Huynh Kevin H, McKernan Gina, Houtrow Amy, Yu Justin
University of Pittsburgh School of Medicine (KH Huynh), Pittsburgh, Pa.
Department of Physical Medicine & Rehabilitation (G McKernan and A Houtrow), University of Pittsburgh School of Medicine, Pittsburgh, Pa.
Acad Pediatr. 2025 Mar;25(2):102611. doi: 10.1016/j.acap.2024.102611. Epub 2024 Nov 23.
Identify factors associated with reduced emotional well-being (EWB) among family caregivers of children with more complex special health care needs (SHCN).
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.
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.
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.
确定在有更复杂特殊医疗需求（SHCN）儿童的家庭照顾者中，与情绪幸福感（EWB）降低相关的因素。
我们将梯度提升树（GBTs）应用于2016 - 2021年全国儿童健康调查，以确定与以下问题相关的因素：1）整体心理健康；2）父母应对方式；3）在有更复杂SHCN儿童的家庭照顾者中父母的恼怒程度。然后我们进行了调整后的逻辑回归和事后边际分析，以描述GBT识别出的因素与照顾者EWB结果之间的关系。
我们的GBT模型的曲线下面积得分在0.69至0.77之间。在我们的样本中，1）照顾者报告缺乏情感支持；2）在为孩子获取所需医疗服务时挫折感增加且付出更多努力；3）孩子存在情绪和行为问题是与照顾者EWB降低相关的因素。在调整回归模型的边际分析中，GBT识别出的因素与照顾者EWB出现不良结果的可能性显著更高相关。例如，与报告有情感支持来源的照顾者相比，缺乏情感支持的照顾者出现心理健康状况差/一般（13.7%对7.8%）、父母应对能力下降（8.0%对2.1%）以及经常因孩子感到困扰（9.9%对5.4%）和生气（3.5%对1.5%） 的预测概率更高。
除了加强护理协调支持外，未来旨在改善有更复杂SHCN儿童的家庭照顾者幸福感的努力可以考虑针对照顾者的情感支持和/或治疗孩子的情绪和行为问题。
