Do Children with Special Health Care Needs with Anxiety have Unmet Health Care Needs? An Analysis of a National Survey

Objective: To describe differences in health care needs between Children with Special Health Care Needs (CSHCN) with and without anxiety and examine the association between anxiety and unmet health care needs. Methods: We analyzed data from the 2009/2010 national survey of CSHCN. The independent variable was anxiety. The main outcomes were health care needs and unmet needs. Covariates included demographics, other co-morbid conditions, and the presence and quality of a medical home. We used bivariate analyses and multivariable logistic regression to assess the relationships among anxiety, covariates, and the outcomes. We stratified our analysis by age (6–11 years, 12–17 years). Propensity score matched paired analysis was used as a sensitivity analysis. Results: Our final sample included 14,713 6–11 year-olds and 15,842 12–17-year-olds. Anxiety was present in 16% of 6–11 year-olds and 23% or 12–17 year-olds. In bivariate analyses, CSHCN with anxiety had increased health care needs and unmet needs, compared to CSHCN without anxiety. In multivariable analyses, only children 12–17 years old with anxiety had increased odds of having an unmet health care need compared to those children without anxiety (OR 1.44 [95% CI 1.17–1.78]). This was confirmed in the propensity score matching analysis (OR 1.12, [95% CI 1.02–1.22]). The specific unmet needs for older CSHCN with anxiety were mental health care (OR 1.54 [95% CI 1.09–2.17]) and well child checkups (OR 2.01 [95% CI 1.18–3.44]). Conclusion: Better integration of the care for mental and physical health is needed to ensure CSHCN with anxiety have all of their health care needs met.