Review of Family Relational Stress and Pediatric Asthma: The Value of Biopsychosocial Systemic Models

• Author: Beatrice L. Wood,Bruce D. Miller,Heather K. Lehman
• Date: 01 June 2015
• Published date: 01 June 2015
• DOI: http://doi.org/10.1111/famp.12139

Review of Family Relational Stress and Pediatric

Asthma: The Value of Biopsychosocial Systemic

Models

BEATRICE L. WOOD*

BRUCE D. MILLER*

HEATHER K. LEHMAN

†

Asthma is the most common chronic disease in children. Despite dramatic advances in

pharmacological treatments, asthma remains a leading public health problem, especially

in socially disadvantaged minority populations. Some experts believe that this health gap

is due to the failure to address the impact of stress on the disease. Asthma is a complex dis-

ease that is influenced by multilevel factors, but the nature of these factors and their inter-

relations are not well understood. This paper aims to integrate social, psych ological, and

biological literatures on relations between family/parental stress and pediatric asthma,

and to illustrate the utility of multilevel systemic models for guiding treatment and stimu-

lating future research. We used electronic database searches and conducted an integ rated

analysis of selected epidemiological, longitudinal, and empirical studies. Evidence is sub-

stantial for the effects of family/parental stress on asthma mediated by both disease man-

agement and psychobiological stress pathways. However, integrative models cont aining

specific pathways are scarce. We present two multilevel models, with suppo rting data, as

potential prototypes for other such models. We conclude that these multilevel systems

models may be of substantial heuristic value in organizing investigations of, and clin ical

approaches to, the complex social–biological aspects of family stress in pediatric asthma.

However, additional systemic models are needed, and the models presented herein could

serve as prototypes for model development.

Keywords: Family; Stress; Asthma ; Biopsychosocial; Epigenesis; Health Disparities

Fam Proc 54:376–389, 2015

This paper reviews the literature focusing on how family stress may affect pediat ric

asthma, with the goal of furthering understanding of the complex biopsychosocial and

social systemic nature of mind–body connections in physical disease. We briefly define

asthma, and its pathogenesis, triggers, and prevalence. The main body of the paper

focuses on an analysis and integration of the family relational stress and asthma litera-

ture organized by an overarching systems framework. We present two specific systemic

socio-psycho-biological models: one focusing on the impact of social stress on child asthma

by way of prenatal stress, and one focusing on specific family relational patterns as they

impact child emotional stress, and asthma. The models are presented as prototypes of the

kind of modeling we believe would foster theory development in stress-related illness by

engaging a systemic biopsychosocial perspective. To illustrate how such modeling might

*Psychiatry and Pediatrics, University at Buffalo, Buffalo, NY.

†

Allergy and Immunology, Woman and Children’s Hospital of Buffalo, Buffalo, NY.

Correspondence concerning this article should be addressed to Beatrice Wood, Psychiatry and Pediat-

rics, University at Buffalo, WCHOB, 219 Bryant Street, Buffalo, NY 14222. E-mail: bwood@buffalo.edu.

376

Family Process, Vol. 54, No. 2, 2015 ©2015 Family Process Institute

doi: 10.1111/famp.12139