Bruce D. Miller

Influence of Specific Emotional States on Autonomic Reactivity and Pulmonary Function in Asthmatic Children

OBJECTIVE Research relating depression/hopelessness to cholinergic activation suggests the hypothesis that sad emotional states evoke patterns of autonomic reactivity that predispose to cholinergically mediated airway constriction in asthma. A corollary hypothesis is that positive (e.g., happy) emotional states evoke opposing effects. The purpose of the current study is to assess whether specific emotional states (sadness and happiness) can be reliably induced, physiologically differentiated, and related to asthma-relevant physiologic (autonomic) reactivity and pulmonary function in asthmatic children. METHOD Twenty-four children, aged 8 to 17 years, with moderate to severe asthma, viewed the movie E.T., The Extra-Terrestrial while having their heart and respiration rate and oxygen saturation continuously recorded. Specific scenes were identified and preselected to evoke sadness, happiness, and a mixture of happiness and sadness. Self-report of emotion and indices of physiologic response were analyzed for these targeted scenes. RESULTS Sadness was associated with greater heart rate variability and instability of oxygen saturation compared with happiness, with mixed results for mixed happiness and sadness. CONCLUSION Results support sadness as evoking patterns of autonomic influence consistent with cholinergically mediated airway constriction. Happiness appears to effect autonomic patterns that would tend to relieve airway constriction.

Depression and asthma: a potentially lethal mixture.

of death due to asthma: a national study. Am .I Epidemiol 1986;124:1004-11. IO. Sears MR, Rea HH, Rothwell RPG, et al. Asthma mortality: comparison between New Zealand and England. Br Med .I 1986;293: 1342-5. Il. Sears MR, Rea HH, Fenwick J, et al. Seventy-five deaths in asthmatics prescribed home nebulisers. Br Med J 1987;294: 477-80 12. Rea HH, Sears MR. Beaglehole R, et al. Lessons from the national asthma mortality study: circumstances surrounding death. NZ Med J 1987;100:10-13. 13. Rothwell RPG, Rea HH, Sears MR, et al. Lessons from the national asthma mortality study: deaths in hospitals. NZ Mcd J 1987;100:199-202. 14. Beaglehole R, Jackson R, Rea H, Sears M. Asthma mortality in New Zealand: a review with some policy implications. NZ Med J (in press). 15. Sears MR, Rea HH, Beaglehole R. Asthma mortality: a review of recent experience in New Zealand. J ALLERGY CLIN IMMUNOL (in press). 16. Strunk RC, Mrazek DA, Fuhrmann GSW, LaBrecque JF. Physiologic and psychological characteristics associated with deaths due to asthma in childhood. A case-controlled study. JAMA 1985;254:1193-8. 17. Sears MR, O’Donnell TV, Rea HH. Asthma mortality and socioeconomic status. NZ Med J 1985;98:765.

Psychophysiologic Reactivity in Asthmatic Children: A Cholinergically Mediated Confluence of Pathways

OBJECTIVE The purpose of this study was to determine the suitability of a newly developed experimental paradigm, designed to assess relationships among emotional responsivity, physiologic (autonomic) reactivity, airway reactivity, and pulmonary function in asthmatic children under controlled conditions of ecologically valid emotional stimulation. METHOD Twenty-four children, aged 8 through 17, with moderate to severe asthma viewed the movie, E.T., the Extra-Terrestrial, while having their heart and respiration rate and oxygen saturation continuously measured and recorded. Airway reactivity was assessed by the methacholine challenge test, and pre- and postmovie pulmonary function by spirometry. Self-report of emotion was recorded for targeted scenes. RESULTS Findings indicated that emotional responsivity and physiologic reactivity to the movie were associated with increased airway reactivity and with decreased pulmonary function. CONCLUSIONS The pattern of results suggests cholinergically mediated psychophysiologic pathways of emotional influence in the asthmatic process for some asthmatic children. A heuristic biopsychosocial model of these pathways is presented.

Maternal depression and parenting in relation to child internalizing symptoms and asthma disease activity.

This study tested a hypothesized model of the relationship between maternal depression and child psychological and physical dysfunction mediated by parenting and medication adherence. A sample of 242 children with asthma, aged 7 to 17, participated with their mothers. Maternal depression was assessed by self-report, and parenting was observed during family interaction tasks. Internalizing symptoms were assessed by self- and clinician reports. Asthma disease activity was assessed according to National Heart Lung and Blood Institute guidelines, and medication adherence was evaluated with a 24-hr recall method. Structural equation modeling indicated that negative parenting partially mediated the relationship between maternal depression and child internalizing symptoms. Child internalizing symptoms, in turn, mediated the associations between both maternal depression and negative parenting and asthma disease activity. Medication adherence did not mediate the link from maternal depression to disease activity. Thus, maternal depression was linked to child psychological dysfunction both directly and indirectly via negative parenting but linked to physical dysfunction only indirectly through psychological dysfunction. These findings suggest that diagnosing and treating depression in mothers of children with asthma would enhance child well-being both psychologically and physically.

Childhood asthma in interaction with family, school, and peer systems: a developmental model for primary care.

The developmental/biopsychosocial approach to primary care of childhood asthma offered in the above model emphasizes four interlocking features: 1. Consideration of the biologic, psychologic, and social aspects of asthma which interact with one another and influence disease management and psychosocial functioning and development of the asthmatic child 2. The importance of balance between disease management and quality of life and developmental needs of the patients and their families 3. Appreciation and facilitation of a developmentally synchronized shift toward self care of the asthma and its social and emotional aspects; 4. Central role played by the primary care provider (or health care team) in integrating developmental/biopsychosocial aspects of comprehensive treatment for childhood asthma.

Psychiatric Symptomatology and Disorders in Caregivers of Children With Asthma

OBJECTIVE. The prevalence of asthma and asthma-related mortality has increased in recent years. Data suggest an association between psychiatric symptoms in the caregiver and asthma-related hospitalizations in the child. We examined the prevalence of psychiatric symptoms and disorders and their relationship to asthma-related service utilization in caregivers of children hospitalized for asthma. PATIENTS AND METHODS. Caregivers (n = 175) were assessed during the child’s hospitalization. The number of asthma-related hospitalizations, emergency department visits, and unscheduled clinic visits in the past 12 months was obtained. The Brief Symptom Inventory, an assessment of psychiatric symptoms including somatic, anxiety, and depression subscales, and the Mini International Neuropsychiatric Interview, a structured clinical interview for psychiatric disorders, were administered. RESULTS. Mean age of the caregivers was 34.2 ± 7.3 years; 96.0% were women; 15.4% were white, 57.7% were black, and 26.3% were Hispanic. A total of 47.9% had incomes less than

Effects of paternal and maternal depressive symptoms on child internalizing symptoms and asthma disease activity: mediation by interparental negativity and parenting.

25000/year. Caregivers with clinically significant elevations in 2 or more Brief Symptom Inventory subscales reported more asthma-related child hospitalizations in the past 12 months than did caregivers with lower Brief Symptom Inventory scores. Asthma-related hospitalizations correlated with Brief Symptom Inventory total, somatic, anxiety, and depression subscale scores. Caregiver diagnosis of an anxiety disorder (n = 36) was associated with more asthma-related hospitalizations in the child. Children of caregivers with current depression (n = 44) had more unscheduled clinic visits than children of caregivers without depression. CONCLUSION. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–defined psychiatric disorders, particularly depressive disorders, were common in caregivers and associated with a greater frequency of asthma-related hospitalizations in the child.

Pilot study of effect of emotional stimuli on tic severity in children with Tourette's syndrome

This study tested a hypothesized model of the relationships among parental depressive symptoms, family process (interparental negativity and negative parenting behavior), child internalizing symptoms, and asthma disease activity. A total of 106 children with asthma, aged 7 to 17, participated with their fathers and mothers. Parental depressive symptoms were assessed by self-report. Interparental and parenting behaviors were observed and rated during family discussion tasks. Child internalizing symptoms were assessed by self-report and by clinician interview and rating. Asthma disease activity was assessed according to National Heart, Lung and Blood Institute guidelines. Results of structural equation modeling generally supported interparental negativity and negative parenting behavior as mediators linking parental depressive symptoms and child emotional and physical dysfunction. However, paternal and maternal depressive symptoms play their role through different pathways of negative family process. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Depressed children with asthma evidence increased airway resistance: “Vagal bias” as a mechanism?

To assess objectively the effects of emotional stimuli on the severity of tics and to determine if such effects were mediated by the autonomic nervous system, we carried out videotape ratings of tics and electrophysiological monitoring of heart beat and respiration on 4 children with Tourettes syndrome while they were watching a movie known to elicit emotional responses relevant to normal childhood events. Measured tic severity was highest during periods associated with anticipation, resolution of emotional changes, and lower concentration, lowest during periods of anger and happiness, and intermediate during periods of sadness and fear. Tic severity did not correlate with heart or respiratory rate. Thus, tics seem influenced differentially by various emotional states, but this effect does not seem to be autonomically mediated.

Pharmacologic management of anxiety disorders in children and adolescents.

BACKGROUND Depression is prevalent in pediatric asthma, and implicated in asthma morbidity and mortality. Pathways linking stress, depression, and asthma are unknown. OBJECTIVES To examine, under controlled laboratory conditions, pathways by which depressive states affect airway function via autonomic dysregulation. METHODS Participants were 171 children with asthma, age 7 to 17 years, presenting to an emergency department for asthma exacerbation. Forty-five children with asthma and high depressive symptoms (D) were contrasted with 45 with low/no depressive symptoms (ND). Depressive symptoms, asthma disease severity, vagal and sympathetic reactivity to film stressors, airflow (FEV1), and airway resistance were compared between the groups. A subgroup with greater airway reactivity (nonmedicated FEV1<80% predicted) was also studied. Correlations among variables were examined for the entire sample. RESULTS Groups did not differ in demographics, disease severity, medications, or adherence. The D group with FEV1<80% predicted showed greater airway resistance throughout all conditions (P = .03), and vagal bias in the film stressors. The D groups vagal response was significant for the sad stimuli: family distress/loss (P = .03), dying (P = .003), and death (P = .03). The ND group showed sympathetic activation to sad stimuli: lonely (P = .04) and dying (P = .04). Depressive symptoms were correlated with respiratory resistance (r = .43; P = .001) and vagal bias in scene 3 (r = .24; P = .03), and vagal bias (scene 3) was correlated with postmovie airway resistance (r = 0.39; P = .004). CONCLUSIONS Children with asthma and depressive symptoms manifest vagal bias when emotionally stressed. Those with depressive symptoms and FEV1<80% manifest greater airway resistance. Depression, vagal bias, and airway resistance were intercorrelated for the full sample.