596 - Predictors of Caregiver Anxiety upon Child Hospital Admission

Publication Number: 2581.596

Casey O'Hare, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Kristina Singh-Verdeflor, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Jennifer Baird, Children's Hospital Los Angeles, Los Angeles, CA, United States; Roger Brown, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Ryan Coller, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Arti D. Desai, University of Washington School of Medicine, Seattle, WA, United States; Anna B. Egan, Children's Hospital Los Angeles, Los Angeles, CA, United States; Kathryn Ensch, American Family Children's Hospital, Madison, WI, United States; Amanda Gatewood, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Danielle Gerber, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Sophie J. Kooiman, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Catherine Arnott. Smith, University of Wisconsin, Madison, WI, United States; Sandy C. Tierney, American Family Children's Hospital, Fitchburg, WI, United States; Sarah Wong, Children's Hospital Los Angeles, Los Angeles, CA, United States; Michelle M. Kelly, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background: Child hospitalization is a known stressor for caregivers, often associated with elevated anxiety. Prior research is mixed on whether specific child and caregiver characteristics predict caregiver anxiety at admission. Understanding these predictors may help hospitals target support interventions.

Objective: To assess associations between patient and caregiver characteristics and caregiver anxiety within 24 hours of hospital admission.

Design/Methods: Retrospective analysis of baseline data from a multisite trial evaluating the impact of sharing clinical notes on caregiver anxiety during pediatric hospitalization. Between April 1 and October 3, 2025, English- or Spanish-speaking caregivers of children ages 0-11 admitted to a pediatric medical service completed a survey within 24 hours of admission to a quaternary children's hospital. The survey assessed demographics (caregiver age, gender, race, education, income, home language), patient's prior hospitalizations, health literacy (Brief Health Literacy Screener) and anxiety (State-Trait Anxiety Inventory for Adults (STAI), 20-item measure assessing current anxiety). Patient age and medical complexity (0-1 vs. ≥2 complex chronic conditions defined by Feudtner's Complex Chronic Conditions classification system) were obtained from the electronic health record. Adjusted logistic regression was used to assess associations between these variables and caregiver anxiety.

Results: Of 134 eligible caregivers approached, 91 enrolled (response rate 68%). Most caregivers were women (79%) and White (82%). Nearly one-third (31%) reported limited to marginal health literacy. About half of the patients (51%) had ≥2 chronic complex conditions. The average caregiver anxiety score on admission was 40 (range 33-48), indicating a moderate level of anxiety (Table 1). In adjusted logistic regression models, no patient or caregiver characteristic, including caregiver health literacy or patient medical complexity, was significantly associated with caregiver anxiety (Table 2).

Conclusion(s): Caregiver anxiety was commonly high within the first 24-hours of their child's hospitalization, suggesting a broadly shared experience regardless of patient or caregiver characteristics. The lack of significant predictors may reflect limited sample size or factors typically unmeasured on admission such as prior stress, mental health history, or perceived illness severity. Future work should examine these influences and test universal, adaptable interventions to support caregivers during their child's hospitalization.

Table 1. Patient and Caregiver Characteristics (n=91)
1. Health literacy measured via the Brief Health Literacy Screening Tool, a 4-item questionnaire with 5-point Likert responses assessing a caregiver's ability to read, understand, exchange, and use health information and resources. Responses were scored following survey guidelines.

Table 2. Associations between Patient and Caregiver Characteristics and Caregiver Anxiety
1. Models adjusted for all variables included in the table
2. Health literacy measured via the Brief Health Literacy Screening Tool, a 4-item questionnaire with 5-point Likert responses assessing a caregiver's ability to read, understand, exchange, and use health information and resources. Responses were scored following survey guidelines.