An application of the Biobehavioral Family Model: Examining the impact of maternal depression on child asthma mediated by insecure attachment and child depression

Objective: Child asthma disparities are prevalent in socio-economically stressed single-parent families. Stress impacts childhood asthma mediated by immune and autonomic pathways, but specific family stress pathways are not well established. This study tests the hypothesis, derived from a version of the Biobehavioral Family Model, that single parent maternal depression impacts child asthma mediated by insecure attachment and child depression. Methods: In a cross-sectional study, children with asthma (age 7–17 years old) from a socio-economically disadvantaged population and their single parent mothers (N = 202) were assessed for depression and attachment security. Child asthma disease activity was assessed by symptom report and lung function tests. Structural equation modeling (SEM) was used to test a model in which caregiver depression impacts child asthma disease activity mediated by insecure attachment and child depression. Results: SEM results indicated that maternal depression statistically predicted child depression (β = 0.21, p < 0.01) and insecure mother–child attachment (β = 0.17, p < 0.05). In addition, insecure attachment statistically predicted child depression (β = 0.50, p < 0.001). Child depression mediated the adverse effects of maternal depression and insecure attachment on child asthma disease activity (β = 0.43, p < 0.01). There was no direct effect of insecure attachment on child asthma. Conclusion: In single-parent families, maternal depression may impact child asthma disease activity, mediated serially by insecure attachment and child depression. Longitudinal and/or intervention studies are needed to establish a causal effect. These findings suggest that caregiver depression and parent–child relationships may be important targets for family intervention. These interventions may help improve child asthma outcomes and reduce health disparities.