The relationship of parental psychopathology and pain-related conditions to child medical management and avoidable emergency pediatric services

Research objective. Studies in health services research have shown that many children do not receive well-child visits or timely care when they are in need of services. A potentially related problem is that a large percentage of emergency department (ED) visits and hospitalizations among children can be avoided. Many intense services occur for medical problems that could have been avoided had the child received timely or required outpatient care. These avoidable ED visits and hospitalizations are often referred to as Ambulatory Care Sensitive services; ACS-ED visits and ACS hospitalizations. Studies have investigated parental psychological characteristics as predisposing factors influencing pediatric service use and found that children whose parents have depressive symptoms or high stress are more-likely to have unmet health care needs. However, more research is needed to better understand how parental psychopathology is associated with inadequate management of child medical service needs.; The objectives of this study were: (1) to investigate whether parental emotional and pain-related distress is associated with a lack of well-child visits, (2) to determine the types of parental emotional and pain-related conditions most predictive of ACS-ED visits and ACS hospitalizations in children (0-18 years), (3) to explore the time interval for when children were most at risk for unstable health with respect to their mother's depressive episodes, and (4) to assess whether treatments for maternal depression can moderate the likelihood of inadequate management of children's medical care needs.; Study design. To investigate these objectives, an observational study was conducted using the 1997-1998 Thomson/Medstat MarketScan claims and administrative dataset. Claims information for 258,332 children and their parents was included in this study. Logistic regression with generalized estimating equations (GEE) was used to assess the odds for children having two well-child visits, at least one ACS-ED visit and one ACS hospitalization during the 2-year study period in relation to parental diagnoses of various mental health and pain-related conditions.; The 2-year study period was also divided into four 6-month time frames: period 1 (January 1-June 30,1997), period 2 (July 1-December 31, 1997), period 3 (January 1-June 30, 1998), and period 4 (July 1-December 31, 1998). These time frames were generated in order to define cohorts of children by various patterns of 2-year maternal depression diagnoses (e.g. continuously depressed, having a new episode of depression in period 2 or period 3, or not having depression) and to observe effects of maternal depression prior to the diagnosis and following treatment. Poisson regression with GEE was used to compare rates of ACS-ED visits and ACS hospitalizations among cohorts of children categorized by the various patterns of 2-year maternal depression diagnoses in each time period. Children of mothers experiencing new episodes of depression were also categorized by whether their mother was adherent to any antidepressant treatments (e.g. drug therapy, psychotherapy, and combination therapy). Survival analyses using Cox proportional hazards models with GEE were used to evaluate the rates of child ACS-ED visits following the mother's initial depression diagnosis using maternal treatment adherence as a moderating or control variable. All of these analyses controlled for child and parental health status, personal demographics, family characteristics, and health plan characteristics. Also, maternal propensity scores for treatment adherence were generated and included in the survival analyses in order to reduce the impact of sample selection bias on the child outcomes.; Population studied. The study population followed for a two year period includes 258,332 children and 262,799 caregivers with private insurance. All visits, procedures, and hospitalizations submitted to their insurance company for payment were anal...