Parents of children with cancer more often seek help for anxiety, depression
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Key takeaways:
- Parents of children with cancer sought mental health care more often than parents of children without cancer.
- Mothers made more mental health visits than fathers.
Parents of children with cancer made mental health visits, including those for anxiety and depression, significantly more often than other parents, according to results published in JAMA Network Open.
More than 18% of parents caring for children with cancer sought mental health care in the cross-sectional study.
“Even after adjusting for sociodemographic characteristics such as insurance coverage, family structures and mental health history, there were substantial increases in the probabilities of parents having anxiety-related, depression-related and any mental health-related visits among families of children with cancer,” Xu Ji, PhD, MSPH, assistant professor in the department of pediatrics and researcher at Winship Cancer Institute of Emory University, told Healio.
Background and methodology
More than 15,000 children had been diagnosed with cancer in 2021, and it is common for their parents to experience both anxiety (up to 74%) and depression (up to 46%), according to background information provided by researchers.
“The psychological stress from caring for seriously ill family members is well documented, particularly for young parents tending to their children,” Ji said. “As health services researchers, we are intrigued by the actual service utilization among this population given their potential high needs for mental health care. Our aim is to pinpoint any existing gaps in service utilization, which could signal areas in need of future enhancement.”
Ji and colleagues used the Merative MarketScan Commercial Claims Database, “a nationwide convenience sample of inpatient, outpatient and pharmacy insurance claims data from employer-sponsored health plans in the U.S.,” to build their study cohort, they wrote.
They included children diagnosed with hematologic, bone and soft tissue, central nervous system or gonadal cancers aged 21 years or younger between July 1, 2010, and the end of 2018.
Researchers focused on mental health visits within 1 year of a child’s diagnosis.
They matched control families at a 5:1 ratio based on the child’s year of birth, sex and geographic region.
The cohort consisted of 4,837 families of children with cancer (4,210 mothers; 4,016 fathers; 76.5% aged between 35 and 54 years; 51.1% PPO insurance plans) and 24,185 control families (21,444 mothers; 19,591 fathers; 73.6% aged between 35 and 54 years; 48.9% PPO).
Results and next steps
Parents of children with cancer had higher rates of anxiety-related visits compared with controls (10.6% vs. 7%).
Parents of children with cancer also made depression-related visits more often (8.4% vs. 6.1%).
They sought care for general mental health issues significantly more (18.1% vs. 13.3%) as well.
Researchers’ adjusted analyses concluded at least one parent of a child with cancer had a 45.7% higher likelihood of having an anxiety-related visit, 36.1% of seeking depression-related care, and 31.3% for any mental health issue.
Researchers did not find any differences in visits for substance use and related disorders.
Mothers sought help more often than fathers for both cohorts (14.7% vs. 8.4% in children with cancer group).
Mothers of children with cancer in urban areas had higher rates of any mental health and depression-related visits, and those in HMO or PPO plans had a higher prevalence of any mental health or anxiety-related care.
“Our findings highlight potential benefits from existing standards of care that recommend routine psychosocial assessment and interventions, which could improve access to mental health care referral and treatment for caregivers,” Ji said. “On the other hand, our findings also reflect the increased risks for mental health challenges faced by parents following their child’s cancer diagnosis. Additionally, the differences between mothers and fathers are interesting and potentially important to look further into.”
Researchers discussed several factors that could contribute to parents of children with cancer more often seeking help for mental health, including seeing their children suffer, prognosis and survival uncertainty, time and effort needed to care for their child’s symptoms as well as other logistical issues, disruptions in work, social and other family responsibilities, and costs.
“The findings we generated in this work offer directions for future interventions,” Ji said. “Such interventions could include providing mental health screening/counseling and timely support to families caring for patients with pediatric cancer, ensuring comprehensive insurance coverage for mental health care, and reenforcing paid medical leave to better meet these parents’ mental health care needs.”
Limitations of the study included not having self-paid, other insurer-paid and non-billed psychosocial service data, as well as a lack of psychosocial and racial information.
Additionally, MarketScan had a nationwide sample of medium-sized and large employers.
“The stark differences between families who care for children with cancer and those who do not indicate higher risks for experiencing mental health conditions among this population,” Ji said. “However, administrative insurance data only capture realized health care services, and do not allow us to measure the proportion of families that need mental health services but are not able to receive such services, such as unmet mental health care needs. Therefore, our future work will use mixed-methods approach to examine potential unmet mental health care needs and identify the barriers to maintaining mental well-being for parents of children with cancer.”
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