered to 177 mothers of young minority children with asthma in inner-city Baltimore, MD and Washington, DC. Medication adherence, disruptiveness of asthma, and select attitudes toward illness and asthma therapy were measured. Six-month data (n = 158) were used to prospectively evaluate long-term symptom control and emergency department use. Independent variables included asthma morbidity, age, depressive symptoms and other psychosocial data. Results No difference in child asthma morbidity was observed between mothers high and low in depressive symptoms. However, mothers with high depressive symptoms reported significantly more problems with their child using inhalers properly [odds ratio (OR) 5.0, 95% confidence interval (CI) 1.3,18.9] and forgetting doses (OR 4.2, 95% CI 1.4,12.4). Depressive symptoms were also associated with greater emotional distress and interference with daily activities caused by the child's asthma, along with less confidence in asthma medications, ability to control asthma symptoms and self-efficacy to cope with acute asthma episodes. In addition, depressed mothers reported less understanding about their child's medications and use (OR 7.7, 95% CI 1.7,35.9). Baseline asthma morbidity, maternal depression scores and family income were independently associated with asthma symptoms 6 months later, whereas medication adherence was not predictive of subsequent asthma morbidity or emergency department use. Conclusions Maternal depressive symptoms were not associated with child asthma morbidity but were associated with a constellation of beliefs and attitudes that may significantly influence adherence to asthma medications and illness management. Identifying and addressing poor psychological adjustment in mothers is important when developing a child's asthma treatment and may facilitate parent,provider communication, medication adherence and asthma management among inner-city children. [source] Biological and environmental initial conditions shape the trajectories of cognitive and social-emotional development across the first years of lifeDEVELOPMENTAL SCIENCE, Issue 1 2009Ruth Feldman Human development is thought to evolve from the dynamic interchange of biological dispositions and environmental provisions; yet the effects of specific biological and environmental birth conditions on the trajectories of cognitive and social-emotional growth have rarely been studied. We observed 126 children at six time-points from birth to 5 years. Intelligence, maternal sensitivity, and child social engagement were repeatedly tested. Effects of neonatal vagal tone (VT) and maternal postpartum depressive symptoms on growth-rates were assessed. Cognitive development showed a substantial growth-spurt between 2 and 5 years and social engagement increased rapidly across the first year and more gradually thereafter. VT improved cognitive and social-emotional growth-rates across the first year, whereas maternal depressive symptoms interfered with growth from 2 to 5 years. Differences between infants with none, one, or two non-optimal birth conditions increased with age. Findings shed light on the dynamics of early development as it is shaped by biological and environmental initial conditions. [source] Depressive symptoms among mothers of children with epilepsy: A review of prevalence, associated factors, and impact on childrenEPILEPSIA, Issue 11 2009Mark A. Ferro Summary The impact of epilepsy is not limited to the child experiencing seizures, but affects all members of the family. As primary caregivers, mothers are particularly at risk for experiencing increased depressive symptoms and risk for clinical depression. The objective of this systematic review was to critically assess available evidence regarding the prevalence, associated factors, and impact of maternal depressive symptoms on child outcomes in epilepsy. Using a modified version of the Quality Index, studies were rigorously evaluated in terms of reporting, external validity, and internal validity. Limitations in the study designs and analytic techniques of previous research are discussed, and study methods to overcome these barriers are presented in order to advance this research area. Up to 50% of mothers of children with epilepsy are at risk for clinical depression. Correlates of maternal depressive symptoms include a number of modifiable risk factors such as role ambiguity, worry, and satisfaction with relationships. In addition, studies suggest that depressive symptoms in mothers have a negative impact on child outcomes in epilepsy including behavior problems and health-related quality of life. The overall mean score on the Quality Index was 9.7, indicating a midrange quality score, suggesting a need for more methodologically robust studies. [source] Six-week postpartum maternal depressive symptoms and 4-month mother,infant self- and interactive contingency,INFANT MENTAL HEALTH JOURNAL, Issue 5 2008Beatrice Beebe Associations of 6-week maternal depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D)] with 4-month mother,infant self- and interactive contingency patterns during face-to-face play were investigated in 132 dyads. Self- and interactive contingency (auto- and lagged cross-correlation, respectively) were assessed by multilevel time-series analysis. Infant and mother gaze, facial and vocal affect, touch, and spatial orientation behaviors were coded second-by-second from split-screen videotape, and a multimodal measure of facial,visual "engagement" was constructed, generating nine modality pairings. With higher CES-D, the self-contingency of both partners was lowered in most modalities. With higher CES-D, interactive contingency values were both heightened (in some modalities) and lowered (in others), varying by partner. These results are consistent with an optimal midrange model. With higher CES-D, interactive contingency showed the following patterns: (a) Mothers and their infants had a reciprocal orientational sensitivity; (b) mothers and infants manifested a reciprocal intermodal discordance in attention versus affect coordination, lowering gaze coordination, but heightening affective coordination; (c) infants heightened, but mothers lowered, touch coordination with partner touch,an "infant approach,mother withdraw" touch pattern. Nonlinear analyses indicated that altered self- and interactive contingency were similar at both the low ("denial") as well as the high ("endorsement") poles of depressive symptoms, in half the findings. These complex, multimodal findings define different aspects of communication disturbance, with relevance for therapeutic intervention. [source] Maternal Cohabitation and Child Well-Being Among Kindergarten ChildrenJOURNAL OF MARRIAGE AND FAMILY, Issue 1 2007Julie E. Artis Using data collected from 10,511 kindergarten children and their parents from the Early Childhood Longitudinal Study,Kindergarten Cohort, this study examines child well-being across cohabiting 2-biological-parent families; cohabiting stepfamilies; married stepfamilies; and married 2-biological-parent families. Findings indicate no differences in child well-being for children living in cohabiting stepfamilies and cohabiting 2-biological-parent families. Multivariate models controlling for child characteristics, economic resources, maternal depressive symptoms, stability, and parenting practices show no significant differences across family types in child well-being indicators, with the exception of reading skills. Important factors in explaining the link between cohabitation and child well-being include economic resources, maternal depressive symptoms, and parenting practices. [source] Effects of Maternal Depressive Symptoms and Infant Gender on the Interactions Between Mothers and Their Medically At-Risk InfantsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2008June Cho ABSTRACT Objective:, To examine the effects of maternal depressive symptoms and infant gender on interactions between mothers and medically at-risk infants. Design:, Longitudinal, descriptive secondary analysis. Setting:, Neonatal intensive care unit, intermediate care unit, and infectious disease clinic of the tertiary medical centers in the Southeast and East. Participants:, One hundred and eight preterm infants and their mothers, 67 medically fragile infants and their mothers, and 83 infants seropositive for HIV and their primary caregivers were studied in their homes between 6 and 24 months. Main Outcome Measures:, Observation and the Home Observation for Measurement of the Environment Inventory were used to assess the interactions of mothers and their medically at-risk infants. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results:, The level of depressive symptoms did not differ between the mothers of boys and mothers of girls in the three groups. Mothers of medically fragile infants had higher levels of depressive symptoms than mothers of preterm infants at 6 months corrected age and similar levels of depressive symptoms as HIV-positive mothers at 12 months. Mothers of medically fragile infants with elevated depressive symptoms were less attentive and more restrictive to their infants. HIV-positive mothers with elevated depressive symptoms were less attentive to their infants. The effects of gender on mother-infant interactions were not moderated by maternal depressive symptoms. Conclusion:, Maternal depressive symptoms had a somewhat negative effect on the interactions of mothers and medically at-risk infants. [source] Can pediatricians accurately identify maternal depression at well-child visits?PEDIATRICS INTERNATIONAL, Issue 2 2010Hiroki Mishina Abstract Background:, The feasibility of a two-item screening tool for maternal depression in a pediatric setting was recently reported. We assessed whether the accuracy of pediatrician recognition of maternal depression during the one-month well-child visit could be improved by an educational intervention using the two-item screening tool. Methods:, We conducted an educational intervention for pediatric residents in a suburban hospital in Tokyo, Japan, with outcome measurement before and after. Resident education included knowledge about postpartum depression and its impact on children, use of the two-item screening tool and available management strategies. Sixteen pediatric residents examined 267 mother,infant dyads during well-child visits. Residents documented the presence or absence of postpartum depressive symptoms on medical records. Depressive symptoms were also determined using the Edinburgh Postnatal Depression Scale (EPDS) survey; residents were not aware of the results. Using the EPDS as a "gold standard," improvement in sensitivity and specificity of resident recognition of maternal depressive symptoms was determined. Results:, The overall prevalence of postpartum depressive symptoms based on the EPDS was 15.4%. The sensitivity of resident recognition was 8% and specificity 98% before intervention, and 12% and 96% afterwards, respectively. The difference was not statistically significant. Residents indicated fear of maternal stigmatization and mothers' receptiveness to discussing depressive symptoms, as well as lack of time and skills, as major barriers to the identification of maternal depression. Conclusions:, A simple educational intervention using a two-item screening tool did not improve the pediatrician's accuracy in detecting depressive symptoms in mothers. Additional strategies to address perceived barriers may be needed. [source] The Course and Quality of Intimate Relationships Among Psychologically Distressed MothersAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 1 2010Lauren M. Papp The longitudinal course and quality of intimate relationships were tested in relation to maternal depressive symptoms in a sample of 1,275 families from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Assessments of mothers' intimate relationship status, intimate relationship quality, and depressive symptoms were obtained on 11 occasions from the birth of a child through age 15. Consistent with predictions, results from hierarchical linear models indicated that maternal depressive symptoms over time were associated with a lower probability of being married and lower levels of relationship quality. The strength of the association between relationship quality and depression was stronger than the linkage between relationship course and depression. Sociodemographic characteristics (e.g., mother age, child gender, ethnicity) were more predictive of trajectories of relationship course than relationship quality. Findings are discussed in terms of efforts to prevent and treat the longitudinal interplay between poor intimate relationship functioning and partners' psychopathology and its implications for the overall health and well-being of parents, couples, and children. [source] Life Events, Chronic Stressors, and Depressive Symptoms in Low-Income Urban Mothers With Asthmatic ChildrenPUBLIC HEALTH NURSING, Issue 4 2009Joan Kub ABSTRACT Objective: This secondary data analysis study examines the relationship between maternal sociodemographic variables, life events, chronic stressors, including asthma control and management and environmental stressors, and maternal depression. Design: Cross-sectional descriptive design study consisting of baseline data from participants enrolled in a randomized asthma communication educational intervention trial. Sample: 201 mothers of children with asthma (ages 6,12), recruited from community pediatric practices and emergency departments of 2 urban university hospitals. Measurement: Life events were measured using standardized items. Chronic stressors were measured using items from the International Asthma and Allergies in Childhood study and maternal and child exposure to violence. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression scale. Results: Close to 25% of the mothers had high depressive symptoms. In separate multiple logistic regression models, education (adjusted odds ratio [AOR]=2.62; 95% confidence interval [CI]=1.07, 6.39) or unemployment (AOR=2.38; 95% CI=1.16, 4.90) and the use of quick relief medications (AOR=2.74; 95% CI=1.33, 5.66) for asthma were positively associated with depressive symptoms. Conclusions: Implications include the need to assess maternal depressive symptoms of mothers of children with asthma, in order to improve asthma management for low-income urban children. [source] The influence of maternal and child characteristics and paternal support on interactions of mothers and their medically fragile infants,RESEARCH IN NURSING & HEALTH, Issue 1 2007Tzu-Ying Lee Abstract The influences of maternal characteristics, infant characteristics, and paternal support on maternal positive involvement and developmental stimulation were examined over time in 59 mothers and their medically fragile infants using an ecological framework. Higher maternal education was associated with greater maternal positive involvement. More maternal depressive symptoms, more infant technological dependence, and lower birthweights were associated with less maternal positive involvement at 6 months but greater involvement at 12 months. Higher paternal helpfulness facilitated positive involvement in mothers with low depressive symptoms but not in those with elevated symptoms. Higher maternal education and more depressive symptoms were associated with more developmental stimulation. Thus, maternal interactive behaviors are affected by maternal, infant, and environment factors, and these effects change over time. © 2007 Wiley Periodicals, Inc. Res Nurs Health 30: 17,30, 2007 [source] Depressive symptoms in mothers of pre-school children Effects of deprivation, social support, stress and neighbourhood social capitalCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2005Richard ReadingArticle first published online: 8 JUN 200 Depressive symptoms in mothers of pre-school children Effects of deprivation, social support, stress and neighbourhood social capital . MulvaneyC & KendrickD. . ( 2005 ) Social Psychiatry and Psychiatric Epidemiology , 40 , 202 , 208 . Background Depressive symptoms in mothers of young children can have serious consequences for the health of the child. In particular, children whose mothers are experiencing depressive symptoms are at significantly greater risk of poisoning and accidental injury. A mother's risk of developing depressive symptoms has been shown to be related to socio-economic disadvantage, high levels of stress and a perceived lack of social support. Residents who perceive their neighbourhoods to be of low social capital are more likely to report poor mental health. The aim of this study was to investigate the relationship between maternal depressive symptoms, deprivation, social support, stress and neighbourhood social capital in a group of mothers living in deprived areas of Nottingham, UK. Design and setting A postal questionnaire at entry to a randomized controlled trial (RCT) assessed socio-demographic characteristics and a second questionnaire, 21 months later, assessed depressive symptoms, perceived lack of social support, self-reported stress and individual-level assessment of neighbourhood social capital. Participants A total of 846 mothers of young children living in deprived areas in Nottingham, UK, enrolled in the control group of an RCT. Results One-third of mothers reported high levels of depressive symptoms. Neighbourhood-level deprivation and receiving means-tested benefits were independently associated with maternal depressive symptoms. A lack of social support and high levels of self-reported stress were also strongly associated with depressive symptoms. Individual-level assessment of neighbourhood social capital was not associated with depressive symptoms amongst mothers after adjusting for self-reported stress. Conclusions Neighbourhood- and individual-level variables of deprivation and psychological distress are more important than mothers' assessment of the social capital of the neighbourhood in which she lives in determining the risk of depressive symptoms. Interventions aimed at supporting mothers of young children may be more effective at reducing the risks of depressive symptoms and consequent risks to the child's health than interventions aimed at improving a neighbourhoods' social capital. [source] Maternal depressive symptoms and adherence to therapy in inner-city children with AsthmaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2004Richard Reading Maternal depressive symptoms and adherence to therapy in inner-city children with Asthma . Bartlet, S.J., Krishnan, J.A., Riekert, K.A., Butz, A.M., Malveaux, F.J. & Rand, C.S. ( 2004 ) Pediatrics113 , 229 , 237 . Context Little is known about how depressive symptoms in mothers affects illness management in inner-city children with asthma. Objective The goal was to determine how maternal depressive symptoms influence child medication adherence, impact of the child's asthma on the mother, and maternal attitudes and beliefs. Methods Baseline and 6-month surveys were administered to 177 mothers of young minority children with asthma in inner-city Baltimore, MD and Washington, DC. Medication adherence, disruptiveness of asthma, and select attitudes toward illness and asthma therapy were measured. Six-month data (n = 158) were used to prospectively evaluate long-term symptom control and emergency department use. Independent variables included asthma morbidity, age, depressive symptoms and other psychosocial data. Results No difference in child asthma morbidity was observed between mothers high and low in depressive symptoms. However, mothers with high depressive symptoms reported significantly more problems with their child using inhalers properly [odds ratio (OR) 5.0, 95% confidence interval (CI) 1.3,18.9] and forgetting doses (OR 4.2, 95% CI 1.4,12.4). Depressive symptoms were also associated with greater emotional distress and interference with daily activities caused by the child's asthma, along with less confidence in asthma medications, ability to control asthma symptoms and self-efficacy to cope with acute asthma episodes. In addition, depressed mothers reported less understanding about their child's medications and use (OR 7.7, 95% CI 1.7,35.9). Baseline asthma morbidity, maternal depression scores and family income were independently associated with asthma symptoms 6 months later, whereas medication adherence was not predictive of subsequent asthma morbidity or emergency department use. Conclusions Maternal depressive symptoms were not associated with child asthma morbidity but were associated with a constellation of beliefs and attitudes that may significantly influence adherence to asthma medications and illness management. Identifying and addressing poor psychological adjustment in mothers is important when developing a child's asthma treatment and may facilitate parent,provider communication, medication adherence and asthma management among inner-city children. [source] |