TABLE 3.

Associations between demographic characteristics and financial burdens and need for mental health services among families of children with congenital heart disease, NS-CSHCN, United States, 2009–2010

	Out-of-pocket expenses >$1000		Family experienced financial problems		Family members stopped working or cut hours to care for child		Family member spends ≥11 hours/week providing or coordinating care		Family members needed mental health services due to child’s condition
	Age 0-5 years aPR (95% CI)	Age 6-17 years aPR (95% CI)	Age 0-5 years aPR (95% CI)	Age 6-17 years aPR (95% CI)	Age 0-5 years aPR (95% CI)	Age 6-17 years aPR (95% CI)	Age 0-5 years aPR (95% CI)	Age 6-17 years aPR (95% CI)	Age 0-5 years aPR (95% CI)	Age 6-17 years aPR (95% CI)
Child’s sex
Female	1.3 (0.9, 1.7)	1.2 (1.0, 1.5)	0.9 (0.7, 1.3)	1.0 (0.8, 1.2)	1.1 (0.9, 1.4)	1.0 (0.8, 1.2)	1.0 (0.7, 1.4)	0.8 (0.6, 1.1)	1.5 (0.9, 2.4)	1.4 (1.0, 2.1)
Male	1	1	1	1	1	1	1	1	1	1
Child’s race/ethnicity
White, Non-Hispanic	1	1	1	1	1	1	1	1	1	1
Black, Non-Hispanic	0.8 (0.3, 2.4)	0.7 (0.4, 1.3)	1.1 (0.6, 2.0)	0.9 (0.6, 1.4)	1.2 (0.7, 1.9)	0.9 (0.6, 1.3)	1.4 (0.9, 2.4)	1.0 (0.6, 1.6)	0.5 (0.1, 2.2)	0.7 (0.4, 1.3)
Hispanic	0.8 (0.4, 1.6)	0.7 (0.5, 1.1)	0.7 (0.4, 1.2)	1.0 (0.7, 1.4)	0.8 (0.5, 1.2)	1.3 (1.0, 1.7)	0.8 (0.4, 1.5)	1.2 (0.8, 1.9)	1.1 (0.4, 3.3)	0.9 (0.4, 1.8)
Othera	1.5 (0.8, 2.6)	0.9 (0.6, 1.5)	2.0 (1.4, 3.0)	1.2 (0.8, 1.8)	1.0 (0.7, 1.6)	1.2 (0.8, 1.9)	1.8 (1.1, 2.9)	1.2 (0.7, 1.9)	2.3 (1.3, 4.2)	1.4 (0.9, 2.4)
Child’s insurance type
Any private	1	1	1	1			1	1	1	1
Public	0.5 (0.3, 1.0)	0.5 (0.3, 0.9)	0.7 (0.5, 1.1)	0.7 (0.5, 1.0)	–e	–e	1.5 (0.9, 2.4)	1.5 (1.0, 2.3)	1.5 (0.8, 3.1)	0.9 (0.5, 1.7)
Uninsured	2.0 (1.1, 3.5)	1.6 (1.0, 2.4)	1.7 (1.0, 2.8)	2.0 (1.5, 2.7)			3.0 (1.7, 5.3)	1.2 (0.5, 2.8)	5.2 (1.8,14.8)	0.9 (0.4, 2.6)
Medical homeb
Yes	1	1	1	1	1	1	1	1	1	1
No	0.9 (0.6, 1.3)	0.8 (0.7, 1.1)	1.8 (1.2, 2.5)	1.2 (0.9, 1.5)	1.2 (0.9, 1.5)	1.1 (0.9, 1.4)	1.4 (0.9, 2.1)	1.2 (0.8, 1.8)	1.2 (0.6, 2.2)	1.3 (0.8, 2.0)
Types of comorbiditiesc
None	1	1	1	1	1	1	1	1	1	1
Developmental	1.0 (0.5, 2.2)	0.8 (0.5, 1.2)	1.4 (0.7, 3.0)	0.7 (0.4, 1.1)	1.1 (0.7, 1.8)	1.1 (0.6, 1.9)	0.9 (0.3, 2.6)	1.1 (0.4, 2.7)	0.7 (0.2, 2.6)	18.3 (3.8, 87.4)
Physical	1.5 (0.9, 2.7)	0.9 (0.6, 1.3)	2.3 (1.3, 4.3)	0.8 (0.6, 1.3)	1.0 (0.7, 1.5)	0.9 (0.5, 1.6)	1.4 (0.7, 2.7)	1.1 (0.4, 3.0)	1.6 (0.7, 3.7)	6.4 (1.2, 33.8)
Both	1.8 (0.9, 3.3)	1.0 (0.7, 1.4)	2.5 (1.3, 4.7)	0.9 (0.6, 1.4)	1.2 (0.8, 1.8)	1.2 (0.7, 1.9)	1.6 (0.8, 3.2)	1.6 (0.7, 3.6)	1.2 (0.5, 3.3)	26.9 (5.9,123.4)f
Condition affects daily activities
Never affected	1	1	1	1	1	1	1	1	1	1
Moderately affect, some of the time	1.0 (0.6, 1.6)	1.1 (0.8, 1.5)	1.3 (0.8, 2.1)	1.6 (1.0, 2.4)	1.9 (1.2, 3.0)	1.6 (1.0, 2.5)	7.2 (3.1, 16.7)	3.2 (1.4, 7.0)	1.8 (0.8, 4.1)	1.8 (0.8, 4.3)
Consistently affect, often a great deal	1.3 (0.8, 2.1)	1.3 (1.0, 1.9)	1.4 (0.9, 2.3)	2.5 (1.6, 3.8)	2.2 (1.4, 3.5)	2.5 (1.6, 4.0)	11.7 (5.1, 26.9)	8.4 (4.1, 17.0)	2.3 (0.9, 6.3)	2.0 (0.9, 4.5)
Family structure
Two parents	1	1	1	1	1	1	1	1	1	1
Mother only	1.1 (0.6, 2.0)	1.2 (0.9, 1.6)	0.7 (0.4, 1.2)	1.4 (1.0, 1.8)	0.9 (0.6, 1.3)	1.0 (0.8, 1.3)	0.9 (0.6, 1.5)	1.2 (0.9, 1.8)	0.8 (0.3, 2.1)	1.1 (0.7, 1.8)
Other structures	1.5 (0.8, 2.8)	0.3 (0.1, 0.7)	1.5 (0.9, 2.4)	1.2 (0.6, 2.2)	1.5 (0.9, 2.3)	0.8 (0.5, 1.3)	1.0 (0.4, 2.8)	1.1 (0.5, 2.2)	0.8 (0.2, 3.5)	1.6 (0.8, 3.2)
Highest education of any household member
<High school	1	1	1	1	1	1	1	1	1	1
High school	0.3 (0.1, 1.4)	0.9 (0.5, 2.0)	1.2 (0.6, 2.6)	1.6 (0.9, 3.0)	1.0 (0.6, 1.7)	2.0 (1.1, 3.7)	2.1 (0.6, 7.2)	1.2 (0.6, 2.2)	0.2 (0.1, 0.9)	0.4 (0.2, 1.0)
>High school	0.7 (0.2, 2.4)	1.1 (0.6, 2.1)	1.2 (0.6, 2.5)	1.9 (1.0, 3.3)	1.0 (0.6, 1.7)	2.1 (1.2, 3.8)	2.3 (0.7, 7.8)	1.2 (0.6, 2.2)	0.5 (0.2, 1.1)	0.9 (0.5, 1.8)
Federal poverty statusd
<100% FPL	0.4 (0.2, 1.1)	0.4 (0.2, 0.8)	1.5 (0.8, 3.0)	1.7 (1.1, 2.8)	1.1 (0.7, 1.6)	1.6 (1.1, 2.2)	1.0 (0.5, 1.9)	1.5 (0.7, 2.9)	0.4 (0.2, 1.2)	1.2 (0.7, 2.3)
100%-199% FPL	0.8 (0.4, 1.4)	0.6 (0.4, 0.9)	1.6 (0.8, 3.0)	1.4 (0.9, 2.0)	1.1 (0.8, 1.6)	1.5 (1.1, 2.1)	1.1 (0.5, 2.1)	1.5 (0.8, 2.7)	0.8 (0.3, 2.5)	1.0 (0.5, 2.0)
200%-399% FPL	1.1 (0.8, 1.6)	0.8 (0.6, 1.0)	1.8 (1.0, 3.1)	1.6 (1.2, 2.2)	0.9 (0.7, 1.3)	1.2 (0.9, 1.6)	1.2 (0.7, 1.9)	1.2 (0.7, 2.1)	2.0 (0.9, 4.4)	0.8 (0.5, 1.4)
≥400% FPL	1	1	1	1	1	1	1	1	1	1
Financial problems
Yes	–	–	–	–	–	–	–	–	1.2 (0.7, 2.2)	2.1 (1.3, 3.3)
No									1	1

All models also adjusted for all variables in table as well as person completing the survey: mother, father, or other family member/guardian, and financial problems was added to mental health needs model. Abbreviations: aPR, adjusted prevalence ratio; CI, confidence interval; FPL, federal poverty level.

^aOther includes respondents identified as Asian, Alaskan Native, American Indian, Native Hawaiian, Pacific Islander, or mixed race.

^bMeets Maternal and Child Health Bureau criteria for a medical home.

^cDevelopmental comorbidities include attention deficit disorder or attention deficit hyperactivity disorder, depression, anxiety, behavioral or conduct problems, autism or an autism spectrum disorder, developmental delay, an intellectual disability or mental retardation, Down syndrome; physical comorbidities include asthma, diabetes, epilepsy or seizure disorder, migraines or frequent headaches, blood problems, cystic fibrosis, cerebral palsy, muscular dystrophy, arthritis or joint problems, allergies, and head injury, concussion or traumatic brain injury.

^dBased on US Department of Health and Human Services poverty guidelines.

^eInsurance type removed from employment impact model based on expected relationship between insurance and employment. Fifty percent of families with uninsured children had employment changes compared with 37% of children with private insurance.

^fLow numbers in cells led to wide confidence intervals that may influence precision of estimates.