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

Record Type:	Language materials, printed : Monograph/item
Title/Author:	The relationship of parental psychopathology and pain-related conditions to child medical management and avoidable emergency pediatric services./
Author:	Logan, Joseph Edward.
Description:	181 p.
Notes:	Adviser: Anne Riley.
Contained By:	Dissertation Abstracts International67-11B.
Subject:	Health Sciences, Health Care Management. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3240763
ISBN:	9780542956119

The relationship of parental psychopathology and pain-related conditions to child medical management and avoidable emergency pediatric services.
Logan, Joseph Edward.

The relationship of parental psychopathology and pain-related conditions to child medical management and avoidable emergency pediatric services. - 181 p.

Adviser: Anne Riley.

Thesis (Ph.D.)--The Johns Hopkins University, 2007.

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.

ISBN: 9780542956119Subjects--Topical Terms:

1017922
Health Sciences, Health Care Management.

The relationship of parental psychopathology and pain-related conditions to child medical management and avoidable emergency pediatric services.
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020 $a 9780542956119
035 $a (UnM)AAI3240763
035 $a AAI3240763
040 $a UnM $c UnM
100 1 $a Logan, Joseph Edward. $3 1288361
245 1 4 $a The relationship of parental psychopathology and pain-related conditions to child medical management and avoidable emergency pediatric services.
300 $a 181 p.
500 $a Adviser: Anne Riley.
500 $a Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6343.
502 $a Thesis (Ph.D.)--The Johns Hopkins University, 2007.
520 $a 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.
520 $a 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.
520 $a 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.
520 $a 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.
520 $a 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 analyzed.
520 $a Principal findings. Children of parents with depression were 11 % less likely to receive at least two well-child visits during the 2-year study (OR=0.89, 95% CI: 0.82-0.92, p<0.01). Also, it was borderline statistically significant that children of parents with schizophrenia were 53% less likely to receive at least two well-child visits during the 2-year study period as well (OR=0.47, 95% CI: 0.19-1.13, p<0.10). Parental conditions significantly and positively associated with children having an ACS-ED visit or an ACS hospitalization included depression (ORED=1.12, 95% CI: 1.02-1.21; ORhos 1.22, 95% CI: 1.01-1.46) anxiety (ORED=1.16, 95% CI: 1.04-1.29; ORhos 1.34, 95% CI: 1.08-1.66), personality disorder (ORED=1.50, 95% CI: 1.09-2.06), adjustment reaction (OR ED=1.20, 95% CI: 1.10-1.30) and parental conditions mildly associated with these services included bipolar disorder (ORED=1.27, 95% CI: 0.98-1.65, p<0.10) and schizophrenia (ORED=1.61, 95% CI: 0.972.70, p<0.10). Maternal depression had the strongest association with inadequate management of children's medical care needs of all the maternal and paternal conditions (ORwell-child=0.87, 95%CI: 0.77-0.98; ORED=1.24, 95% CI: 1.11-1.21; ORhos=1.24, 95% CI: 0.98-1.57, p<0.10).
520 $a Children whose mothers experienced continuous depression, who were also hospitalized, were 3.76 (95% CI: 1.60-9.50) to 4.48 (95% CI: 1.50-13.1, p<0.05) times more likely to have an ACS-ED visit in time periods 1 and 3 and 7.09 (95% CI: 1.50-32.8) times more likely to have an ACS hospitalization in time period 3 than children of non-depressed mothers. This finding held for children of mothers with continuous depression (without hospitalization), as well, who were more likely to have an ACS-ED visit in period 2 (IRR: 1.51, 95% CI: 0.98-2.31, p<0.10) and period 3 (IRR: 1.43, 0.98-2.14, p<0.10) than children of non-depressed mothers in the same time periods. Children of mothers experiencing an episode of depression treatment for the first time in at least 6 months were more likely to have an ACS-ED visit, an ACS hospitalization, or both, than children of non-depressed mothers. Also, there was little association between maternal treatment adherence and rate of child ACS-ED visits. In fact, children of mothers who used psychotherapy regularly following initial diagnosis tend to have higher rates of ACS-ED visits (HR: 2.04, 95% CI: 1.01-4.10) than children of non-adherent mothers after adjusting for other covariates, including child health status, maternal depression severity, and maternal propensity for therapy use.
520 $a Other findings from this study included: (1) the likelihood of inadequate child medical management was highest among mothers with greater co-morbidity and mothers with depression and back pain, (2) children who did not receive a diagnosis of a chronic condition during the 2-year study were more likely to show signs of inadequate medical management than those with chronic conditions if a parent had a diagnosed mental disorder, and (3) among children of mothers with depression or depression with back pain, those 14-18 years of age were more likely to show signs of inadequate medical management than children of 0-5 years, children of 6-10 years, and children of 11-13 years.
520 $a Conclusions. Parental psychopathology is strongly associated with missed opportunities for preventive care and higher use of emergency department care and hospitalizations, especially if it co-occurs with pain-related health conditions. Also, this study showed that children were more likely to have avoidable ED visits and hospitalizations when the mother was in treatment for depression and not prior to diagnosis when the syndrome was expected to be most impairing on the caregiver.
520 $a Implications for policy, delivery, or practice. Mental health providers, pediatricians, policy makers, and insurers need to consider the rate of parental mental health conditions as a determining factor in children missing preventive care visits and using emergency and higher intensity services. Pediatricians need to consider parental health and mental health to manage child health effectively. Mental health providers have an opportunity for improving child health and reducing family emergencies by addressing the needs of families to care for their children.
590 $a School code: 0098.
650 4 $a Health Sciences, Health Care Management. $3 1017922
650 4 $a Health Sciences, Mental Health. $3 1017693
650 4 $a Health Sciences, Public Health. $3 1017659
690 $a 0347
690 $a 0573
690 $a 0769
710 2 0 $a The Johns Hopkins University. $3 1017431
773 0 $t Dissertation Abstracts International $g 67-11B.
790 $a 0098
790 1 0 $a Riley, Anne, $e advisor
791 $a Ph.D.
792 $a 2007
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3240763