496 - Cumulative Probability of Mental and Behavioral Health Diagnoses Among Mothers of Military-Connected Children with Medical Complexity

Publication Number: 1476.496

Dana Joseph, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Jackielyn Lanning, Naval Health Research Center (Leidos, Inc.), Seattle, WA, United States; Seneca Freyleue, Geisel School of Medicine at Dartmouth, Providence, RI, United States; Saskia L. Vanderwiel, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Celeste Romano, Naval Health Research Center (Leidos, Inc.), San Diego, CA, United States; David C. Goodman, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Andrew Schaefer, Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Gia Gumbs, Naval Health Research Center (Leidos, Inc.), San Diego, CA, United States; Monica A. Lutgendorf, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicin, Bethesda, MD, United States; Ava Marie S. Conlin, Naval Health Research Center, San Diego, CA, United States; Clinton Hall, Naval Health Research Center (Leidos, Inc.), San Diego, CA, United States; James OMalley, James O'Malley, Lebanon, NH, United States; JoAnna Leyenaar, The Dartmouth Institute of Health Policy & Clinical Practie, Lebanon, NH, United States

Background: Mothers of children with medical complexity (CMC) face unique caregiving challenges that may increase their risk of mental health conditions. This may be particularly true for military-connected families who may experience increased psychosocial stress related to frequent relocation and deployment. Limited research has characterized differences in risk for maternal mental and behavioral health (M/BH) diagnoses associated with a child's medical complexity diagnosis; this understanding is critical for informing interventions and support services.

Objective: This study aimed to describe the cumulative probability of maternal M/BH diagnoses in military-connected birthing parents in the year prior to and up to 5 years following delivery and identify how the cumulative probability differed for parents whose child was diagnosed with a complex medical condition.

Design/Methods: We conducted a retrospective cohort study using 2014-2023 TRICARE claims data, analyzing live births to active-duty military personnel and their dependents between 2014-2018. We examined demographic, birthing parent, and sponsor (military service member) characteristics. Maternal M/BH diagnoses were identified using AHRQ Clinical Classification Software and required documentation of diagnoses in a given condition group on at least 2 different dates within one year or at least once during a hospitalization. CMC were identified using the Pediatric Medical Complexity Algorithm and Complex Chronic Condition Classification System.

Results: Among 314,362 mother-child dyads, 10.0% (n=31586) of children met CMC criteria (Table). Over half of mothers of CMC had at least one documented M/BH health diagnosis during the observation period (52.9%, n=16717) compared to 46.7% (n=132,122) of mothers whose child did not have a CMC diagnosis (Figure). Among mothers with and without CMC, the most common conditions were anxiety disorders (31.8%, N=99835) and mood disorders (24.3%, N=76265), followed by adjustment disorders (22.7%, N=71224) and other disorders (7.7%, N=24089). Cumulative risks in mothers of CMC increased more rapidly over time for all M/BH conditions.

Conclusion(s): Approximately one in two military-connected mothers experienced a M/BH diagnosis in the year prior to or five years following delivery, with anxiety and mood disorders predominating. These findings highlight substantial and sustained mental health needs among mothers caring for CMC as well as those without CMC, underscoring the importance of early screening, longitudinal monitoring, and coordinated family-centered mental health support for military-connected families.

Figure. Cumulative risk of maternal mental and behavioral health diagnoses from the year prior to birth to 5 years following delivery, stratified by medical complexity status in their child.
Cumulative risk curves for M/BH diagnoses for mothers from the year prior to birth through 60 months are shown for children with (blue line) and without (black line) medical complexity. Vertical dashed lines represent the time of birth. At-risk sample sizes at each time point are shown below each plot.

Table. Demographic and clinical characteristics of maternal-child dyads, stratified by medical complexity status.
Baseline demographic and clinical characteristics are summarized for children stratified by medical complexity status. Values are presented as counts (n) and percentages (%) unless otherwise specified. Comparisons highlight differences in population composition, including sex, gestational age, mode of delivery, birthing parent characteristics, and military sponsor characteristics.