Poorer Caregiver Mental and Social Health Is Associated With Worse Respiratory Outcomes in Preschool Children With Recurrent Wheezing

Abstract

Background: Mental and social health in caregivers of preschool children has been inadequately studied, but it may influence respiratory symptom recognition and management.

Objective: To identify preschool caregivers at highest risk for poor mental and social health outcomes on the basis of patient-reported outcome measures.

Methods: Female caregivers 18 to 50 years old (N = 129) with a preschool child aged 12 to 59 months with recurrent wheezing and at least 1 exacerbation in the previous year completed 8 validated patient-reported outcome measures of mental and social health. k-means cluster analysis was performed using the T score for each instrument. Caregiver/child dyads were followed for 6 months. Primary outcomes included caregiver quality of life and wheezing episodes in their preschool children.

Results: Three clusters of caregivers were identified: low risk (n = 38), moderate risk (n = 56), and high risk (n = 35). The high-risk cluster had the lowest life satisfaction, meaning and purpose, and emotional support and the highest social isolation, depression, anger, perceived stress, and anxiety that persisted for more than 6 months. This cluster had the poorest quality of life and marked disparities in social determinants of health. Preschool children from caregivers in the high-risk cluster had more frequent respiratory symptoms and a higher occurrence of any wheezing episode, but a lower outpatient physician utilization for wheezing management.

Conclusions: Caregiver mental and social health is associated with respiratory outcomes in preschool children. Routine assessment of mental and social health in caregivers is warranted to promote health equity and improve wheezing outcomes in preschool children.

Keywords: Anxiety; Asthma control; Caregiver burden; Depression; Disparity; Mental health; Patient-reported outcomes; Social determinants of health; Stress; Wheezing.

Figure 1.

(A) Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ) scores at 6 months, by cluster assignment, and association of PACQLQ scores at 6 months with caregiver (B) life satisfaction, (C) social isolation, and (D) perceived stress T-scores. Dashed lines indicate the 95% confidence interval of the regression line.

Figure 2.

(A) Child Symptom Questionnaire scores at 6 months in preschool children, by caregiver cluster assignment, (B) association of Children Symptom Questionnaire scores with Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ) scores, and children with (C) any wheezing episode and (D) an outpatient visit for wheezing by 6 months. Dashed lines indicate the 95% confidence interval of the regression line.