Health Care, Educational, and Vocational Transitions in Young Adults With Pediatric-Onset Disabilities: Associations With Social Determinants of Health.

Abstract

Objective: We aim to describe health care, vocational, and educational transitions in young adults with pediatric-onset disabilities and to examine the associations with social determinants of health and depressive symptoms.

Design: This cross-sectional study used multinomial and binary logistic regression to examine the associations of sociodemographic factors and depressive symptoms with health care, educational, and vocational transitions.

Setting: Participants were recruited from outpatient specialty clinics in a rehabilitation medicine department at a quaternary academic children's hospital.

Participants: Transition age adults with acquired brain injury (17), spina bifida (10), and neuromuscular disorders (28) participated in this study.

Interventions: Not applicable.

Main outcome measures: Participants provided information about their current health care utilization and educational/vocational status.

Results: Twenty-five percent of participants were unsure of their primary resource for preventative health care; this uncertainty was associated with White race/Hispanic ethnicity (P=.004) and public insurance (P=.02). When asked about their primary health care resource if they are sick or have an immediate health-related question, 18% identified the emergency department; this was significantly related to greater neighborhood disadvantage (P=.009). Considering current educational and vocational status, having a job while also going to school was associated with more self-reported depressive symptoms (P=.009) and younger age (P=.02).

Conclusions: Outcomes during the transition to adulthood are related to multiple factors, including race and ethnicity, public insurance, neighborhood disadvantage, and depressive symptoms. Targeted interventions to support health care, vocational, and educational transitions in the context of social determinants of health and mental health status are needed.