The feasibility of identifying financial hardship in a tertiary paediatric setting, and associations with caregiver and child mental health

Background: Financial hardship is a social determinant of health but is rarely assessed by healthcare services. This study (1) investigated the feasibility and acceptability of asking caregivers about financial hardship during a routine clinical encounter, and (2) described associations between financial hardship and caregiver and child mental health. Methods: Design: Cross-sectional survey. Setting: Day Medical Unit of Australia's largest public paediatric hospital, 1 April-31 July 2021. Participants: Families with children aged 2–17 years with chronic medical conditions. Measures: Caregiver-reported: financial hardship (3 study-designed items dichotomised into any (yes) versus none (no)) and mental health (Depression Anxiety Stress Scales (DASS), with subscales classified as poor (moderate/severe/extremely severe) versus not (none/mild)). Caregivers and young people aged 11–17 years reported child mental health (Strengths and Difficulties Questionnaire (SDQ), categorised as normal/borderline/abnormal). Analysis: Feasibility and acceptability were assessed by response proportions. Chi square tests assessed associations between mental health and financial hardship. Results: 160/193 (83%) of caregivers and 50/79 (63%) of 11–17-year-olds consented and completed the surveys. 22% of families reported financial hardship and 24% of caregivers reported moderate-to-severe mental health on at least one DASS subscale. Abnormal mental health (SDQ) was common for children according to caregivers (40%) and young people themselves (43%). Financial hardship was associated with poorer mental health when reported by caregivers for themselves and their children, but not when reported by the young person (noting numbers were small). Discussion: Tertiary healthcare may offer a feasible setting for identifying and responding to common and adverse social conditions such as financial hardship and mental health.