Lawrence-Sidebottom Darian, McAlister Kelsey L, McCutchen Donna, Roots Monika, Huberty Jennifer
Bend Health Inc., Madison, WI, USA.
Fit Minded Inc., Phoenix, AZ, USA.
Digit Health. 2025 Jul 28;11:20552076251361589. doi: 10.1177/20552076251361589. eCollection 2025 Jan-Dec.
Children's mental health (MH) places significant strain on their caregivers, who often experience disrupted sleep and heightened stress. Given the close relationship between caregiver and child MH symptoms, understanding how digital MH interventions (DMHIs) influence both child and caregiver symptoms is essential for optimizing family-centered treatment approaches.
The purpose of this study was to (a) examine associations between child MH and caregiver sleep problems and stress before beginning MH treatment, (b) explore whether a child's engagement level with a DMHI moderates their rate of MH improvement, and (c) determine whether a child's rate of MH improvement is associated with their caregiver's rate of improvement in sleep problems and stress.
Child-caregiver pairs ( = 3104) completed assessments approximately monthly over at least three months of care to assess caregiver sleep problems and stress, and child MH outcomes. Associations between caregiver and child MH symptoms at baseline were tested. Linear mixed-effects models tested whether engagement was associated with child symptom improvements, and to test whether child outcomes were associated with monthly improvements in their caregiver.
Caregiver sleep problems were associated with child internalizing symptoms (anxiety, depression, and sleep problems; < .001). Stress was associated with child externalizing symptoms (inattention, hyperactivity, and opposition; < .001) and younger child age ( < .001). Improvements in symptoms were marginally larger for children with more frequent coaching and therapy sessions ( = .066). Larger improvements in child symptoms were significantly associated with larger improvements in caregiver sleep problems and stress (s < .001).
Caregivers of children with more severe symptoms experienced higher stress and sleep disturbances. Greater session engagement was linked to greater child symptom improvement, and greater child symptom improvement was associated with greater reductions in caregiver sleep problems and stress. This highlights how a pediatric DMHI can drive meaningful improvements in MH that extend beyond the child, creating positive ripple effects for caregivers as well.
儿童心理健康（MH）给其照顾者带来了巨大压力，照顾者常常睡眠中断且压力增大。鉴于照顾者与儿童MH症状之间的密切关系，了解数字MH干预措施（DMHIs）如何影响儿童和照顾者的症状对于优化以家庭为中心的治疗方法至关重要。
本研究的目的是：（a）在开始MH治疗前，检查儿童MH与照顾者睡眠问题及压力之间的关联；（b）探讨儿童对DMHI的参与程度是否会调节其MH改善率；（c）确定儿童MH改善率是否与其照顾者睡眠问题及压力的改善率相关。
儿童-照顾者对（n = 3104）在至少三个月的护理期间大约每月完成一次评估，以评估照顾者的睡眠问题和压力以及儿童的MH结果。测试了基线时照顾者与儿童MH症状之间的关联。线性混合效应模型测试了参与度是否与儿童症状改善相关，并测试了儿童结果是否与其照顾者的每月改善情况相关。
照顾者的睡眠问题与儿童内化症状（焦虑、抑郁和睡眠问题；p <.001）相关。压力与儿童外化症状（注意力不集中、多动和对立；p <.001）以及儿童年龄较小（p <.001）相关。接受更频繁辅导和治疗的儿童症状改善幅度略大（p = 0.066）。儿童症状的更大改善与照顾者睡眠问题和压力的更大改善显著相关（ps <.001）。
症状较严重儿童的照顾者经历了更高的压力和睡眠障碍。更高的参与度与儿童症状的更大改善相关，而儿童症状的更大改善与照顾者睡眠问题和压力的更大减轻相关。这凸显了儿科DMHI如何能推动MH方面有意义的改善，这种改善不仅惠及儿童，还能给照顾者带来积极连锁反应。
