Chronicity of mental comorbidity in children with new-onset physical illness

Child Care Health Dev. 2019 Jul;45(4):559-567. doi: 10.1111/cch.12667. Epub 2019 May 21.

Abstract

Background: Evidence suggests that physical and mental illnesses are strongly correlated in children. This study examined patterns of the chronicity of multimorbidity (co-occurring physical and mental illness); estimated homotypic continuity; and modelled factors associated with chronicity in children newly diagnosed with a chronic physical illness.

Methods: Children aged 6-16 years diagnosed with one of asthma, diabetes, epilepsy, food allergy, or juvenile arthritis were recruited from two children's hospitals and followed for 6 months. Child mental illness was measured using the parent-reported Mini International Neuropsychiatric Interview and Ontario Child Health Study Emotional Behavioural Scales at baseline and 6 months later. Children were stratified into three groups: no multimorbidity, acute (multimorbidity at only one assessment), and persistent (multimorbidity at both assessments).

Results: Forty-nine children were available for analysis: no multimorbidity (n = 18), acute (n = 13), and persistent (n = 18). Homotypic continuity was highest for conduct disorder (67.5%) and lowest for major depression (16.7%). Unadjusted analyses showed positive associations between child and parent behavioural symptoms, as well as family functioning with persistent multimorbidity. These associations remained after adjustment, ranging from odds ratio (OR) = 1.29 [1.01, 1.64] for depression to OR = 1.61 [1.11, 2.33] and OR = 1.61 [1.10, 2.35] for attention-deficit hyperactivity and oppositional defiant, respectively, in child models. In parent models, associations remained for parental anxiety (OR = 1.18 [1.04, 1.34]) and stress (OR = 1.15 [1.02, 1.31]).

Conclusions: Multimorbidity is persistent in children newly diagnosed with physical illnesses, regardless of the mental comorbidity experienced. Integrating family-centred mental health services soon after the diagnosis of a physical illness should be prioritized in pediatric settings.

Keywords: adolescent; chronic disease; mental disorder; multimorbidity; prospective cohort.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Child
  • Child Behavior Disorders / epidemiology
  • Child Behavior Disorders / psychology
  • Child Health Services / organization & administration
  • Child of Impaired Parents / psychology
  • Chronic Disease / epidemiology*
  • Chronic Disease / psychology
  • Comorbidity
  • Family Health
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neurodevelopmental Disorders / epidemiology*
  • Neurodevelopmental Disorders / psychology
  • Ontario / epidemiology
  • Parents / psychology
  • Pilot Projects
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Quality of Life
  • Socioeconomic Factors