Parental Mental Health Care After Their Child's Pediatric Intensive Care Hospitalization

Abstract

Objectives: Post-traumatic stress disorder, depression, and anxiety have all been found in parents of PICU survivors. How these research findings translate to actual use of mental health services by parents remains unknown.

Design: Retrospective observational cohort study.

Setting: Insurance claims data from 2006 to 2013 obtained from the IBM MarketScan Commercial Database.

Patients: Parents of PICU survivors.

Interventions: We examined rates of: 1) mental health diagnoses, 2) outpatient mental health visits, and 3) prescriptions for antidepressants and anxiolytics among parents, 6 months before and 6 months after their child's PICU admission, using each parent as their own control.

Measurements and main results: Of the 95,070 parents identified, 9.5% received a new mental health diagnosis in the 6 months after their child's PICU hospitalization, which represented a 110% increase from pre-PICU rates. A smaller proportion of parents were given new prescriptions for antidepressants (3.4%) and anxiolytics (3.9%) in the 6 months after their child's PICU hospitalization. Mothers were twice as likely to receive a new mental health diagnosis and be taking a new medication than fathers in the post-PICU period. The parental diagnosis of acute stress disorder or post-traumatic stress disorder increased by 87% from the pre-PICU to the post-PICU period.

Conclusions: After their child's PICU hospitalization, the proportion of parents with a new mental health diagnosis nearly doubled. Mothers were at nearly twice the risk of receiving a new mental health diagnosis and receiving a new mental health medication compared with fathers. The proportion of parents receiving mental healthcare is much lower than the proportion reporting mental health symptoms in long-term outcomes studies. Whether this indicates a gap in healthcare delivery for parents with mental health symptoms remains unknown.

Figure 1.. New mental health care use by mothers and fathers in the 6 months after their child’s discharge from the PICU

In the 6 months post-PICU hospitalization, new prescriptions for antidepressants were given to 3.4% of parents and new prescriptions for anxiolytics were given to 3.9% of parents. Overall, mothers were twice as likely to have a new claim for these medications than fathers. New mental health conditions were diagnosed in 9.5% of parents. Depression and anxiety were the most common new diagnoses. Very few parents had new claims for outpatient mental health visits in the 6 months after their child’s discharge from the PICU.

Figure 2.. New antidepressant and anxiolytic use by mothers and fathers in subgroup analysis.

In all subgroups, mothers consistently had higher rates of prescription medication use than fathers. Parents of children with longer ICU lengths of stay had higher rates of medication use than those whose children had short ICU lengths of stay. Rates of prescription medication use were highest for parents whose child died in the 6 months after PICU hospitalization.