RESUMEN

Previous research suggests that family dysfunction may be related to lower health-related quality of life (HRQoL) in parent caregivers, but it is unknown if this association exists in the context of child mental illness. Therefore, the objectives of this study were to compare HRQoL between parent caregivers and Canadian population norms using the Short Form 36 Health Survey (SF-36); examine associations between family functioning and parental HRQoL; and investigate whether child and parental factors moderate associations between family functioning and parental HRQoL. Cross-sectional data were collected from children receiving mental healthcare at a pediatric hospital and their parents (n = 97). Sample mean SF-36 scores were compared to Canadian population norms using t-tests and effect sizes were calculated. Multiple regression was used to evaluate associations between family functioning and parental physical and mental HRQoL, adjusting for sociodemographic and clinical covariates. Proposed moderators, including child age, sex, and externalizing disorder, and parental psychological distress, were tested as product-term interactions. Parents had significantly lower physical and mental HRQoL versus Canadian norms in most domains of the SF-36, and in the physical and mental component summary scores. Family functioning was not associated with parental physical HRQoL. However, lower family functioning predicted lower parental mental HRQoL. Tested variables did not moderate associations between family functioning and parental HRQoL. These findings support the uptake of approaches that strive for collaboration among healthcare providers, children, and their families (i.e., family-centered care) in child psychiatry settings. Future research should explore possible mediators and moderators of these associations.

RESUMEN

BACKGROUND: Motor vehicle crashes (MVCs) are a leading cause of nonfatal injury in the United States and impose a high financial cost to the patient and the economy. For many patients, this cost may be financially devastating and contribute to worsening health outcomes after injury. We aimed to describe the population level risk of catastrophic health expenditure (CHE) and determine factors associated with risk of CHE. METHODS: We performed a retrospective review using the 2014-2017 Nationwide Inpatient Sample. The study population consisted of uninsured and privately insured adults aged 26 to 64 years who were hospitalized for nonneurologic traumatic injury due to MVCs. Our measure of financial hardship was CHE, which was defined as hospital charges ≥40% of postsubsistence income. Income estimates were derived from zip-code level data using Γ distribution modeling. RESULTS: Our sample included 189,000 patients, of which 149,705 had private insurance and 39,375 were uninsured. The median estimated income for the study cohort was $66,118 (interquartile range, $65,353-$66,884). The median cost of hospitalization was $53,467 (interquartile range, $29,854-$99,914). In addition, 91.5% of uninsured patients suffering from MVC are at risk for CHE, and 10.1% of privately insured patients are at risk for CHE. Among the insured, Black, Hispanic, and low income were associated with CHE. CONCLUSION: Nine of 10 uninsured patients are at risk for CHE after hospitalization for MVC. Despite having insurance, 10% of patients are still at risk of CHE. Black, Hispanic, and low-income communities are at highest risk of having private insurance and still experiencing CHE. This is the first population level analysis after the implementation of the Affordable Care Act that assesses the financial burden of no insurance and underinsurance. These data are important to understand the effectiveness of insurance coverage and guide hospital and policy level interventions to prevent CHE. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.

Asunto(s)

Gastos en Salud , Patient Protection and Affordable Care Act , Adulto , Humanos , Estados Unidos/epidemiología , Accidentes de Tránsito , Seguro de Salud , Vehículos a Motor

RESUMEN

BACKGROUND: The comorbidity of mental illnesses is common in child and adolescent psychiatry. Children with internalizing-externalizing comorbidity often experience worse health outcomes compared to children with a single diagnosis. Greater knowledge of functioning among children with internalizing-externalizing comorbidity can help improve mental health care. OBJECTIVE: The objective of this exploratory study was to examine whether internalizing-externalizing comorbidity was associated with impaired functioning in children currently receiving mental health services. METHODS: The data came from a cross-sectional clinical sample of 100 children aged 4-17 with mental illness and their parents recruited from an academic pediatric hospital. The current mental illnesses in children were measured using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), and the level of functioning was measured using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. Linear regression was used to estimate the association between internalizing-externalizing comorbidity and level of functioning, adjusting for demographic, psychosocial, and geographic covariates. RESULTS: Internalizing-externalizing comorbidity in children was associated with worse functioning compared to children with strictly internalizing comorbidities, ß = 0.32 (p = 0.041). Among covariates, parent's psychological distress, ß = 0.01 (p = 0.004), and distance to the pediatric hospital, ß = 0.38 (p = 0.049) were associated with worse functioning in children. CONCLUSIONS: Health professionals should be mindful that children with internalizing-externalizing comorbidity may experience worsening functioning that is disruptive to daily activities and should use this information when making decisions about care. Given the exploratory nature of this study, additional research with larger and more diverse samples of children is warranted.