Parenting Stress, Community Support, and Unmet Health Care Needs of Children in the US

ObjectivesIn 2018, approximately 2.3 million children in the United States had unmet healthcare needs (UHCN). To date, studies examining associations between UHCN and parent stress and support have had limited generalizability. This study aimed to investigate the relationship between children's UHCN and parenting stress and support using a nationally representative sample. Additionally, this study aimed to assess associations between unmet mental health needs and these parental well-being measures.MethodsHouseholds with children ages 0-17 and complete data on UHCN in the combined 2016, 2017, 2018, and 2019 cohorts of the National Survey of Children's Health (NSCH) met inclusion criteria. Logistic regressions were used to evaluate associations between overall UHCN and outcome measures of parental coping, aggravation, emotional support, and neighborhood support. Associations between mental UHCN and these outcome measures were analyzed in a subset limited to children with mental health conditions. Regressions were adjusted for potential confounders, including demographics, household income, medical home status, and health insurance (adequacy/type).ResultsIn our sample of 131,299 children, overall UHCN were associated with poorer parental coping (aOR = 5.35, 95% CI: [3.60, 7.95]), greater parental aggravation (aOR = 3.35, 95% CI: [2.73, 4.12]), and non-supportive neighborhood (aOR = 2.22, 95% CI: [1.86, 2.65]). Mental UHCN were similarly associated with parental coping and aggravation and neighborhood support in the mental health subset.Conclusions for PracticeHealthcare professionals must address the needs of children with UHCN and collaborate with community organizations and child advocates to promote coordinated and comprehensive care and adequately support caregivers. What is already known on this subject?Research has shown that parenting stress and support may impact a child's patterns of healthcare utilization. However, the relationship between parenting stress/support and unmet healthcare needs, rather than utilization, has yet to be explored in a large, nationally representative dataset.What this study adds?In a nationally representative sample of children in the United States, overall unmet healthcare needs were found to be associated with poorer parental coping, greater parental aggravation, and living in a non-supportive neighborhood. Mental unmet healthcare needs were associated with the same measures among children with mental health conditions.