Child Caregiving Burden and Preventative Health Care Utilization Among Mothers With Mental Disorders

Purpose: Persons with mental disorders experience higher rates of chronic illness that are due in part to suboptimal self-care, including underutilization of preventative health care services (Doherty & Gaughran, 2014: Ross et al., 2015; Tilbrook, Polsky & Lofters, 2010; Xiang, Lee & Kang., 2015). Mothers with mental disorders may experience an additional barrier to utilizing preventative health care services, exacerbated by their role as mothers, including sometimes caring for children with significant health and behavioral health problems. The impact of child caregiving has not been assessed as a factor in utilization of preventative health care services among mothers with mental disorders. The current study applies the caregiving process and caregiver burden model (Raina et al., 2004), a multidimensional model of parental caregiving, to explore the impact of child caregiving burden on preventative health care service utilization among a racially/ethnically diverse sample of mothers who are receiving services for mental disorders. 

Methods: This presentation is a secondary analysis of baseline data from a randomized trial testing a family-strengthening home-health intervention, Healthy Home, for 123 mothers with mental disorders and their children. First, this study will describe indicators of constructs in the caregiving process and caregiver burden model including demographic characteristics (mother’s age, family income, mother’s education, health insurance status), family/child characteristics (number of children, mean age of children, health and behavioral health problems), caregiving strain due to a child’s health condition, mother’s parenting self-agency, mother’s mental health status (depression, anxiety) and mother’s utilization of three types of preventative health services (pap smear, dental visits, and non-emergency visits with a physician). Second, we use path analysis to examine the links between these constructs to partially test the caregiving process and caregiver burden model.  

Results: The majority (80%) of mothers self-identified as Hispanic, 12% Black/African American, and 7% White, 1% unknown ethnicity.  About half (49%) of the mothers said their monthly family income was under $1000/month. Most (88%) of the mothers had a Pap smear in the last 3 years, 77% had visited a physician in the last year, and about half (49%) saw a dentist in the last year. The majority (75%) had Medicaid, and about a fifth (18%) paid for insurance out of pocket.   Mean age of mothers was 34.55 (SD = 15.07) years, and average years of education was 7.39 (SD = 22.20). On average, mothers had 1.99 (SD = 1.21) children, with a mean age of 8.81 (SD = 3.88) years. Worse child health was related to caregiving strain, B = 0.50, SE = 0.09, p < .001 and child internalizing problems were related to mother’s anxiety, B = 0.04, SE = 0.02, p = .017. Mother’s depression was linked to likelihood of having a Pap smear in the past three years, B = -1.76, SE = 0.72, p = .014, OR = 0.90. Child externalizing behaviors were related to parenting self-agency, B = -0.04 SE = 0.01, p < .001, and mother’s dental visits, B = -0.10, SE = 0.04, p= .006, OR = 0.17.

Conclusion: Caring for children with physical and behavioral health problems adds psychological strain and can be a barrier to some types of preventative health care among women with mental disorders. Mental health service providers should assess the demands and strains associated with caring for children when treating women with mental disorders. Interventions are needed to increase support and caregiving capacity for mothers with mental disorders who are caring for children with physical and behavioral health problems so that mothers are not overburdened and can attend to their own health needs. A family-based intervention that addresses physical and mental wellbeing of mothers with mental disorders and their children can be used to promote preventative health care utilization and improve physical wellbeing of this vulnerable population.