Disproportionately High Rates of Burnout Among Disabled Caregivers During the COVID-19 Pandemic

Disproportionately High Rates of Burnout Among Disabled Caregivers During the COVID-19 Pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Disproportionately High Rates of Burnout Among Disabled Caregivers During the COVID-19 Pandemic Samantha Streuli, Imani Beckett, Marlene Flores, Vinton Omaleki, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4391256/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Burnout is exhaustion caused by exposure to chronic stress. Prior to the COVID-19 pandemic, people with disabilities experienced high levels of burnout due to discrimination, barriers to accessing resources, and lack of accommodations. Caregivers have also experienced high levels of burnout during the COVID-19 pandemic. Background While researchers have examined burnout among caregivers of disabled children, less research has focused on the experiences of disabled caregivers. We examined the association between caregiver disability and burnout during the pandemic. Methods We distributed an online survey to caregivers of children enrolled in socially vulnerable elementary and middle schools in San Diego County, California between September and December, 2022. Our survey included demographic questions, questions about pandemic experiences, and a continuous burnout measure. We analyzed survey data to test our hypothesis that caregivers with a disability experienced higher levels of burnout than their non-disabled counterparts during the height of the COVID-19 pandemic. We used multivariable linear regression analysis adjusting for household income and caregiver education level. Results Disabled caregivers self-reported higher levels of burnout than non-disabled caregivers ( B = 0.72; p < 0.001) during the COVID-19 pandemic in bivariate and multivariable analyses. Caregivers with a higher household income ( B = 0.04; p = 0.017) and more education ( B = 0.13; p = 0.005) also reported higher levels of burnout. Conclusion The COVID-19 pandemic exacerbated existing difficulties faced by disabled caregivers who often struggle to balance the demands of caregiving with their available resources. Targeted programs and policies are needed to support disabled caregivers during health emergencies that exacerbate existing inequities in access to resources. burnout caregiving COVID-19 disability Background The concept of burnout has been used colloquially by people in the United States (US) to describe the social problem of exhaustion caused by chronic stress since at least the 1970s [ 1 ]. While people initially used burnout to talk about labor issues, it has remained part of the broader public discourse on stress and exhaustion, and has been frequently used in recent years to describe the impact of COVID-19 on mental health [ 2 – 4 ]. Within the context of scholarly research, burnout has been used to understand people’s experiences with work, caregiving, disability, and more [ 5 – 7 ]. Burnout has been associated with factors such as lower levels of education, lower socioeconomic status, racial and ethnic marginalization, and lack of community and structural support [ 7 , 8 – 11 ]. Although there is no current consensus among researchers on the definition, etiology, or measurement of burnout, most definitions converge on the idea that burnout results from a general imbalance between demands and resources [ 12 ]. Thus, our working definition of burnout within this article is focused on this imbalance of resources and demands. Studies of caregiver burnout have found that caregivers experiencing burnout are more emotionally distant from their children, more physically and mentally exhausted, and experience greater feelings of inadequacy in caregiving abilities compared to those without burnout [ 12 ]. While both mothers and fathers have been found to experience caregiver burnout, there is a higher rate of caregiver burnout among mothers on average [13}. During the COVID-19 pandemic, caregivers experienced increasing demands on their time and the necessity to engage in more risk-mitigation activities. At the same time, many caregivers also lost access to social support and financial resources during the pandemic, which required them to “do more with less” and resulted in higher rates of caregiver burnout [ 14 ]. Some researchers have found that caregivers of children with disabilities report higher rates of burnout, which may be mitigated by greater social support [ 15 , 16 ]. During the COVID-19 pandemic, caregivers of children with disabilities also reported increased challenges due to lack of structural and community support [ 11 ]. Disabled people in the US experience significant challenges due to factors such as systemic ableism [ 17 ]. These issues are further compounded for disabled people who are impacted by other forms of oppression due to their social identities. For example, women and people with Hispanic ancestry are more likely to be disabled in comparison to men and non-Hispanic white people [ 18 , 19 ]. Disabled people are also more likely to have less education and lower household incomes, leading to particular challenges with accessing resources [ 20 , 21 ]. Despite the direct impact of these stressors on disabled people, existing research predominantly focuses on disabled people as a cause of burnout in others (e.g. caregivers, employers) [ 7 ]. This has been a particularly prominent aspect of research on caregiver burnout, which often emphasizes the increased challenges and burnout that non-disabled caregivers experience when caring for disabled children [ 22 , 23 ]. During the COVID-19 pandemic, disabled people experienced significant psychological stress due to increased exposure to illness as well as heightened institutional and interpersonal discrimination [ 24 ]. Disabled people also experienced greater challenges in accessing their basic needs during the COVID-19 pandemic [ 25 ]. Despite the increasing challenges faced by disabled people and caregivers during the pandemic, there is little current research on the impact of COVID-19 on disabled caregivers. This project seeks to understand whether disabled caregivers experienced higher rates of burnout during the COVID-19 pandemic compared to non-disabled caregivers. Methods Sample Data included in these analyses were collected as part of the Safer at School Early Alert (SASEA) project. Between Fall 2020 and Spring 2022, SASEA researchers analyzed wastewater to track rates of COVID-19 infection in elementary and middle schools in San Diego County, California that were identified as socially vulnerable according to the California Healthy Places Index [26]. The SASEA project discontinued wastewater testing at schools in late 2022 and began to focus on providing other COVID-19 resources to socially vulnerable schools in San Diego County. Research during this period included surveying caregivers of children attending SASEA schools to elucidate their attitudes, perceptions, and experiences during the pandemic. Further project details are available elsewhere [25, 27]. The sample was drawn from 30 elementary and middle schools that had participated in the SASEA project. Every two weeks between September and December 2022, the SASEA team sent flyers to caregivers from participating SASEA schools via email with a link to a self-administered online survey. The SASEA team also printed physical copies of flyers and distributed them to schools. All caregivers were allowed to participate and those who participated were offered entry into a raffle for a $100 gift card. Surveys and flyers were available in English and Spanish. Caregivers were provided with a phone number to call if they preferred to complete the survey over the phone with a trained, bilingual (English/Spanish) research assistant. All participants provided signed or verbal consent, and all research procedures were reviewed and cleared by the [ANONYMIZED FOR REVIEW] Institutional Review Board (IRB). Measures Primary Outcome: Caregiver burnout was measured using a single survey item which asked, “Overall, based on your definition of burnout, how would you rate your level of burnout?” Possible answers ranged from 1-5, where 1 indicated low/no burnout (“I enjoy my daily activities. I have no symptoms of burnout.”) and 5 indicated very high burnout (“I feel completely burned out and often wonder if I can go on. I am at the point where I may need some change or may need to seek some sort of help.”). This is a validated single-item measure of burnout developed by Rohland and colleagues as an alternative to the Maslach Burnout Inventory [28]. For this analysis, burnout was treated as a continuous variable with values ranging from 1-5. Primary Predictor: Caregiver disability status was measured using the Global Activities Limitations Indicator (GALI) [29], a validated single survey item that asks participants to self-report: “For at least the past 6 months, to what extent have you or someone in your household been limited because of a health problem in the activities people usually do? Severely limited? Limited but not severely? Or not limited at all?” Participants who indicated any limitation were then asked to indicate whether the individual with limited ability was themselves, a child under age 18, an adult aged 18-65, or an adult over age 65. We created a binary variable where caregivers who identified themselves as being either “severely limited” or “limited but not severely” were categorized as “disabled” (1) and caregivers who indicated no limitations were categorized as “not disabled” (0). Demographics & Potential Confounders Caregivers were asked to report their gender as Male, Female, or Non-Binary. Because less than 1% of caregivers (n=1) reported being Non-Binary, we excluded the Non-Binary participant from analyses and dichotomized gender into Male and Female. Caregivers were asked to report their highest level of education from four possible categories: Some High School, High school, Bachelors, or Graduate Degree. Participants were asked to report their household income before taxes in 2021 on an ordinal scale ranging from Less than $15,000 to Over $100,000. Child’s race and ethnicity were based on caregiver reporting. Race categories included American Indian or Alaskan Native, Black or African American, Asian, Native Hawaiian or Pacific Islander, White, and Other. Ethnicity was coded as a binary variable for Hispanic and non-Hispanic. Analyses We first conducted descriptive analysis of caregiver gender, child’s reported race and ethnicity, household income, and caregiver education level. Next, we conducted bivariate tests between our main outcome of interest (burnout), our primary predictor (caregiver disability), and hypothesized confounders. We used Student’s t-tests to look for associations between caregiver burnout and binary variables (caregiver disability status, caregiver gender, and child’s ethnicity) and one-way Analysis of Variance (ANOVA) to look at the relationship between caregiver burnout and variables with more than two categories (household income, race, and caregiver education level) (Table 1). We then assessed associations between covariates and the primary predictor variable (caregiver disability) using chi-square analyses (Table 2). Finally, we ran a series of ordinary least squares (OLS) regression analyses to examine relationships between burnout scores and caregiver disability adjusting for potential confounders. We performed regression validation by checking for linearity and looked at residual and fitted plots for our model to ensure that the mean of distribution errors was zero. Results of regression analyses were used to build a final multivariable model including variables significantly associated with burnout (Table 3). Results Sample Demographics A total of 763 individuals responded to the survey, 20% of whom identified as disabled. The majority of participants (87.7%) identified as female while 12.3% identified as male. Most participants (55.8%) had a high school education or less. Seventy-eight percent of participants identified their child’s ethnicity as Hispanic. The mean burnout score for the full sample was 2.1 (SD 1.0) on a scale of 1 (low/no burnout) to 5 (high burnout). Bivariate Analyses Caregivers with a disability reported significantly higher burnout scores (2.66) compared to caregivers without a disability (1.96; p < 0.001) (Table 1 ). Higher burnout scores were significantly associated with both higher income and higher caregiver education levels. Caregiver gender showed no significant association with burnout scores. Caregivers without a disability were significantly more likely to report an income above the full sample mean ( $ 35,000- $ 49,999) in comparison to caregivers with a disability (p = 0.02). No other covariates showed significant associations with caregiver disability status in these analyses (Table 2 ). Multivariable Regression Analysis Using multivariable linear regression analysis to control for potential confounders, we found that caregiver disability was independently associated with higher burnout scores ( b = 0.72; p < 0.001). Higher household income and higher levels of caregiver education also remained associated with higher rates of burnout, but other covariates did not and were excluded from the final model (Table 3 ). Discussion We found that disabled caregivers reported higher rates of burnout during the COVID-19 pandemic than non-disabled caregivers even after controlling for potential confounders. Previous literature on burnout in relation to disability has often focused on how being a caregiver to a disabled person can cause burnout [ 7 , 15 , 16 ]. However, researchers have recently begun to focus on how disabled people themselves may experience burnout, with a particular emphasis on “autistic burnout” [ 30 ]. To better understand the unique experiences of disabled people, researchers have suggested using minority stress models to examine burnout among disabled people because these models can address the imbalance between demands and resources as well as experiences of discrimination, internalized stigma, and social limitations that lead to increased burnout [ 31 – 33 ]. Disabled caregivers in particular may face significant demands that they are unable to meet due to lack of access to necessary support, which may increase burnout [ 25 , 34 ]. While we know that the COVID-19 pandemic has increased demands upon caregivers and led to greater caregiver burnout [ 14 ], our work shows that disabled caregivers have been especially impacted during the pandemic. Popular discourse surrounding disability often frames it as a “burden,” not only to the disabled person themself but to their broader care network, medical and social service systems, and the economy [ 35 , 36 ]. This framing can lead to the perception that the disabled individual is a burden and that their basic needs are only worth meeting if they do not constitute any “undue burden” on able-bodied people [ 37 ]. Various studies on caregivers of disabled children have emphasized the additional burden of caring for a disabled child, often focusing on poor physical and mental health outcomes for caregivers [ 22 , 23 , 38 ]. Regardless of their intention, these approaches to disability and caregiving can contribute to stigmatizing narratives of disability as a burden, particularly when comparing caregivers of disabled children to caregivers of non-disabled children [ 39 ]. While some disabled people may indeed feel burdened by the management of their symptoms and care, disability justice approaches highlight the fact that living in an ableist society where one is faced with interpersonal microaggressions and significant structural barriers to resource navigation also has a substantial impact on the opportunities, resources, and outcomes of disabled people [ 35 , 40 ]. Similarly, disability justice has emphasized that disabled people are often caregivers as well as recipients of care, which complicates the traditional narrative of disabled people as merely “burdensome” recipients of care [ 41 ]. The current research study provides further illustration of the fact that disabled caregivers have been unduly burdened during COVID-19. It was somewhat unexpected that higher-income caregivers with more education reported more burnout in our study given that higher incomes and education can increase access to resources and reduce burnout [ 9 ]. Disabled caregivers within our sample also reported lower mean incomes than non-disabled caregivers, which we expected could contribute to burnout. One potential explanation for higher rates of burnout among higher-income caregivers during COVID-19 could be the greater number of middle to high-income caregivers working from home and taking on additional childcare during COVID-19 while continuing to work from home [ 42 ]. Additionally, higher-income caregivers may have been more likely to take on additional tasks to compensate for COVID-19 impacts on their children such as spending more time finding and coordinating alternative educational options during school closures [ 43 ]. These additional tasks may have contributed to the imbalance between resources and demands among higher-income caregivers. It is also possible that highly educated and higher income parents lacked familiarity with the already-limited assistance programs that exist to support those with fewer resources, and may have struggled with accessing them during the pandemic. More intersectional research is warranted to understand how struggles to balance resources and demands are specifically impacted by health emergencies, particularly for disabled individuals and other people who may be privileged in some areas (e.g. higher socioeconomic status) but marginalized in others. Limitations and Future Research While previous research on caregiver burnout has focused on the gendered dynamics of this phenomenon [ 13 ], the sample for this study consisted mostly of women, making it difficult to produce a robust analysis of how burnout may vary according to caregiver gender. Our survey also did not include questions on relationship status or co-parenting, which could have a substantial impact on caregiver burnout [ 44 ]. Additionally, our measures of children’s race and ethnicity were based only on caregiver reporting, and we did not have a broad representation of all racial and ethnic categories. Previous research reporting racial and ethnic differences in disability and caregiver stress suggests that further analyses on a more racially and ethnically diverse sample are warranted [ 45 , 46 ]. If we are to gain a better understanding of burnout and inequity, using minority stress models that also measure exposures to structural racism and other forms of discrimination may be a useful approach [ 7 , 15 , 16 , 47 ]. There has been a substantial amount of research on measuring burnout [ 5 – 7 , 44 ]. However, more work is needed to examine how burnout might be understood, used, and interpreted across cultural and linguistic groups and how this concept can be applied to experiences beyond work and caregiving [ 7 , 48 ]. Our study consisted of only one burnout measure emphasizing the way that caregivers themselves interpreted the term “burnout.” Future research on burnout could use qualitative approaches to determine a contextually specific definition of the term prior to conducting surveys. Research could also emphasize determining a more appropriate term to examine the imbalance between resources and demands among populations of interest. Additionally, previous research on reducing caregiver burnout has focused primarily on individual caregiver behavioral changes such as emotional regulation and self-compassion to reduce burnout [ 49 , 51 ]. Future studies of burnout among disabled and other marginalized caregivers should consider not only these individual behaviors, but structural ableism and racism and how this can impact caregiver burnout. We used the Global Activities Limitations Indicator (GALI) 29 to determine disability status. While the GALI is a useful indicator of disability status according to perceived limitations, there are other ways to measure disability that may provide more detailed information on individual experiences and specific barriers [ 52 ]. More research is needed to determine how specific disability experiences may differentially impact burnout for disabled caregivers. Future studies can also make use of minority stress models to better measure and understand the various factors that contribute to burnout among disabled caregivers [ 7 ]. Conclusions Disabled caregivers had higher rates of burnout than non-disabled caregivers during the COVID-19 pandemic. While disabled people are often framed as recipients of resources and care, it is important to also recognize their roles as caregivers who are impacted by interpersonal and structural ableism while trying to balance the demands of caregiving with their available resources. More programs and policies are needed to support disabled caregivers, especially during health emergencies that exacerbate existing inequities in access to resources. Abbreviations SASEA – Safer at School Early Alert GALI – Global Activity Limitations Indicator ANOVA – Analysis of Variance OLS – Ordinary Least Squares Declarations Ethics Approval and Consent to Participate All participants provided signed or verbal consent, and all research procedures were reviewed and cleared by the University of California San Diego Institutional Review Board (IRB) Protocol # 800612. Consent for Publication Not Applicable Availability of Data and Materials To maintain participant privacy and anonymity, data are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This work was supported by funding from the National Institutes of Health (1U01HD108787-01, 5K01MH112436–05, T32AI007384) and the San Diego Health & Human Services Agency (Project #2002967). The funders had no direct role in conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript. Author’s Contributions RFM was responsible for funding acquisition; SS and RFM were responsible for conception and design of the work; RFM, MF, VO, AH, and TL were responsible for data collection and management; IB, SS, and RFM conducted data analyses and drafted the manuscript; RG provided assistance with data analyses and interpretations; IB, SS, RFM, MF, VO, AH, RG, and TL contributed to data interpretation and manuscript reviewing and revisions. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank the San Diego Health & Human Services Agency for their vision and leadership. We would also like to thank the community members who participated in this research for sharing their time and expertise. References Maslach C, Schaufeli WB. Historical and conceptual development of burnout. In: Professional burnout: Recent developments in theory and research. CRC Press; 2018. p. 1-16. Joy R. COVID Fatigue: How to cope with pandemic burnout. Healthline. 2021 Oct 18. Available from: https://www.healthline.com/health/mental-health/covid-fatigue Yıldırım M, Solmaz F. COVID-19 burnout, COVID-19 stress and resilience: Initial psychometric properties of COVID-19 Burnout Scale. Death Stud. 2022;46(3):524-32. Saey TH. Why Pandemic Fatigue and COVID-19 Burnout Took Over in 2022. ScienceNews. 2022 Dec 9. Available from: https://www.sciencenews.org/article/pandemic-fatigue-end-covid-19-burnout-2022 Shoman Y, Rousson V, Bianchi R, Guseva Canu I. Holistic Assessment of Factors Associated with Exhaustion, the Main Symptom of Burnout: A Meta-Analysis of Longitudinal Studies. Int J Environ Res Public Health. 2022;19(20):13037. Roskam I, Raes ME, Mikolajczak M. Exhausted caregivers: Development and Preliminary Validation of the parental Burnout Inventory. Front Psychol. 2017;8:163. Wolbring G, Lillywhite A. Burnout through the Lenses of Equity/Equality, Diversity and Inclusion and Disabled People: A Scoping Review. Societies. 2023;13(5):131. Rashkovits S, Livne Y. The effect of education level on psychological empowerment and burnout-the mediating role of workplace learning behaviors. Int J Psychol Behav Sci. 2013;7(6):1896-1901. Roskam I, Vancorenland S, Avalosse H, Mikolajczak M. The missing link between poverty and child maltreatment: parental burnout. Child Abuse Negl. 2022;134:105908. Gorski PC. Fighting racism, battling burnout: Causes of activist burnout in US racial justice activists. Ethn Racial Stud. 2019;42(5):667-87. Seo JH, Kim HK. What is the burnout of mothers with infants and toddlers during the COVID-19 pandemic? in relation to parenting stress, depression, and parenting efficacy. Int J Environ Res Public Health. 2022;19(7):4291. Mikolajczak M, Roskam I. A Theoretical and Clinical Framework for parental Burnout: The Balance Between Risks and Resources (BR2). Front Psychol. 2018;9:886. Roskam I, Mikolajczak M. Gender differences in the nature, antecedents and consequences of parental burnout. Sex Roles. 2020;83(7-8):485-98. Griffith AK, Bedard KE, Eaton A, Ackerlund Brandt JA, Jha P. Effects of the COVID-19 Pandemic on parental Burnout and parenting Practices: Analyses Using a Retrospective Pretest. Chronic Stress (Thousand Oaks). 2022;6:24705470221114059. Weiss MJ. Hardiness and social support as predictors of stress in mothers of typical children, children with autism, and children with mental retardation. Autism: Int J Res Pract. 2002;6(1):115-30. Lindström C, Aman J, Norberg AL. Increased prevalence of burnout symptoms in parents of chronically ill children. Acta Paediatr (Oslo, Norway: 1992). 2010;99(3):427-32. Bogart KR, Dunn DS. Ableism special issue introduction. J Soc Issues. 2019;75(3):650-64. World Health Organization. World report on disability 2011. World Health Organization; 2011. Hayward MD, Hummer RA, Chiu CT, González-González C, Wong R. Does the Hispanic paradox in US adult mortality extend to disability? Popul Res Policy Rev. 2014;33:81-96. Schur L, Han K, Kim A, Ameri M, Blanck P, Kruse D. Disability at work: A look back and forward. J Occup Rehabil. 2017;27:482-97. Parish SL, Grinstein-Weiss M, Yeo YH, Rose RA, Rimmerman A. Assets and income: Disability-based disparities in the United States. Soc Work Res. 2010;34(2):71-82. Young E, Milligan K, Henze M, Johnson S, Weyman K. Caregiver burnout, gaps in care, and COVID-19: Effects on families of youth with autism and intellectual disability. Can Fam Physician. 2021;67(7):506-8. Hochman Y, Shpigelman CN, Holler R, Werner S. “Together in a pressure cooker”: parenting children with disabilities during the COVID-19 lockdown. Disabil Health J. 2022;15(3):101273. Brown RL, Ciciurkaite G. Disability, Discrimination, and Mental Health during the COVID-19 Pandemic: A Stress Process Model. Soc Ment Health. 2022;12(3):215-29. Streuli S, Garfein RS, Gaines T, Fielding-Miller R. COVID-19 disproportionately impacts access to basic needs among households with disabled members. Disabil Health J. 2023;16(2):101443. Public Health Alliance of Southern California. California Healthy Places Index. 2019. Available from: https://healthyplacesindex.org. Fielding-Miller R, Karthikeyan S, Gaines T, Garfein RS, Salido RA, Cantu VJ, et al. Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools. Lancet Reg Health–Am. 2023;19. Rohland BM, Kruse GR, Rohrer JE. Validation of a single‐item measure of burnout against the Maslach Burnout Inventory among physicians. Stress Health. 2004;20(2):75-9. Van Oyen H, Bogaert P, Yokota RT, Berger N. Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI). Arch Public Health. 2018;76:1-11. Raymaker DM, Teo AR, Steckler NA, Lentz B, Scharer M, Delos Santos A, et al. “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism Adulthood. 2020;2(2):132-43. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674. Lund EM. Examining the potential applicability of the minority stress model for explaining suicidality in individuals with disabilities. Rehabil Psychol. 2021;66(2):183. Franks N, Mullens AB, Aitken S, Brömdal A. Fostering Gender-IQ: Barriers and Enablers to Gender-affirming Behavior Amongst an Australian General Practitioner Cohort. J Homosex. 2022;1-24. DeZelar S, Lightfoot E. Parents With Disabilities: A Case Study Exploration of Support Needs and the Potential of a Supportive Intervention. Fam Soc. 2019;100(3):293-304. Taylor S. Beasts of burden: Animal and disability liberation. The New Press; 2017. Lero D, Pletsch C, Hilbrecht M. Introduction to the special issue on disability and work: Toward re-conceptualizing the'burden'of disability. Disabil Stud Q. 2012;32(3). Montague-Asp H, Piepzna-Samarasinha LL, Shlasko D, Siegel LL. Ableism and Disability Justice. Teaching Divers Soc Justice. Baker BL, Blacher J, Olsson MB. Preschool children with and without developmental delay: behaviour problems, parents’ optimism and well-being. J Intellect Disabil Res. 2005;49(8):575-90. Bixby LE. Disability Is Not a Burden: The Relationship between Early Childhood Disability and Maternal Health Depends on Family Socioeconomic Status. J Health Soc Behav. 2023;00221465231167560. Jóhannsdóttir Á, Egilson S Þ, Haraldsdóttir F. Implications of internalised ableism for the health and wellbeing of disabled young people. Sociol Health Illn. 2022;44(2):360-76. Piepzna-Samarasinha LL. Care work: Dreaming disability justice. arsenal pulp press; 2018. Wang MT, Henry DA, Del Toro J, Scanlon CL, Schall JD. COVID-19 employment status, dyadic family relationships, and child psychological well-being. J Adolesc Health. 2021;69(5):705-12. Bacher-Hicks A, Goodman J, Mulhern C. Inequality in household adaptation to schooling shocks: Covid-induced online learning engagement in real time. J Public Econ. 2021;193:104345. Roskam I, Brianda ME, Mikolajczak M. A step forward in the conceptualization and measurement of parental burnout: The parental Burnout Assessment (PBA). Front Psychol. 2018;9:758. Nam Y, Wikoff N, Sherraden M. Racial and ethnic differences in parenting stress: Evidence from a statewide sample of new mothers. J Child Fam Stud. 2015;24(2):278-88. Goyat R, Vyas A, Sambamoorthi U. Racial/ethnic disparities in disability prevalence. J Racial Ethn Health Disparities. 2016;3:635-45. Lett E, Asabor E, Beltrán S, Cannon AM, Arah OA. Conceptualizing, contextualizing, and operationalizing race in quantitative health sciences research. Ann Fam Med. 2022;20(2):157-63. Schaufeli WB. Burnout: A short socio-cultural history. In: Burnout, fatigue, exhaustion: An interdisciplinary perspective on a modern affliction. 2017. p. 105-127. Nguyen TM, Nguyen AH, Tran PTT, Vo HTP. Self‐compassion reduces parental burnout: Mediation roles of parental psychological control and support. Personal Relationships. 2023;30(1):262-77. Swit CS, Breen R. Parenting during a pandemic: Predictors of parental burnout. J Fam Issues. 2023;44(7):1817-37. Urbanowicz AM, Shankland R, Rance J, Bennett P, Leys C, Gauchet A. Cognitive behavioral stress management for parents: Prevention and reduction of parental burnout. Int J Clin Health Psychol. 2023;23(4):100365. Sabariego C, Oberhauser C, Posarac A, Bickenbach J, Kostanjsek N, Chatterji S, et al. Measuring disability: comparing the impact of two data collection approaches on disability rates. Int J Environ Res Public Health. 2015;12(9):10329-51. Tables Table 1. Mean Burnout Scores by Covariates of Interest Among caregivers of kids enrolled in socially vulnerable schools in San Diego County Mean Burnout Score* SD p-value Disability Status † Not Disabled Disabled 1.96 2.66 0.91 1.05 <0.001 Caregiver Gender Female Male 2.11 1.96 0.98 0.97 0.146 Household Income ‡ Less than 15K: 15-19,999K 20-24,999K 25-34,999K 35-49,999K 50-74,999K 75-99,999K 100k & above 1.87 1.86 2.16 2.20 1.82 2.21 2.19 2.31 0.91 1.09 1.26 1.03 0.79 0.99 0.97 0.90 0.001 Caregiver Education Level ‡ Some High School High School Bachelors Graduate 1.81 2.05 2.15 2.37 0.96 1.00 0.95 0.93 0.001 Child Race ‡ American Indian or Alaskan Native Black or African American Asian Native Hawaiian or Pacific Islander White Other 2.33 2.10 1.95 2.50 2.19 1.94 0.58 1.18 0.81 1.18 0.98 0.96 0.028 Child Ethnicity † Non-Hispanic Hispanic 2.24 2.02 0.98 0.97 0.003 *Burnout scores ranged from 1-5. †Statistically significant difference in Student’s t-tests. ‡Statistically significant difference in one-way ANOVA. Table 2. Disability Status and Covariates of Interest Among caregivers of kids enrolled in socially vulnerable schools in San Diego County Not Disabled (n=612) Disabled (n=151) Full Sample (n=763) Caregiver Gender Female Male 534 (87.3%) 78 (12.7%) 135 (89.4%) 16 (10.6%) 669 (87.7%) 94 (12.3%) Household Income* Less than 15K: 15-19,999K 20-24,999K 25-34,999K 35-49,999K 50-74,999K 75-99,999K 100k & above 45 (7.4%) 25 (4.1%) 31 (5.1%) 70 (11.5%) 92 (15.1%) 112 (18.4%) 52 (8.5%) 103 (16.9%) 23 (15.2%) 10 (6.6%) 7 (4.6%) 20 (13.2%) 16 (10.6%) 20 (13.2%) 20 (13.2%) 20 (13.2%) 68 (8.9%) 35 (4.6%) 38 (5.0%) 90 (11.8%) 108 (14.2%) 132 (17.4%) 72 (9.5%) 123 (16.2%) Caregiver Education Level Some High School High School Bachelors Graduate 57 (9.4%) 281 (46.4%) 190 (31.4%) 78 (12.9%) 17 (11.3%) 67 (44.7%) 45 (30.0%) 21 (14.0%) 74 (9.8%) 348 (46.0%) 235 (31.1%) 99 (13.1%) Child Race American Indian or Alaskan Native Black or African American Asian Native Hawaiian or Pacific Islander White Other 3 (0.5%) 40 (6.5%) 55 (9.0% 8 (1.3%) 316 (51.6%) 190 (31.0%) 0 (0.0%) 11 (7.3%) 11 (7.3%) 3 (2.0%) 90 (59.6%) 36 (23.8%) 3 (0.4%) 51 (6.7%) 66 (8.7%) 11 (1.4%) 406 (53.2%) 226 (29.6%) Child Ethnicity Non-Hispanic Hispanic 226 (37.8%) 372 (62.2%) 62 (41.3%) 88 (58.7%) 288 (38.5%) 460 (78.0%) *Statistically significant difference in chi-square analyses at a level of p<0.05. Table 3. Multivariable analysis of factors associated with burnout score among caregivers of kids enrolled in socially vulnerable schools in San Diego County b 95% CI p-value Disabled Caregiver (ref: not disabled) 0.72 0.55-0.90 <0.001 Household Income (ref: <15k) 0.04 0.01-0.08 0.017 Caregiver Education Level (ref: Some high school) 0.13 0.04-0.23 0.005 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4391256","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":302616731,"identity":"33cc6e93-41e1-45b2-899a-f7ae55d41d26","order_by":0,"name":"Samantha Streuli","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBADGTb2BiBlYEGUakaQWh42ngMgLRIkaGGQSABxiNAi3378+eOKisM8fJLPr274USDBwN/enYBXi8GZHMPGM2cO87BJ55Td7AE6TOLM2Q34tTDkMDY2toG1pN3gAWoxkMjFr0W+//nDxsZ/QC2SZ9Ju/iFGC8ONBMPGxgagFgn2Y7eJssXgxhvDmQ3H0oGBnMN2W8ZAgoegX+T70x98bKixlgMG3bObb/7YyPG39xJwGALwGIBJYpWDAPsDUlSPglEwCkbBCAIAos1FDSdzYGIAAAAASUVORK5CYII=","orcid":"","institution":"National Environmental Health Association","correspondingAuthor":true,"prefix":"","firstName":"Samantha","middleName":"","lastName":"Streuli","suffix":""},{"id":302616732,"identity":"de59a16c-baa6-4bdc-95c7-bce7239436a3","order_by":1,"name":"Imani Beckett","email":"","orcid":"","institution":"University of California San Diego","correspondingAuthor":false,"prefix":"","firstName":"Imani","middleName":"","lastName":"Beckett","suffix":""},{"id":302616733,"identity":"84a54339-e98c-4cee-bd32-510106477338","order_by":2,"name":"Marlene Flores","email":"","orcid":"","institution":"University of California San Diego","correspondingAuthor":false,"prefix":"","firstName":"Marlene","middleName":"","lastName":"Flores","suffix":""},{"id":302616734,"identity":"dd22b988-1a3e-4415-a154-a231d36c887f","order_by":3,"name":"Vinton Omaleki","email":"","orcid":"","institution":"University of California San Diego","correspondingAuthor":false,"prefix":"","firstName":"Vinton","middleName":"","lastName":"Omaleki","suffix":""},{"id":302616735,"identity":"fcd55882-2d19-4380-a640-c0ed43544665","order_by":4,"name":"Ashkan Hassani","email":"","orcid":"","institution":"University of California San Diego","correspondingAuthor":false,"prefix":"","firstName":"Ashkan","middleName":"","lastName":"Hassani","suffix":""},{"id":302616736,"identity":"1d9ae635-4762-42b6-ab2f-7fd3219d7ecb","order_by":5,"name":"Tina Le","email":"","orcid":"","institution":"University of California San Diego","correspondingAuthor":false,"prefix":"","firstName":"Tina","middleName":"","lastName":"Le","suffix":""},{"id":302616737,"identity":"747531fa-966f-49a6-81dc-3c6527fe76b3","order_by":6,"name":"Richard Garfein","email":"","orcid":"","institution":"University of California San Diego","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"","lastName":"Garfein","suffix":""},{"id":302616740,"identity":"434456a0-7d2a-42b6-835e-cb885237fc98","order_by":7,"name":"Rebecca Fielding-Miller","email":"","orcid":"","institution":"University of California San Diego","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Fielding-Miller","suffix":""}],"badges":[],"createdAt":"2024-05-08 19:53:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4391256/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4391256/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74144607,"identity":"f1d13b39-8cfd-40a5-84a8-4025812cd5d9","added_by":"auto","created_at":"2025-01-18 15:01:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":950139,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4391256/v1/9eb7ec7d-0edb-46ee-8f9d-42ed431ea900.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Disproportionately High Rates of Burnout Among Disabled Caregivers During the COVID-19 Pandemic","fulltext":[{"header":"Background","content":"\u003cp\u003eThe concept of burnout has been used colloquially by people in the United States (US) to describe the social problem of exhaustion caused by chronic stress since at least the 1970s [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While people initially used burnout to talk about labor issues, it has remained part of the broader public discourse on stress and exhaustion, and has been frequently used in recent years to describe the impact of COVID-19 on mental health [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Within the context of scholarly research, burnout has been used to understand people\u0026rsquo;s experiences with work, caregiving, disability, and more [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Burnout has been associated with factors such as lower levels of education, lower socioeconomic status, racial and ethnic marginalization, and lack of community and structural support [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Although there is no current consensus among researchers on the definition, etiology, or measurement of burnout, most definitions converge on the idea that burnout results from a general imbalance between demands and resources [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Thus, our working definition of burnout within this article is focused on this imbalance of resources and demands.\u003c/p\u003e \u003cp\u003eStudies of caregiver burnout have found that caregivers experiencing burnout are more emotionally distant from their children, more physically and mentally exhausted, and experience greater feelings of inadequacy in caregiving abilities compared to those without burnout [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. While both mothers and fathers have been found to experience caregiver burnout, there is a higher rate of caregiver burnout among mothers on average [13}. During the COVID-19 pandemic, caregivers experienced increasing demands on their time and the necessity to engage in more risk-mitigation activities. At the same time, many caregivers also lost access to social support and financial resources during the pandemic, which required them to \u0026ldquo;do more with less\u0026rdquo; and resulted in higher rates of caregiver burnout [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Some researchers have found that caregivers of children with disabilities report higher rates of burnout, which may be mitigated by greater social support [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. During the COVID-19 pandemic, caregivers of children with disabilities also reported increased challenges due to lack of structural and community support [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDisabled people in the US experience significant challenges due to factors such as systemic ableism [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These issues are further compounded for disabled people who are impacted by other forms of oppression due to their social identities. For example, women and people with Hispanic ancestry are more likely to be disabled in comparison to men and non-Hispanic white people [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Disabled people are also more likely to have less education and lower household incomes, leading to particular challenges with accessing resources [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Despite the direct impact of these stressors on disabled people, existing research predominantly focuses on disabled people as a \u003cem\u003ecause\u003c/em\u003e of burnout in others (e.g. caregivers, employers) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This has been a particularly prominent aspect of research on caregiver burnout, which often emphasizes the increased challenges and burnout that non-disabled caregivers experience when caring for disabled children [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. During the COVID-19 pandemic, disabled people experienced significant psychological stress due to increased exposure to illness as well as heightened institutional and interpersonal discrimination [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Disabled people also experienced greater challenges in accessing their basic needs during the COVID-19 pandemic [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Despite the increasing challenges faced by disabled people and caregivers during the pandemic, there is little current research on the impact of COVID-19 on disabled caregivers. This project seeks to understand whether disabled caregivers experienced higher rates of burnout during the COVID-19 pandemic compared to non-disabled caregivers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData included in these analyses were collected as part of the Safer at School Early Alert (SASEA) project. Between Fall 2020 and Spring 2022, SASEA researchers analyzed wastewater to track rates of COVID-19 infection in elementary and middle schools in San Diego County, California that were identified as socially vulnerable according to the California Healthy Places Index [26]. The SASEA project discontinued wastewater testing at schools in late 2022 and began to focus on providing other COVID-19 resources to socially vulnerable schools in San Diego County. Research during this period included surveying caregivers of children attending SASEA schools to elucidate their attitudes, perceptions, and experiences during the pandemic. Further project details are available elsewhere [25, 27].\u003c/p\u003e\n\u003cp\u003eThe sample was drawn from 30 elementary and middle schools that had participated in the SASEA project. Every two weeks between September and December 2022, the SASEA team sent flyers to caregivers from participating SASEA schools via email with a link to a self-administered online survey. The SASEA team also printed physical copies of flyers and distributed them to schools. All caregivers were allowed to participate and those who participated were offered entry into a raffle for a $100 gift card. Surveys and flyers were available in English and Spanish. Caregivers were provided with a phone number to call if they preferred to complete the survey over the phone with a trained, bilingual (English/Spanish) research assistant. All participants provided signed or verbal consent, and all research procedures were reviewed and cleared by the [ANONYMIZED FOR REVIEW] Institutional Review Board (IRB).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMeasures\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePrimary Outcome:\u003c/u\u003e Caregiver burnout was measured using a single survey item which asked, “Overall, based on your definition of burnout, how would you rate your level of burnout?” Possible answers ranged from 1-5, where 1 indicated low/no burnout (“I enjoy my daily activities. I have no symptoms of burnout.”) and 5 indicated very high burnout (“I feel completely burned out and often wonder if I can go on. I am at the point where I may need some change or may need to seek some sort of help.”). This is a validated single-item measure of burnout developed by Rohland and colleagues as an alternative to the Maslach Burnout Inventory [28]. For this analysis, burnout was treated as a continuous variable with values ranging from 1-5.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePrimary Predictor:\u003c/u\u003e Caregiver disability status was measured using the Global Activities Limitations Indicator (GALI) [29], a validated single survey item that asks participants to self-report: “For at least the past 6 months, to what extent have you or someone in your household been limited because of a health problem in the activities people usually do? Severely limited? Limited but not severely? Or not limited at all?” Participants who indicated any limitation were then asked to indicate whether the individual with limited ability was themselves, a child under age 18, an adult aged 18-65, or an adult over age 65. We created a binary variable where caregivers who identified themselves as being either “severely limited” or “limited but not severely” were categorized as “disabled” (1) and caregivers who indicated no limitations were categorized as “not disabled” (0).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDemographics \u0026amp; Potential Confounders\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eCaregivers were asked to report their gender as Male, Female, or Non-Binary. Because less than 1% of caregivers (n=1) reported being Non-Binary, we excluded the Non-Binary participant from analyses and dichotomized gender into Male and Female. Caregivers were asked to report their highest level of education from four possible categories: Some High School, High school, Bachelors, or Graduate Degree. Participants were asked to report their household income before taxes in 2021 on an ordinal scale ranging from Less than $15,000 to Over $100,000. Child’s race and ethnicity were based on caregiver reporting. Race categories included American Indian or Alaskan Native, Black or African American, Asian, Native Hawaiian or Pacific Islander, White, and Other. Ethnicity was coded as a binary variable for Hispanic and non-Hispanic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnalyses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe first conducted descriptive analysis of caregiver gender, child’s reported race and ethnicity, household income, and caregiver education level. Next, we conducted bivariate tests between our main outcome of interest (burnout), our primary predictor (caregiver disability), and hypothesized confounders.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe used Student’s t-tests to look for associations between caregiver burnout and binary variables (caregiver disability status, caregiver gender, and child’s ethnicity) and one-way Analysis of Variance (ANOVA) to look at the relationship between caregiver burnout and variables with more than two categories (household income, race, and caregiver education level) (Table 1). We then assessed associations between covariates and the primary predictor variable (caregiver disability) using chi-square analyses (Table 2).\u003c/p\u003e\n\u003cp\u003eFinally, we ran a series of ordinary least squares (OLS) regression analyses to examine relationships between burnout scores and caregiver disability adjusting for potential confounders. We performed regression validation by checking for linearity and looked at residual and fitted plots for our model to ensure that the mean of distribution errors was zero. Results of regression analyses were used to build a final multivariable model including variables significantly associated with burnout (Table 3).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSample Demographics\u003c/h2\u003e \u003cp\u003eA total of 763 individuals responded to the survey, 20% of whom identified as disabled. The majority of participants (87.7%) identified as female while 12.3% identified as male. Most participants (55.8%) had a high school education or less. Seventy-eight percent of participants identified their child\u0026rsquo;s ethnicity as Hispanic. The mean burnout score for the full sample was 2.1 (SD 1.0) on a scale of 1 (low/no burnout) to 5 (high burnout).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBivariate Analyses\u003c/h2\u003e \u003cp\u003eCaregivers with a disability reported significantly higher burnout scores (2.66) compared to caregivers without a disability (1.96; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Higher burnout scores were significantly associated with both higher income and higher caregiver education levels. Caregiver gender showed no significant association with burnout scores.\u003c/p\u003e \u003cp\u003eCaregivers without a disability were significantly more likely to report an income above the full sample mean (\u003cspan\u003e$\u003c/span\u003e35,000-\u003cspan\u003e$\u003c/span\u003e49,999) in comparison to caregivers with a disability (p\u0026thinsp;=\u0026thinsp;0.02). No other covariates showed significant associations with caregiver disability status in these analyses (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eMultivariable Regression Analysis\u003c/h2\u003e \u003cp\u003eUsing multivariable linear regression analysis to control for potential confounders, we found that caregiver disability was independently associated with higher burnout scores (\u003cem\u003eb\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.72; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Higher household income and higher levels of caregiver education also remained associated with higher rates of burnout, but other covariates did not and were excluded from the final model (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe found that disabled caregivers reported higher rates of burnout during the COVID-19 pandemic than non-disabled caregivers even after controlling for potential confounders.\u003c/p\u003e \u003cp\u003ePrevious literature on burnout in relation to disability has often focused on how being a caregiver to a disabled person can cause burnout [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, researchers have recently begun to focus on how disabled people themselves may experience burnout, with a particular emphasis on \u0026ldquo;autistic burnout\u0026rdquo; [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. To better understand the unique experiences of disabled people, researchers have suggested using minority stress models to examine burnout among disabled people because these models can address the imbalance between demands and resources as well as experiences of discrimination, internalized stigma, and social limitations that lead to increased burnout [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Disabled caregivers in particular may face significant demands that they are unable to meet due to lack of access to necessary support, which may increase burnout [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. While we know that the COVID-19 pandemic has increased demands upon caregivers and led to greater caregiver burnout [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], our work shows that disabled caregivers have been especially impacted during the pandemic.\u003c/p\u003e \u003cp\u003ePopular discourse surrounding disability often frames it as a \u0026ldquo;burden,\u0026rdquo; not only to the disabled person themself but to their broader care network, medical and social service systems, and the economy [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This framing can lead to the perception that the disabled individual is a burden and that their basic needs are only worth meeting if they do not constitute any \u0026ldquo;undue burden\u0026rdquo; on able-bodied people [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Various studies on caregivers of disabled children have emphasized the additional burden of caring for a disabled child, often focusing on poor physical and mental health outcomes for caregivers [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Regardless of their intention, these approaches to disability and caregiving can contribute to stigmatizing narratives of disability as a burden, particularly when comparing caregivers of disabled children to caregivers of non-disabled children [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. While some disabled people may indeed feel burdened by the management of their symptoms and care, disability justice approaches highlight the fact that living in an ableist society where one is faced with interpersonal microaggressions and significant structural barriers to resource navigation also has a substantial impact on the opportunities, resources, and outcomes of disabled people [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Similarly, disability justice has emphasized that disabled people are often caregivers as well as recipients of care, which complicates the traditional narrative of disabled people as merely \u0026ldquo;burdensome\u0026rdquo; recipients of care [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The current research study provides further illustration of the fact that disabled caregivers have been unduly burdened during COVID-19.\u003c/p\u003e \u003cp\u003eIt was somewhat unexpected that higher-income caregivers with more education reported more burnout in our study given that higher incomes and education can increase access to resources and reduce burnout [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Disabled caregivers within our sample also reported lower mean incomes than non-disabled caregivers, which we expected could contribute to burnout. One potential explanation for higher rates of burnout among higher-income caregivers during COVID-19 could be the greater number of middle to high-income caregivers working from home and taking on additional childcare during COVID-19 while continuing to work from home [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Additionally, higher-income caregivers may have been more likely to take on additional tasks to compensate for COVID-19 impacts on their children such as spending more time finding and coordinating alternative educational options during school closures [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. These additional tasks may have contributed to the imbalance between resources and demands among higher-income caregivers. It is also possible that highly educated and higher income parents lacked familiarity with the already-limited assistance programs that exist to support those with fewer resources, and may have struggled with accessing them during the pandemic. More intersectional research is warranted to understand how struggles to balance resources and demands are specifically impacted by health emergencies, particularly for disabled individuals and other people who may be privileged in some areas (e.g. higher socioeconomic status) but marginalized in others.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Research\u003c/h2\u003e \u003cp\u003eWhile previous research on caregiver burnout has focused on the gendered dynamics of this phenomenon [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], the sample for this study consisted mostly of women, making it difficult to produce a robust analysis of how burnout may vary according to caregiver gender. Our survey also did not include questions on relationship status or co-parenting, which could have a substantial impact on caregiver burnout [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Additionally, our measures of children\u0026rsquo;s race and ethnicity were based only on caregiver reporting, and we did not have a broad representation of all racial and ethnic categories. Previous research reporting racial and ethnic differences in disability and caregiver stress suggests that further analyses on a more racially and ethnically diverse sample are warranted [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. If we are to gain a better understanding of burnout and inequity, using minority stress models that also measure exposures to structural racism and other forms of discrimination may be a useful approach [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere has been a substantial amount of research on measuring burnout [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. However, more work is needed to examine how burnout might be understood, used, and interpreted across cultural and linguistic groups and how this concept can be applied to experiences beyond work and caregiving [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Our study consisted of only one burnout measure emphasizing the way that caregivers themselves interpreted the term \u0026ldquo;burnout.\u0026rdquo; Future research on burnout could use qualitative approaches to determine a contextually specific definition of the term prior to conducting surveys. Research could also emphasize determining a more appropriate term to examine the imbalance between resources and demands among populations of interest. Additionally, previous research on reducing caregiver burnout has focused primarily on individual caregiver behavioral changes such as emotional regulation and self-compassion to reduce burnout [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Future studies of burnout among disabled and other marginalized caregivers should consider not only these individual behaviors, but structural ableism and racism and how this can impact caregiver burnout.\u003c/p\u003e \u003cp\u003eWe used the Global Activities Limitations Indicator (GALI)\u003csup\u003e29\u003c/sup\u003e to determine disability status. While the GALI is a useful indicator of disability status according to perceived limitations, there are other ways to measure disability that may provide more detailed information on individual experiences and specific barriers [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. More research is needed to determine how specific disability experiences may differentially impact burnout for disabled caregivers. Future studies can also make use of minority stress models to better measure and understand the various factors that contribute to burnout among disabled caregivers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDisabled caregivers had higher rates of burnout than non-disabled caregivers during the COVID-19 pandemic. While disabled people are often framed as recipients of resources and care, it is important to also recognize their roles as caregivers who are impacted by interpersonal and structural ableism while trying to balance the demands of caregiving with their available resources. More programs and policies are needed to support disabled caregivers, especially during health emergencies that exacerbate existing inequities in access to resources.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003eSASEA \u0026ndash; Safer at School Early Alert\u003c/li\u003e\n \u003cli\u003eGALI \u0026ndash;\u0026nbsp;Global Activity Limitations Indicator\u003c/li\u003e\n \u003cli\u003eANOVA \u0026ndash; Analysis of Variance\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOLS \u0026ndash; Ordinary Least Squares\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided signed or verbal consent, and all research procedures were reviewed and cleared by the University of California San Diego Institutional Review Board (IRB) Protocol # 800612.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo maintain participant privacy and anonymity, data are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by funding from the National Institutes of Health (1U01HD108787-01, 5K01MH112436–05, T32AI007384) and the San Diego Health \u0026amp; Human Services Agency (Project #2002967). The funders had no direct role in conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRFM was responsible for funding acquisition; SS and RFM were responsible for conception and design of the work; RFM, MF, VO, AH, and TL were responsible for data collection and management; IB, SS, and RFM conducted data analyses and drafted the manuscript; RG provided assistance with data analyses and interpretations; IB, SS, RFM, MF, VO, AH, RG, and TL contributed to data interpretation and manuscript reviewing and revisions. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the San Diego Health \u0026amp; Human Services Agency for their vision and leadership. We would also like to thank the community members who participated in this research for sharing their time and expertise.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMaslach C, Schaufeli WB. Historical and conceptual development of burnout. In: Professional burnout: Recent developments in theory and research. CRC Press; 2018. p. 1-16.\u003c/li\u003e\n\u003cli\u003eJoy R. COVID Fatigue: How to cope with pandemic burnout. Healthline. 2021 Oct 18. Available from: https://www.healthline.com/health/mental-health/covid-fatigue\u003c/li\u003e\n\u003cli\u003eYıldırım M, Solmaz F. COVID-19 burnout, COVID-19 stress and resilience: Initial psychometric properties of COVID-19 Burnout Scale. Death Stud. 2022;46(3):524-32.\u003c/li\u003e\n\u003cli\u003eSaey TH. Why Pandemic Fatigue and COVID-19 Burnout Took Over in 2022. ScienceNews. 2022 Dec 9. Available from: https://www.sciencenews.org/article/pandemic-fatigue-end-covid-19-burnout-2022\u003c/li\u003e\n\u003cli\u003eShoman Y, Rousson V, Bianchi R, Guseva Canu I. Holistic Assessment of Factors Associated with Exhaustion, the Main Symptom of Burnout: A Meta-Analysis of Longitudinal Studies. Int J Environ Res Public Health. 2022;19(20):13037.\u003c/li\u003e\n\u003cli\u003eRoskam I, Raes ME, Mikolajczak M. Exhausted caregivers: Development and Preliminary Validation of the parental Burnout Inventory. Front Psychol. 2017;8:163.\u003c/li\u003e\n\u003cli\u003eWolbring G, Lillywhite A. Burnout through the Lenses of Equity/Equality, Diversity and Inclusion and Disabled People: A Scoping Review. Societies. 2023;13(5):131.\u003c/li\u003e\n\u003cli\u003eRashkovits S, Livne Y. The effect of education level on psychological empowerment and burnout-the mediating role of workplace learning behaviors. Int J Psychol Behav Sci. 2013;7(6):1896-1901.\u003c/li\u003e\n\u003cli\u003eRoskam I, Vancorenland S, Avalosse H, Mikolajczak M. The missing link between poverty and child maltreatment: parental burnout. Child Abuse Negl. 2022;134:105908.\u003c/li\u003e\n\u003cli\u003eGorski PC. Fighting racism, battling burnout: Causes of activist burnout in US racial justice activists. Ethn Racial Stud. 2019;42(5):667-87.\u003c/li\u003e\n\u003cli\u003eSeo JH, Kim HK. What is the burnout of mothers with infants and toddlers during the COVID-19 pandemic? in relation to parenting stress, depression, and parenting efficacy. Int J Environ Res Public Health. 2022;19(7):4291.\u003c/li\u003e\n\u003cli\u003eMikolajczak M, Roskam I. A Theoretical and Clinical Framework for parental Burnout: The Balance Between Risks and Resources (BR2). Front Psychol. 2018;9:886.\u003c/li\u003e\n\u003cli\u003eRoskam I, Mikolajczak M. Gender differences in the nature, antecedents and consequences of parental burnout. Sex Roles. 2020;83(7-8):485-98.\u003c/li\u003e\n\u003cli\u003eGriffith AK, Bedard KE, Eaton A, Ackerlund Brandt JA, Jha P. Effects of the COVID-19 Pandemic on parental Burnout and parenting Practices: Analyses Using a Retrospective Pretest. Chronic Stress (Thousand Oaks). 2022;6:24705470221114059.\u003c/li\u003e\n\u003cli\u003eWeiss MJ. Hardiness and social support as predictors of stress in mothers of typical children, children with autism, and children with mental retardation. Autism: Int J Res Pract. 2002;6(1):115-30.\u003c/li\u003e\n\u003cli\u003eLindstr\u0026ouml;m C, Aman J, Norberg AL. Increased prevalence of burnout symptoms in parents of chronically ill children. Acta Paediatr (Oslo, Norway: 1992). 2010;99(3):427-32.\u003c/li\u003e\n\u003cli\u003eBogart KR, Dunn DS. Ableism special issue introduction. J Soc Issues. 2019;75(3):650-64.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. World report on disability 2011. World Health Organization; 2011.\u003c/li\u003e\n\u003cli\u003eHayward MD, Hummer RA, Chiu CT, Gonz\u0026aacute;lez-Gonz\u0026aacute;lez C, Wong R. Does the Hispanic paradox in US adult mortality extend to disability? Popul Res Policy Rev. 2014;33:81-96.\u003c/li\u003e\n\u003cli\u003eSchur L, Han K, Kim A, Ameri M, Blanck P, Kruse D. Disability at work: A look back and forward. J Occup Rehabil. 2017;27:482-97.\u003c/li\u003e\n\u003cli\u003eParish SL, Grinstein-Weiss M, Yeo YH, Rose RA, Rimmerman A. Assets and income: Disability-based disparities in the United States. Soc Work Res. 2010;34(2):71-82.\u003c/li\u003e\n\u003cli\u003eYoung E, Milligan K, Henze M, Johnson S, Weyman K. Caregiver burnout, gaps in care, and COVID-19: Effects on families of youth with autism and intellectual disability. Can Fam Physician. 2021;67(7):506-8.\u003c/li\u003e\n\u003cli\u003eHochman Y, Shpigelman CN, Holler R, Werner S. \u0026ldquo;Together in a pressure cooker\u0026rdquo;: parenting children with disabilities during the COVID-19 lockdown. Disabil Health J. 2022;15(3):101273.\u003c/li\u003e\n\u003cli\u003eBrown RL, Ciciurkaite G. Disability, Discrimination, and Mental Health during the COVID-19 Pandemic: A Stress Process Model. Soc Ment Health. 2022;12(3):215-29.\u003c/li\u003e\n\u003cli\u003eStreuli S, Garfein RS, Gaines T, Fielding-Miller R. COVID-19 disproportionately impacts access to basic needs among households with disabled members. Disabil Health J. 2023;16(2):101443.\u003c/li\u003e\n\u003cli\u003ePublic Health Alliance of Southern California. California Healthy Places Index. 2019. Available from: https://healthyplacesindex.org.\u003c/li\u003e\n\u003cli\u003eFielding-Miller R, Karthikeyan S, Gaines T, Garfein RS, Salido RA, Cantu VJ, et al. Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools. Lancet Reg Health\u0026ndash;Am. 2023;19.\u003c/li\u003e\n\u003cli\u003eRohland BM, Kruse GR, Rohrer JE. Validation of a single‐item measure of burnout against the Maslach Burnout Inventory among physicians. Stress Health. 2004;20(2):75-9.\u003c/li\u003e\n\u003cli\u003eVan Oyen H, Bogaert P, Yokota RT, Berger N. Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI). Arch Public Health. 2018;76:1-11.\u003c/li\u003e\n\u003cli\u003eRaymaker DM, Teo AR, Steckler NA, Lentz B, Scharer M, Delos Santos A, et al. \u0026ldquo;Having all of your internal resources exhausted beyond measure and being left with no clean-up crew\u0026rdquo;: Defining autistic burnout. Autism Adulthood. 2020;2(2):132-43.\u003c/li\u003e\n\u003cli\u003eMeyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674.\u003c/li\u003e\n\u003cli\u003eLund EM. Examining the potential applicability of the minority stress model for explaining suicidality in individuals with disabilities. Rehabil Psychol. 2021;66(2):183.\u003c/li\u003e\n\u003cli\u003eFranks N, Mullens AB, Aitken S, Br\u0026ouml;mdal A. Fostering Gender-IQ: Barriers and Enablers to Gender-affirming Behavior Amongst an Australian General Practitioner Cohort. J Homosex. 2022;1-24.\u003c/li\u003e\n\u003cli\u003eDeZelar S, Lightfoot E. Parents With Disabilities: A Case Study Exploration of Support Needs and the Potential of a Supportive Intervention. Fam Soc. 2019;100(3):293-304.\u003c/li\u003e\n\u003cli\u003eTaylor S. Beasts of burden: Animal and disability liberation. The New Press; 2017.\u003c/li\u003e\n\u003cli\u003eLero D, Pletsch C, Hilbrecht M. Introduction to the special issue on disability and work: Toward re-conceptualizing the\u0026apos;burden\u0026apos;of disability. Disabil Stud Q. 2012;32(3).\u003c/li\u003e\n\u003cli\u003eMontague-Asp H, Piepzna-Samarasinha LL, Shlasko D, Siegel LL. Ableism and Disability Justice. Teaching Divers Soc Justice.\u003c/li\u003e\n\u003cli\u003eBaker BL, Blacher J, Olsson MB. Preschool children with and without developmental delay: behaviour problems, parents\u0026rsquo; optimism and well-being. J Intellect Disabil Res. 2005;49(8):575-90.\u003c/li\u003e\n\u003cli\u003eBixby LE. Disability Is Not a Burden: The Relationship between Early Childhood Disability and Maternal Health Depends on Family Socioeconomic Status. J Health Soc Behav. 2023;00221465231167560.\u003c/li\u003e\n\u003cli\u003eJ\u0026oacute;hannsd\u0026oacute;ttir \u0026Aacute;, Egilson S \u0026THORN;, Haraldsd\u0026oacute;ttir F. Implications of internalised ableism for the health and wellbeing of disabled young people. Sociol Health Illn. 2022;44(2):360-76.\u003c/li\u003e\n\u003cli\u003ePiepzna-Samarasinha LL. Care work: Dreaming disability justice. arsenal pulp press; 2018.\u003c/li\u003e\n\u003cli\u003eWang MT, Henry DA, Del Toro J, Scanlon CL, Schall JD. COVID-19 employment status, dyadic family relationships, and child psychological well-being. J Adolesc Health. 2021;69(5):705-12.\u003c/li\u003e\n\u003cli\u003eBacher-Hicks A, Goodman J, Mulhern C. Inequality in household adaptation to schooling shocks: Covid-induced online learning engagement in real time. J Public Econ. 2021;193:104345.\u003c/li\u003e\n\u003cli\u003eRoskam I, Brianda ME, Mikolajczak M. A step forward in the conceptualization and measurement of parental burnout: The parental Burnout Assessment (PBA). Front Psychol. 2018;9:758.\u003c/li\u003e\n\u003cli\u003eNam Y, Wikoff N, Sherraden M. Racial and ethnic differences in parenting stress: Evidence from a statewide sample of new mothers. J Child Fam Stud. 2015;24(2):278-88.\u003c/li\u003e\n\u003cli\u003eGoyat R, Vyas A, Sambamoorthi U. Racial/ethnic disparities in disability prevalence. J Racial Ethn Health Disparities. 2016;3:635-45.\u003c/li\u003e\n\u003cli\u003eLett E, Asabor E, Beltr\u0026aacute;n S, Cannon AM, Arah OA. Conceptualizing, contextualizing, and operationalizing race in quantitative health sciences research. Ann Fam Med. 2022;20(2):157-63.\u003c/li\u003e\n\u003cli\u003eSchaufeli WB. Burnout: A short socio-cultural history. In: Burnout, fatigue, exhaustion: An interdisciplinary perspective on a modern affliction. 2017. p. 105-127.\u003c/li\u003e\n\u003cli\u003eNguyen TM, Nguyen AH, Tran PTT, Vo HTP. Self‐compassion reduces parental burnout: Mediation roles of parental psychological control and support. Personal Relationships. 2023;30(1):262-77.\u003c/li\u003e\n\u003cli\u003eSwit CS, Breen R. Parenting during a pandemic: Predictors of parental burnout. J Fam Issues. 2023;44(7):1817-37.\u003c/li\u003e\n\u003cli\u003eUrbanowicz AM, Shankland R, Rance J, Bennett P, Leys C, Gauchet A. Cognitive behavioral stress management for parents: Prevention and reduction of parental burnout. Int J Clin Health Psychol. 2023;23(4):100365.\u003c/li\u003e\n\u003cli\u003eSabariego C, Oberhauser C, Posarac A, Bickenbach J, Kostanjsek N, Chatterji S, et al. Measuring disability: comparing the impact of two data collection approaches on disability rates. Int J Environ Res Public Health. 2015;12(9):10329-51.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Mean Burnout Scores by Covariates of Interest Among caregivers of kids enrolled in socially vulnerable schools in San Diego County\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"637\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.16300940438872%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Burnout Score*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.16300940438872%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisability Status\u003c/strong\u003e\u0026dagger;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp;Not Disabled\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Disabled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.96\u003c/p\u003e\n \u003cp\u003e2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.16300940438872%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaregiver Gender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.11\u003c/p\u003e\n \u003cp\u003e1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.16300940438872%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Income\u003c/strong\u003e\u0026Dagger;\u003c/p\u003e\n \u003cp\u003eLess than 15K:\u003c/p\u003e\n \u003cp\u003e15-19,999K\u003c/p\u003e\n \u003cp\u003e20-24,999K\u003c/p\u003e\n \u003cp\u003e25-34,999K\u003c/p\u003e\n \u003cp\u003e35-49,999K\u003c/p\u003e\n \u003cp\u003e50-74,999K\u003c/p\u003e\n \u003cp\u003e75-99,999K\u003c/p\u003e\n \u003cp\u003e100k \u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003cp\u003e2.20\u003c/p\u003e\n \u003cp\u003e1.82\u003c/p\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003cp\u003e2.19\u003c/p\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.16300940438872%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaregiver Education Level\u003c/strong\u003e\u0026Dagger;\u003c/p\u003e\n \u003cp\u003eSome High School\u003c/p\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003cp\u003eBachelors\u003c/p\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.16300940438872%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild Race\u003c/strong\u003e\u0026Dagger;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eAmerican Indian or Alaskan Native\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Black or African American\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Asian\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Native Hawaiian or Pacific Islander\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; White\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003cp\u003e2.10\u003c/p\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003cp\u003e2.50\u003c/p\u003e\n \u003cp\u003e2.19\u003c/p\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.16300940438872%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild Ethnicity\u003c/strong\u003e\u0026dagger;\u003c/p\u003e\n \u003cp\u003eNon-Hispanic\u003c/p\u003e\n \u003cp\u003eHispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.24\u003c/p\u003e\n \u003cp\u003e2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.278996865203762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Burnout scores ranged from 1-5.\u0026nbsp;\u0026dagger;Statistically significant difference in Student\u0026rsquo;s t-tests.\u0026nbsp;\u0026Dagger;Statistically significant difference in one-way ANOVA.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Disability Status and Covariates of Interest Among caregivers of kids enrolled in socially vulnerable schools in San Diego County\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"638\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.22257053291536%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot Disabled\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n=612)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisabled\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n=151)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull Sample\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n=763)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.22257053291536%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaregiver Gender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e534 (87.3%)\u003c/p\u003e\n \u003cp\u003e78 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e135 (89.4%)\u003c/p\u003e\n \u003cp\u003e16 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e669 (87.7%)\u003c/p\u003e\n \u003cp\u003e94 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.22257053291536%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Income*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eLess than 15K:\u003c/p\u003e\n \u003cp\u003e15-19,999K\u003c/p\u003e\n \u003cp\u003e20-24,999K\u003c/p\u003e\n \u003cp\u003e25-34,999K\u003c/p\u003e\n \u003cp\u003e35-49,999K\u003c/p\u003e\n \u003cp\u003e50-74,999K\u003c/p\u003e\n \u003cp\u003e75-99,999K\u003c/p\u003e\n \u003cp\u003e100k \u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (7.4%)\u003c/p\u003e\n \u003cp\u003e25 (4.1%)\u003c/p\u003e\n \u003cp\u003e31 (5.1%)\u003c/p\u003e\n \u003cp\u003e70 (11.5%)\u003c/p\u003e\n \u003cp\u003e92 (15.1%)\u003c/p\u003e\n \u003cp\u003e112 (18.4%)\u003c/p\u003e\n \u003cp\u003e52 (8.5%)\u003c/p\u003e\n \u003cp\u003e103 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (15.2%)\u003c/p\u003e\n \u003cp\u003e10 (6.6%)\u003c/p\u003e\n \u003cp\u003e7 (4.6%)\u003c/p\u003e\n \u003cp\u003e20 (13.2%)\u003c/p\u003e\n \u003cp\u003e16 (10.6%)\u003c/p\u003e\n \u003cp\u003e20 (13.2%)\u003c/p\u003e\n \u003cp\u003e20 (13.2%)\u003c/p\u003e\n \u003cp\u003e20 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68 (8.9%)\u003c/p\u003e\n \u003cp\u003e35 (4.6%)\u003c/p\u003e\n \u003cp\u003e38 (5.0%)\u003c/p\u003e\n \u003cp\u003e90 (11.8%)\u003c/p\u003e\n \u003cp\u003e108 (14.2%)\u003c/p\u003e\n \u003cp\u003e132 (17.4%)\u003c/p\u003e\n \u003cp\u003e72 (9.5%)\u003c/p\u003e\n \u003cp\u003e123 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.22257053291536%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaregiver Education Level\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSome High School\u003c/p\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003cp\u003eBachelors\u003c/p\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57 (9.4%)\u003c/p\u003e\n \u003cp\u003e281 (46.4%)\u003c/p\u003e\n \u003cp\u003e190 (31.4%)\u003c/p\u003e\n \u003cp\u003e78 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17 (11.3%)\u003c/p\u003e\n \u003cp\u003e67 (44.7%)\u003c/p\u003e\n \u003cp\u003e45 (30.0%)\u003c/p\u003e\n \u003cp\u003e21 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e74 (9.8%)\u003c/p\u003e\n \u003cp\u003e348 (46.0%)\u003c/p\u003e\n \u003cp\u003e235 (31.1%)\u003c/p\u003e\n \u003cp\u003e99 (13.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.22257053291536%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild Race\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eAmerican Indian or Alaskan Native\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Black or African American\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Asian\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Native Hawaiian or Pacific Islander\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; White\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (0.5%)\u003c/p\u003e\n \u003cp\u003e40 (6.5%)\u003c/p\u003e\n \u003cp\u003e55 (9.0%\u003c/p\u003e\n \u003cp\u003e8 (1.3%)\u003c/p\u003e\n \u003cp\u003e316 (51.6%)\u003c/p\u003e\n \u003cp\u003e190 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003cp\u003e11 (7.3%)\u003c/p\u003e\n \u003cp\u003e11 (7.3%)\u003c/p\u003e\n \u003cp\u003e3 (2.0%)\u003c/p\u003e\n \u003cp\u003e90 (59.6%)\u003c/p\u003e\n \u003cp\u003e36 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (0.4%)\u003c/p\u003e\n \u003cp\u003e51 (6.7%)\u003c/p\u003e\n \u003cp\u003e66 (8.7%)\u003c/p\u003e\n \u003cp\u003e11 (1.4%)\u003c/p\u003e\n \u003cp\u003e406 (53.2%)\u003c/p\u003e\n \u003cp\u003e226 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.22257053291536%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild Ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNon-Hispanic\u003c/p\u003e\n \u003cp\u003eHispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e226 (37.8%)\u003c/p\u003e\n \u003cp\u003e372 (62.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62 (41.3%)\u003c/p\u003e\n \u003cp\u003e88 (58.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.592476489028215%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e288 (38.5%)\u003c/p\u003e\n \u003cp\u003e460 (78.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Statistically significant difference in chi-square analyses at a level of p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Multivariable analysis of factors associated with burnout score among caregivers of kids enrolled in socially vulnerable schools in San Diego County\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.919743178170144%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eb\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.919743178170144%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisabled Caregiver\u0026nbsp;\u003c/strong\u003e(ref: not disabled)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e0.55-0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.919743178170144%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Income\u003c/strong\u003e (ref: \u0026lt;15k)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e0.01-0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.919743178170144%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaregiver Education Level\u0026nbsp;\u003c/strong\u003e(ref: Some high school)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e0.04-0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"burnout, caregiving, COVID-19, disability","lastPublishedDoi":"10.21203/rs.3.rs-4391256/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4391256/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBurnout is exhaustion caused by exposure to chronic stress. Prior to the COVID-19 pandemic, people with disabilities experienced high levels of burnout due to discrimination, barriers to accessing resources, and lack of accommodations. Caregivers have also experienced high levels of burnout during the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWhile researchers have examined burnout among caregivers of disabled children, less research has focused on the experiences of disabled caregivers. We examined the association between caregiver disability and burnout during the pandemic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe distributed an online survey to caregivers of children enrolled in socially vulnerable elementary and middle schools in San Diego County, California between September and December, 2022. Our survey included demographic questions, questions about pandemic experiences, and a continuous burnout measure. We analyzed survey data to test our hypothesis that caregivers with a disability experienced higher levels of burnout than their non-disabled counterparts during the height of the COVID-19 pandemic. We used multivariable linear regression analysis adjusting for household income and caregiver education level.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDisabled caregivers self-reported higher levels of burnout than non-disabled caregivers (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.72; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) during the COVID-19 pandemic in bivariate and multivariable analyses. Caregivers with a higher household income (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04; p\u0026thinsp;=\u0026thinsp;0.017) and more education (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.13; p\u0026thinsp;=\u0026thinsp;0.005) also reported higher levels of burnout.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe COVID-19 pandemic exacerbated existing difficulties faced by disabled caregivers who often struggle to balance the demands of caregiving with their available resources. Targeted programs and policies are needed to support disabled caregivers during health emergencies that exacerbate existing inequities in access to resources.\u003c/p\u003e","manuscriptTitle":"Disproportionately High Rates of Burnout Among Disabled Caregivers During the COVID-19 Pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-22 07:37:44","doi":"10.21203/rs.3.rs-4391256/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"956fe251-abfb-442d-bb71-41ddacf9e945","owner":[],"postedDate":"May 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-18T14:53:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-22 07:37:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4391256","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4391256","identity":"rs-4391256","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}