Peer-reviewed article

Effect of requiring advanced respiratory support on disaster-related anxiety among caregivers of children with medical complexity: a cross-sectional study.

Hisao Nakai, Shiro Ozasa, Yukari Matsumoto, Keiko Takushima · 7 May 2026

Abstract

BACKGROUND: The population of children with medical complexity (CMC) is increasing globally. Caregivers must provide highly individualized care, and there may be "information asymmetry" between families and support providers. Infrastructure disruptions during disasters, such as power outages and communication failures, threaten the survival of CMC. This study aimed to estimate the independent effect (after adjusting for daily confounding factors) of requiring advanced respiratory support (ARS) on three types of disaster-related anxiety. METHODS: A cross-sectional online survey was conducted from August to October 2025, targeting caregivers of CMC via a nationwide support network in Japan. Participants were categorized into an ARS group (requiring invasive/non-invasive ventilation, high-flow nasal cannula, or frequent suctioning) and a non-ARS group. Anxiety was assessed across three domains: (1) accurate transmission of information to medical professionals met for the first time, (2) transmission of information in situations where communication methods are unavailable, and (3) continuity of care during power outages. With ARS as the primary independent variable, binomial logistic regression was performed to calculate adjusted odds ratios (AOR), controlling for covariates, including caregiver and child ages, evacuation method difficulty, and daily information-sharing satisfaction. RESULTS: Data from 279 caregivers were analyzed (child mean age: 9.5 ± 7.0 years). Binomial logistic regression showed that requiring ARS had a significant independent effect on anxiety about the accurate transmission of information to medical professionals met for the first time (AOR: 2.60; 95% confidence interval [CI]: 1.13-5.99; p = 0.025) and continuity of care during power outages (AOR: 5.87; 95% CI: 2.99-11.52; p < 0.001), but not for situations where communication methods were unavailable. CONCLUSIONS: Caregivers of CMC requiring ARS experience significantly greater anxiety during disasters, caregivers of CMC requiring ARS experience significantly greater anxiety about communicating information to medical professionals and continuity of care. To ensure CMC safety, transitioning to digital personal health records to complement oral and paper-based methods should be considered. Bridging these information gaps may reduce caregiver anxiety and facilitate rapid triage during emergencies.