It's known that children with special health care needs, such as asthma, allergies, or attention disorders, have a high risk of emotional and behavioral disorders. But there is little research on the impact of poverty, crime, unemployment, and a lack of social support on the mental health of such children.

Researchers surveyed caregivers (63% black) of 257 Midwestern inner-city children with special health care needs and found that most reported feeling a moderate level of stress related to money, job satisfaction, parenting, and housing. Caregivers were given the Child Behavior Checklist for recording behavioral problems in their chronically ill children (ages two to 18 years); 38% of the children received scores indicating they had behavioral or mental health problems that warranted treatment. White children had more behavioral problems than black children did. In addition, the children with poorer health or poorer access to health care tended to have worse behavioral scores.

Study coauthor Joan Austin, of the Indiana University School of Nursing, encourages nurses "to consider the community environment when caring for children. Our study supports the need for multilevel and systems approaches to nursing care that involve coordination and collaboration, not only within the health care professions, but also among a broad array of community partners. The multiple influences on child health need to be addressed if we are to improve outcomes in children with special health care needs who are living in stressful living environments."

Jaffee KD, et al. Psychiatr Serv 2005;56 (1):63-9.