Factors associated with psychological distress among family caregivers of preschool children with autism: an analysis

Objective To identify factors associated with psychological distress among family caregivers of preschool-aged children with Autism Spectrum Disorder (ASD) using LASSO regression and random forest algorithms. Methods A convenience sampling method was employed to recruit 213 caregivers of preschool-aged children with ASD from three institutions in Urumqi between December 2023 and October 2024. Participants completed a demographic questionnaire and the Symptom Checklist-90. Predictors were screened through LASSO regression, and a random forest risk assessment model was constructed and validated on the test set. A logistic regression model was simultaneously developed for comparative validation. Results The top five factors associated with caregivers’ psychological distress are comorbid conditions in children with ASD, daily care hours, marital status, the severity of the child’s ASD, and employment status. The model outperformed logistic regression on both the training set (AUC = 0.845, sensitivity=0.893, specificity=0.913, accuracy=0.933, F1 score=0.901) and test set (AUC = 0.87, sensitivity=0.733, specificity=0.727, accuracy=0.710, F1 score=0.721). Decision curve analysis demonstrated clinical utility across threshold probability ranges of 0–0.85. Conclusion Factors associated with psychological distress among autism caregivers include comorbidity status, caregiving duration, marital status, disease severity, and employment status. These findings provide evidence-based guidance for early psychological intervention targeting high-risk caregivers.