Predicting Emotional Well-Being in Caregivers of Children With More Complex Special Health Care Needs.

OBJECTIVE

Identify factors associated with reduced emotional well-being (EWB) among family caregivers of children with more complex special health care needs (SHCN).

METHODS

We applied gradient-boosted trees (GBTs) to the 2016-21 National Survey of Children's Health to identify factors associated with questions assessing 1) global mental health, 2) parental coping, and 3) parental aggravation among family caregivers of children with more complex SHCN. We then conducted adjusted logistic regression and post-hoc margins analyses to describe the relationships between GBT-identified factors and caregiver EWB outcomes.

RESULTS

Our GBT models' area under the curve scores ranged from 0.69 to 0.77. Among our sample, 1) caregiver reported lack of emotional support, 2) increased levels of frustration and effort in getting their child needed health services, and 3) the presence of child emotional and behavioral conditions were factors associated with reduced caregiver EWB. In margins analyses of adjusted regression models, GBT-identified factors were associated with significantly higher likelihoods of adverse caregiver EWB outcomes. For example, compared to caregivers who reported a source of emotional support, the predicted probabilities of experiencing poor/fair mental health (13.7% vs 7.8%), reduced parental coping (8.0% vs 2.1%), and frequently feeling bothered by (9.9% vs 5.4%) and angry with (3.5% vs 1.5%) their child were higher among caregivers who lacked emotional support.

CONCLUSIONS

In addition to enhanced care coordination support, future efforts aiming to improve well-being among family caregivers of children with more complex SHCN could consider targeting caregiver emotional support and/or treatment of child emotional and behavioral conditions.