Does Unmet Need for Healthcare Services Among Children With Anxiety Affect Family Time Burden?

Research Objective: Family members spend considerable time providing health care and arranging and coordinating health care for children with chronic health conditions. We assess whether unmet need for recommended treatments for anxiety (mental health services and prescription medication) is associated with increased family time burden.

Study Design: We used data from the 2009-2010 National Survey of Children with Special Health Care Needs to study the association between several health system, health status and demographic factors and parent's report of need and unmet need for healthcare services. We used multinomial logistic regression to conduct this analysis. We then assessed the relationship between unmet need and time spent by family members (1) providing health care at home and (2) arranging/coordinating health care for children with anxiety. We used ordinary least squares regression to control for need (severity of anxiety and comorbidity), enabling (family income, health insurance, and medical home), and predisposing (demographic) factors.

Population Studied: Of the 5,587 children with anxiety for whom information was available on these variables, we analyzed the 3,760 children whose parent/guardian reported that they needed both mental health services and prescription medication.

Principal Findings:

We classified unmet need into four categories:

1. Both mental health care (MHC) and prescription medication (Rx) needs met; (76%)
2. MHC but not Rx needs met (4%)
3. Rx but not MHC needs met (17%)
4. Both MHC and Rx needs unmet (3%)

• Odds of having both needs unmet was higher among children with more severe anxiety, those lacking a medical home, and among the uninsured compared to those with private insurance.
• Unmet need for both mental health care and prescription medication was associated with an additional 4 hours/week providing health care and 2 hours/week arranging/coordinating health care.
• Unmet need for either mental health care or prescription medication was associated with modest increases in both types of family time burden, with a larger increase providing health care than arranging/coordinating care. Unmet need for mental health care alone was associated with greater time burden than unmet need for just prescription medication.

Conclusions:

Compared to families of children with anxiety who received both types of recommended treatments for that condition, those with unmet needs for mental health services and prescription medication spent on average an extra 34 minutes per day providing health care at home, and an extra 17 minutes per business day arranging or coordinating their health care. This association persists even when other important predictors of time burden such as illness severity, comorbidity, and access to care are taken into account.

Implications for Policy or Practice:

The amount of time family members spend providing health care and arranging/coordinating care is an often-overlooked aspect of family burden of chronic illness. Enabling factors such as type of insurance and presence of a medical home, and need factors such as severity of anxiety are associated with whether parents believe their child needs counseling and medication to treat their anxiety– an important precursor to seeking those types of care. Healthcare providers and policymakers can reduce this burden on families by being aware of the importance of these types of informal care, and by improving access to health insurance and patient-centered medical homes.