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

Abstract

Mental and social health in preschool caregivers has been inadequately studied but may influence respiratory symptom recognition and management. This study identified preschool caregivers at highest risk for poor mental and social health outcomes based on patient-reported outcome measures. We hypothesized that caregivers with the poorest mental and social health would have worse quality of life and preschool children with more wheezing episodes. Female caregivers (N=129) with a preschool child 12-59 months of age with recurrent wheezing and at least one exacerbation in the previous year completed eight validated patient-reported outcome measures of mental and social health. K-means cluster analysis was performed utilizing each instrument T-score. Caregiver/child dyads were followed for 6 months. Primary outcomes included caregiver quality of life and wheezing episodes in their preschool children. Three clusters of caregivers were identified ("low risk", n=38; "moderate risk", n=56; "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 over six months. This cluster had the poorest quality of life and marked disparities in social determinants of health. Preschool children from high risk caregivers had more frequent respiratory symptoms and a higher occurrence of any wheezing episode, but lesser outpatient physician utilization for wheezing management. 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.