Breath by Proxy: Caregiver Distress Affects Childhood Asthma Maintenance

Traumatology | 2025, Vol. 31, No. 1, pp. 1-8.

The Association Between Polyvictimization and Asthma Among Children and Youth in Ontario

Shannon L. Stewart - interRAI Lab, Faculty of Education, The University of Western Ontario

Natalia Lapshina - interRAI Lab, Faculty of Education, The University of Western Ontario

Valbona Semovski - interRAI Lab, Faculty of Education, The University of Western Ontario

Abigail Withers - interRAI Lab, Faculty of Education, The University of Western Ontario

Objective: To evaluate the co-occurrence of polyvictimization (i.e., two or more different types of traumas), socioeconomic factors, caregiver distress, and asthma among Canadian children and youth living in Ontario, Canada.

Method: Retrospective data collected from 9,942 children and youth (Mage = 12.32, SDage = 3.56) between 4 and 18 years of age, who completed the interRAI Child and Youth Mental Health assessment from mental health agencies, were analyzed. Data were used to explore the co-occurrence of socioeconomic factors (e.g., home environment, frequent disruptions in care), caregiver distress, and polyvictimization with asthma.

Results: In unadjusted and adjusted models, children with one, two, or three or more traumas were more likely to have the diagnosis than children with no trauma. Additionally, the child or youth’s home environment and higher caregiver distress were significantly related to the likelihood of an asthma diagnosis. Sex and age were not related.

Conclusions: In clinical practice, trauma-informed interventions addressing the child or youth’s mental and physical health could improve treatment outcomes. Additionally, the inclusion of interventional strategies specifically for caregivers of these children and youth could optimize asthma outcomes.

interRAI, stress, interpersonal trauma, asthma, children and adolescents

“Asthma, characterized by episodic breathlessness and tightness in the chest, is one of the most common chronic respiratory diseases in childhood… The development of asthma is multifaceted and complex, with many risk factors being implicated in the onset and course of the disease, such as allergens and socioeconomic stress… There is evidence to suggest that genetics and the environment (e.g., maternal smoking and high sugar intake during pregnancy) contribute to the risk of developing asthma in childhood… 

Caregivers are expected to manage the stressors that are attributed to asthma (e.g., administering medications, intervening during emergencies)… The mental health of caregivers has implications on the child’s asthma, with studies suggesting stress or depression on the part of caregivers being correlated with a biological response by the child. Additionally, when caregivers are in such high-pressure situations, they may reduce support for their child. Caregivers struggling with mental health concerns are at an increased risk of abusing or neglecting their children” (p. 1- 2).

“ACEs are defined as traumatic events taking place in childhood and adolescence between the ages of 0 and 17 years old. ACEs can take several different forms, including direct child maltreatment (i.e., experience of physical, sexual, and/or emotional abuse) or indirect victimization (i.e., witnessing domestic violence, caregiver’s depressive symptoms… Children exposed to one type of ACE are at greater risk for experiencing other types as well… several studies have highlighted the detrimental effects of being exposed to multiple types of trauma during the same time period, referred to as polyvictimization… 

Several mechanisms could be at play to potentiate a relationship between polyvictimization and asthma. Gaietto and Celedón (2022) suggest childhood trauma can influence the development of asthma directly through stress responses, immunity, and airway inflammation or indirectly through poor diet, less exercise, as well as increased risk of obesity. Chronic stress in childhood is associated with an increased risk of developing asthma, which the diathesis-stress model could explain” (p. 2).

“The interRAIChYMH assessment is a comprehensive, standardized, and multisectoral mental health instrument for children aged 4– 18 years… The polyvicimization variable consists of the child’s lifetime history of traumatic events and experiences of unmet basic needs/ neglect. Traumatic life events were assessed with four items: witnessing domestic violence, being a victim of sexual assault or abuse, physical assault or abuse, and emotional abuse (e.g., persistently hostile environment, invalidated self-esteem, needs, and wants)... Two questions addressed household problems: inadequate heating or cooling and lack of personal safety… One item assessed whether the child was raised with frequent disruptions in care… Three items assessed caregiver distress: parent/primary guardian had experienced major life stressors in the last 90 days; parent/primary guardian was unable or unwilling to continue in caring activities; and parent/primary guardian expressed feelings of distress, anger, or depression” (p. 3- 4).

“One-fifth of the sample experienced one type of trauma, while more than one-tenth of the sample experienced two types of trauma, and almost one-sixth experienced three or more types of trauma. In the sample, more than 8% of children and youth had asthma… children who lived in homes with inadequate heating or cooling or lack of personal safety had greater odds to have the diagnosis” (p. 4).

“Taken together, our study’s findings support that psychosocial stressors linked to traumatic experiences may contribute to the development and maintenance of pediatric asthma… Identifying and addressing any dysfunctional family environments or maternal distress could help in preventing or reducing the risk of developing asthma” (p. 6).

“Examining polyvictimization in the context of asthma may shed future light on specific risk factors that co-occur and also facilitate possible early and novel intervention efforts for children and youth with the diagnosis” (p. 2).

“The child or youth’s physical environment can contain indoor allergens that exacerbate asthma symptoms…When caregivers are faced with their own mental illnesses, their ability to effectively meet the physical and emotional needs of their child may be affected… It is also possible that household distress could influence the development and maintenance of asthma symptoms. Exposure to maternal distress in early childhood (birth-7-years-old) can contribute to the development of asthma” (p. 5).

“It is imperative that future research is conducted to continue understanding the relationship between polyvictimization and asthma… Follow-up studies should conduct analyses to examine the different types of trauma and a diagnosis of asthma to further understand the mechanisms underlying the relationship” (p. 6).

“Trauma-informed interventions that consider the role of the caregivers may positively alter that child’s developmental trajectory, circumventing both short- and long-term consequences of polyvictimization and alleviating complications for asthma that may be exacerbated by caregiver distress” (p. 6).

“In our study, a significant relationship between polyvictimization and an asthma diagnosis was identified, such that children with one, two, or three or more traumas were more likely in odds to have the diagnosis compared to children with no interpersonal trauma” (p. 5- 6).

“Given the retrospective studies that, longitudinally, these children are at increased risk for a variety of medical conditions [coupled] with results reported herein, early intervention and prevention efforts are essential. In clinical practice, assessing exposure to interpersonal traumas would be helpful when treating children with asthma… the inclusion of family adaptation when discussing the child or youth’s asthma diagnosis is pivotal in understanding how to adequately care for children and youth with asthma” (p. 6).

As always, please join the discussion below if you have thoughts or comments to add!

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