Associations Between Psychosocial Stress, Child's Anxiety, and Lung Function in Mid-Childhood

Background Reducing the risk of respiratory disease during the plastic stages of lung development could have long-term health impacts. Psychosocial stress has been previously linked to adverse childhood respiratory outcomes, but the influence of child's anxiety and sex differences has not been completely elucidated. Aim To examine the association between maternal stress, child anxiety and lung function in children and to explore differences by sex. Methods Cross-sectional analyses included 294 mother-child pairs from the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) birth cohort in Mexico City. Children's lung function was tested once at ages 8-13 years ofage, height and sex adjusted z-scores were estimated for forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC and forced expiratory flow at 25-75% of the pulmonary volume (FEF25-75%). Maternal stress was assessed via the Crisis in Family Systems-Revised (CRISYS-R) survey, used toreport of negative life events experienced in the past 6 months and dichotomized at the median (<3 and ≥3). Child's self-reported anxiety was assessed using the Revised Children's Manifest Anxiety Scale short form and dichotomized at the clinically relevant cutoff (t-score≥60). The association between maternal stress, child anxiety and lung function outcomes was examined using linear models. Effect modification by sex was examined with interaction terms and in stratified analyses. Results We did not find any association between maternal stress and any lung function outcome. Clinically elevated child anxiety symptoms were associated with lower FEV1 (β= -0.36, 95% CI -0.69, -0.02). We found no evidence of effect modification by sex. Conclusions Results highlight the importance of considering childhood mental health in relation to lung function outcomes.