174 - Social Determinants of Health and Post-Traumatic Stress Symptoms in Caregivers of Children with Cancer

Publication Number: 174.6661

Shilpa Nataraj, Lucile Packard Children's Hospital Stanford, Cupertino, CA, United States; Bianca Pamela. Perdomo, University of California, San Diego School of Medicine, La Jolla, CA, United States; Nikhil Kumar, Chla, Los Angeles, CA, United States; Paula Aristizabal, University of California San Diego Department of Pediatrics, San Diego, CA, United States

Background: Children with cancer and their caregivers experience significant distress, particularly post-traumatic stress symptoms (PTSS). Social determinants of health (SDoH) may influence a family’s ability to navigate a new childhood cancer diagnosis and treatment. The role of SDoH on PTSS in caregivers of children with cancer has not been well-studied in minoritized populations.

Objective: To assess associations between SDoH and PTSS in Hispanic and non-Hispanic caregivers of children with cancer.

Design/Methods: Caregivers of children aged 0-17 years with newly diagnosed cancer (n=239) participated in this cross-sectional study between 2017 and 2022. Socio-demographics, health literacy (HL), acculturation, and PTSS were measured using a sociodemographic questionnaire, Newest Vital Sign (NVS), Short Acculturation Scale for Hispanics (SASH), and Impact of Events Scale-Revised (IES-R with subscales for intrusion, hyperarousal, and avoidance), respectively. IES-R scores > 24 are associated with an increased likelihood of developing post-traumatic stress disorder (PTSD). Statistical analyses were conducted using Fisher’s exact test, Wilcoxon rank sum test, and univariable and multivariable linear and logistic regression.

Results: Both Hispanic caregivers (n=134) and non-Hispanic caregivers (n=105) reported high levels of PTSS (mean IES-R for Hispanic caregivers=36.78 and non-Hispanic caregivers=28.34). Hispanic caregivers had significantly higher levels of avoidance (p < 0.001), hyperarousal (p < 0.001), intrusion (p=0.018), and total PTSS (p < 0.001) compared to non-Hispanic caregivers. Public insurance (p=0.020) and Spanish language use for medical communication (p=0.001) were significantly associated with higher PTSS on multivariable analysis. On logistic regression, caregivers with limited English proficiency were 2.34 times more likely to have an IES-R score > 24, thus with an increased likelihood of developing PTSD compared to caregivers with adequate English proficiency (OR 2.34, with 95% confidence interval 1.21, 4.80). HL and acculturation were not significantly associated with PTSS.

Conclusion(s): Caregivers of children with newly diagnosed cancer experience significant PTSS overall. Hispanic ethnicity and SDoH, such as public insurance, Spanish language used for medical communication, and limited English proficiency were associated with increased PTSS. Our results underscore the importance of early identification of caregivers at high risk for PTSS and psychosocial interventions tailored to cultural and language needs, with the goal of improving mental health outcomes in minoritized groups.