Abstract
Objectives
In 2018, approximately 2.3 million children in the United States had unmet healthcare needs (UHCN). To date, studies examining associations between UHCN and parent stress and support have had limited generalizability. This study aimed to investigate the relationship between children’s UHCN and parenting stress and support using a nationally representative sample. Additionally, this study aimed to assess associations between unmet mental health needs and these parental well-being measures.
Methods
Households with children ages 0–17 and complete data on UHCN in the combined 2016, 2017, 2018, and 2019 cohorts of the National Survey of Children’s Health (NSCH) met inclusion criteria. Logistic regressions were used to evaluate associations between overall UHCN and outcome measures of parental coping, aggravation, emotional support, and neighborhood support. Associations between mental UHCN and these outcome measures were analyzed in a subset limited to children with mental health conditions. Regressions were adjusted for potential confounders, including demographics, household income, medical home status, and health insurance (adequacy/type).
Results
In our sample of 131,299 children, overall UHCN were associated with poorer parental coping (aOR = 5.35, 95% CI: [3.60, 7.95]), greater parental aggravation (aOR = 3.35, 95% CI: [2.73, 4.12]), and non-supportive neighborhood (aOR = 2.22, 95% CI: [1.86, 2.65]). Mental UHCN were similarly associated with parental coping and aggravation and neighborhood support in the mental health subset.
Conclusions for Practice
Healthcare professionals must address the needs of children with UHCN and collaborate with community organizations and child advocates to promote coordinated and comprehensive care and adequately support caregivers.
Significance
Research has shown that parenting stress and support may impact a child’s patterns of healthcare utilization. However, the relationship between parenting stress/support and unmet healthcare needs, rather than utilization, has yet to be explored in a large, nationally representative dataset.
AbstractSection What this study adds?In a nationally representative sample of children in the United States, overall unmet healthcare needs were found to be associated with poorer parental coping, greater parental aggravation, and living in a non-supportive neighborhood. Mental unmet healthcare needs were associated with the same measures among children with mental health conditions.
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Data Availability
Dataset is made publicly available by the United States Centers for Disease Control and Prevention.
Code Availability
Code for statistical analyses available upon request.
References
American Academy of Pediatrics (2021). AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health. Retrieved September 11, 2023, from https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/.
American Academy of Child and Adolescent Psychiatry (2022, May 4). Severe Shortage of Child and Adolescent Psychiatrists Illustated in AACAP Workforce Maps AACAP. https://www.aacap.org/aacap/zLatest_News/Severe_Shortage_Child_Adolescent_Psychiatrists_Illustrated_AACAP_Workforce_Maps.aspx.
Berg, K. L., Shiu, C. S., Feinstein, R. T., Msall, M. E., & Acharya, K. (2018). Adverse childhood experiences are Associated with Unmet Healthcare needs among children with Autism Spectrum Disorder. The Journal of Pediatrics, 202, 258–264. https://doi.org/10.1016/j.jpeds.2018.07.021.
Bitsko, R. H., Holbrook, J. R., Ghandour, R. M., Blumberg, S. J., Visser, V. N., Perou, R., & Walkup, J. T. (2018). Epidemiology and impact of Health Care provider–diagnosed anxiety and Depression among US children. Journal of Developmental & Behavioral Pediatrics, 39(5), 395–403. https://doi.org/10.1097/DBP.0000000000000571.
Brown, N. M., Green, J. C., Desai, M. M., Weitzman, C. C., & Rosenthal, M. S. (2013). Need and Unmet need for Care Coordination among Children with Mental Health conditions. Pediatrics, 133(3), 530–537. https://doi.org/10.1542/peds.2013-2590.
Child and Adolescent Health Measurement Initiative (CAHMI), Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) (2019). 2017–2018 National Survey of Children’s Health (2 Years Combined Data Set): Child and Family Health Measures, National Performance and Outcome Measures, and Subgroups, SPSS Codebook, Version 1.0. Retrieved April 23, 2020, from www.childhealthdata.org.
Child and Adolescent Health Measurement Initiative (CAHMI), Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) (2018). 2018 National Survey of Children’s Health (NSCH) data query. Retrieved April 20, 2020, from www.childhealthdata.org.
Cousino, M. K., & Hazen, R. A. (2013). Parenting stress among caregivers of children with chronic illness: A systematic review. Journal of Pediatric Psychology, 38(8), 809–828. https://doi.org/10.1093/jpepsy/jst049.
Deater-Deckard, K. (1998). Parenting stress and child adjustment: Some old hypotheses and new questions. Clinical Psychology: Science and Practice, 5, 314–332. https://doi.org/10.1111/j.1468-2850.1998.tb00152.x.
Drews-Botsch, C., Celano, M., Cotsonis, G., DuBois, L., & Lambert, S. R. (2019). Parenting stress and adherence to occlusion therapy in the infant Aphakia Treatment Study: A secondary analysis of a Randomized Clinical Trial. Translational Vision Science & Technology, 8(1), 3. https://doi.org/10.1167/tvst.8.1.3.
Farmer, J. E., Marien, W. E., Clark, M. J., Sherman, A., & Selva, T. J. (2004). Primary care supports for children with Chronic Health conditions: Identifying and Predicting Unmet Family needs. Journal of Pediatric Psychology, 29(5), 355–367. https://doi.org/10.1093/jpepsy/jsh039.
Fuller, A. E., Garg, A., Brown, N. M., Tripodis, Y., Oyeku, S. O., & Gross, R. S. (2020). Relationships between Material Hardship, Resilience, and Health Care Use. Pediatrics, 145(2), e20191975. https://doi.org/10.1542/peds.2019-1975.
Golfenshtein, N., Srulovici, E., & Medoff-Cooper, B. (2015). Investigating parenting stress across pediatric health conditions—A systematic review. Comprehensive Child and Adolescent Nursing, 39(1), 41–79. https://doi.org/10.3109/01460862.2015.1078423.
Graaf, G., Annis, I., Martinez, R., & Thomas, K. C. (2021). Predictors of Unmet Family Support Service needs in families of children with Special Health Care needs. Maternal and Child Health Journal, 25, 1274–1284. https://doi.org/10.1007/s10995-021-03156-w.
Green, A., Hayman, L. L., Cromwell, J., & Phipatanakul, W. (2016). Child, parent and environmental characteristics’ influence on parent Asthma Management behaviors in an Inner-City Population. Nursing Research, 65(2), E3–E3. https://doi.org/10.1097/NNR.0000000000000152.
Gupta, V. B. (2007). Comparison of parenting stress in different developmental disabilities. Journal of Developmental and Physical Disabilities, 19, 417–425. https://doi.org/10.1007/S10882-007-9060-X.
Hargreaves, D. S., Elliott, M. N., Viner, R. M., Richmond, T. K., & Schuster, M. A. (2015). Unmet Health Care need in US adolescents and Adult Health outcomes. Pediatrics, 136(3), 513–520. https://doi.org/10.1542/peds.2015-0237.
Janicke, D. M., & Finney, J. W. (2001). Children’s primary Health Care services: Social-cognitive factors related to utilization. Journal of Pediatric Psychology, 28(8), 547–558. https://doi.org/10.1093/jpepsy/jsg045.
Janicke, D. M., & Finney, J. W. (2003). Children’s primary Health Care services: Social-cognitive factors related to utilization. Journal of Pediatric Psychology, 28(8), 547–558. https://doi.org/10.1093/jpepsy/jsg045.
Jimenez, M. E., Martinez Alcaraz, E., Williams, J., & Strom, B. L. (2017). Access to Developmental Pediatrics evaluations for At-Risk children. Journal of Developmental and Behavioral Pediatrics: JDBP, 38(3), 228–232. https://doi.org/10.1097/DBP.0000000000000427.
Johnson, Y. L., Woodward, K., Dampier, C., Cohen, L., & Sil, S. (2022). Biopsychosocial Factors Associated with parenting stress in Pediatric Sickle Cell Disease. Journal of Clinical Psychology in Medical Settings, 29, 365–374. https://doi.org/10.1007/s10880-021-09837-6.
Karpur, A., Lello, A., Frazier, T., Dixon, P. J., & Shih, A. J. (2019). Health disparities among children with Autism Spectrum disorders: Analysis of the National Survey of children’s Health 2016. Journal of Autism and Developmental Disorders, 49, 1652–1664. https://doi.org/10.1007/s10803-018-3862-9.
Kidwell, K. M., Nelson, T. D., & Van Dyk, T. (2015). Parenting stress and child physical health among a low-income sample: The moderating role of child anxiety. Journal of Health Psychology, 20(11), 1377–1387. https://doi.org/10.1177/1359105313512352.
Kwon, S., O’Neill, M. E., & Foster, C. C. (2022). The associations of Child’s clinical conditions and behavioral problems with parenting stress among families of preschool-aged children: 2018–2019 National Survey of Child Health. Children, 9, 241. https://doi.org/10.3390/children9020241.
Langkamp, D. L., Lehman, A., & Lemeshow, S. (2010). Techniques for Handling Missing Data in Secondary Analyses of Large Surveys. Academic Pediatrics, 10(3), 205–210. doi:https://doi.org/10.1016/j.acap.2010.01.005.
Leitch, S., Sciberras, E., Post, B., Gerner, B., Rinehart, N., Nicholson, J. M., & Evans, S. (2019). Experience of stress in parents of children with ADHD: A qualitative study. International Journal of Qualitative Studies on Health and Well-being, 14(1), 1690091. https://doi.org/10.1080/17482631.2019.1690091.
Lindly, O. J., Chavez, A. E., & Zuckerman, K. E. (2016). Unmet Health services need among US children with Developmental disabilities: Associations with Family Impact and Child Functioning. Journal of Developmental & Behavioral Pediatrics, 37(9), 712–723. https://doi.org/10.1097/DBP.0000000000000363.
Litt, J. S., & McCormick, M. C. (2014). Care Coordination, the family-centered Medical Home, and functional disability among children with Special Health Care needs. Academic Pediatrics, 15(2), 185–190. https://doi.org/10.1016/j.acap.2014.08.006.
Liu, S. Y., Pabayo, R., & Muennig, P. (2021). Perceived discrimination and increased odds of Unmet Medical needs among US children. International Journal of Health Services: Planning Administration Evaluation, 51(3), 364–370. https://doi.org/10.1177/0020731421997087.
MacArthur, N. S., & Blewett, L. A. (2023). Contributions of Key Components of a Medical Home on Child Health outcomes. Maternal and Child Health Journal, 27(3), 476–486. https://doi.org/10.1007/s10995-022-03539-7.
Newacheck, P. W., Hughes, D. C., Hung, Y. Y., Wong, S., & Stoddard, J. J. (2000). The Unmet Health Needs of America’s children. Pediatrics, 105(4), 989–997. https://doi.org/10.1542/peds.105.S3.989.
Olfson, M. (2016). Building the Mental Health Workforce Capacity needed to treat adults with Serious Mental illnesses. Health Affairs, 35(6), 983–990. https://doi.org/10.1377/hlthaff.2015.1619.
Pannebakker, N. M., Kocken, P. L., Theunissen, M. H. C., van Mourik, K., Crone, M. R., Numans, M. E., & Reijneveld, S. A. (2018). Services use by children and parents in multiproblem families. Children and Youth Services Review, 84, 222–228. https://doi.org/10.1371/journal.pone.0231620.
Parasuraman, S. R., Anglin, T. M., McLellan, S. E., Riley, C., & Mann, M. Y. (2018). Health Care utilization and Unmet need among Youth with Special Health Care needs. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 63(4), 435–444. https://doi.org/10.1016/j.jadohealth.2018.03.020.
Pinquart, M. (2018). Parenting stress in caregivers of children with chronic physical condition-A meta-analysis. Stress and Health: Journal of the International Society for the Investigation of Stress, 34(2), 197–207. https://doi.org/10.1002/smi.2780.
Raphael, J. L., Zhang, Y., Liu, H., & Giardino, A. P. (2010). Parenting stress in US families: Implications for paediatric healthcare utilization. Child: Care Health and Development, 36(2), 216–224. https://doi.org/10.1111/j.1365-2214.2009.01052.x.
Raphael, J. L., Butler, A. M., & Giordano, T. (2013). Parental information, motivation, and adherence behaviors among children with Sickle Cell Disease. Pediatric Blood & Cancer, 60(7), 1204–1210. https://doi.org/10.1002/pbc.24466.
Rovane, A. K., Hock, R. M., & January, S. A. (2020). Adherence to behavioral treatments and parent stress in families of children with ASD. Research in Autism Spectrum Disorders, 77, 101609. https://doi.org/10.1016/j.rasd.2020.101609.
Sakkalou, E., Sakki, H., O’Reilly, M. A., Salt, A. T., & Dale, N. J. (2018). Parenting stress, anxiety, and depression in mothers with visually impaired infants: A cross-sectional and longitudinal cohort analysis. Developmental Medicine & Child Neurology, 60, 290–298. https://doi.org/10.1111/dmcn.13633.
Schieve, L. A., Boulet, S. L., Kogan, M. D., Yeargin-Allsopp, M., Boyle, C. A., Visser, S. N., Blumberg, S. J., & Rice, C. (2011). Parenting aggravation and autism spectrum disorders: 2007 National Survey of children’s Health. Disability and Health Journal, 4(3), 143–152. https://doi.org/10.1016/j.dhjo.2010.09.002.
Smiley, Y., Silberholz, E., Bekele, E., & Brodie, N. (2022). Caregiver stress and social determinants of health in key populations: Immigrant parents, parents of children with medical complexity, and adolescent parents. Current Opinion in Pediatrics, 34(5), 521–530. https://doi.org/10.1097/MOP.0000000000001163.
Streisand, R., & Tercyak, K. (2004). Parenting chronically ill children–the scope and impact of pediatric parenting stress. In M. Hoghughi, & N. Long (Eds.), Handbook of parenting: Theory and research for practice (pp. 181–197). SAGE Publications Ltd.
Sutton, K., Patrick, K., Maybery, D., & Eaton, K. (2016). The immediate impact of a brief rural mental health workforce recruitment strategy. Rural Society, 25(2), 87–103. https://doi.org/10.1080/10371656.2016.1194327.
Turner, A., Ricketts, T., & Leslie, L. K. (2020). Comparison of Number and Geographic Distribution of Pediatric Subspecialists and Patient Proximity to Specialized Care in the US between 2003 and 2019. JAMA Pediatrics, 174(9), 852–860. https://doi.org/10.1001/jamapediatrics.2020.1124.
U.S. Census Bureau (2018). Retrieved April 23, 2020 from 2017 National Survey of Children’s Health: Methodology Report. https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/methodology/2017-NSCH-Methodology-Report.pdf.
Wexler, M. G., McGean, M., Tripodis, Y., Tolliver, D., Messmer, E., Brochier, A., & Garg, A. (2022). The Association between racial discrimination, race, and Social Class With Health among US children. Academic Pediatrics, 22(7), 1228–1236. https://doi.org/10.1016/j.acap.2022.05.020.
Williams, N. A., & Burnfield, J. M. (2019). Psychological difficulties and parental well-being in children with musculoskeletal problems in the 2011/2012 National Survey of children’s Health. Rehabilitation Psychology, 64(1), 87–97. https://doi.org/10.1037/rep0000251.
Woltmann, E., Grogan-Kaylor, A., Perron, B., Georges, H., Kilbourne, A. M., & Bauer, M. S. (2012). Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: Systematic review and meta-analysis. The American Journal of Psychiatry, 169(8), 790–804. https://doi.org/10.1176/appi.ajp.2012.11111616.
Yorke, I., White, P., Weston, A., Rafla, M., Charman, T., & Simonoff, E. (2018). The Association between emotional and behavioral problems in children with Autism Spectrum Disorder and Psychological Distress in their parents: A systematic review and Meta-analysis. Journal of Autism and Developmental Disorders, 48(10), 3393–3415. https://doi.org/10.1007/s10803-018-3605-y.
Acknowledgements
The authors would like to thank Sarah A. Keim, PhD, MA, MS at the Center for Biobehavioral Health of Nationwide Children’s Hospital and the Department of Epidemiology at Ohio State University College of Public Health for her careful review and insightful comments regarding this manuscript.
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Ms. Campisi conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Mr. Pham designed the study, carried out the analyses, and reviewed and revised the manuscript. Mr. Rapoport conceptualized and designed the study, carried out the analyses, and reviewed and revised the manuscript. Dr. Adesman conceptualized and designed the study, reviewed and revised the manuscript, and critically reviewed the manuscript for important intellectual content.
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Campisi, C., Pham, D., Rapoport, E. et al. Parenting Stress, Community Support, and Unmet Health Care Needs of Children in the US. Matern Child Health J 28, 1010–1019 (2024). https://doi.org/10.1007/s10995-024-03912-8
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DOI: https://doi.org/10.1007/s10995-024-03912-8