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These findings also contribute to the converging evidence that risk for mental disorder is relatively consistent among children with various physical conditions. This increased risk is supported by some previous studies.
Inattentiveness may co-occur with core symptoms of generalised anxiety disorder, manifesting because of hypervigilance in avoiding food allergens. From a biological perspective, there is evidence of shared immunological 63 and inflammatory 64 responses for allergic conditions and attention-deficit hyperactivity disorder which may explain this association. Given the small number of children with food allergy in our sample, these interpretations are by no means definitive, but instead are offered as hypotheses to be tested rigorously in larger samples.
In general, the sample consisted of high socioeconomic two-parent families, which may have contributed to the lack of sociodemographic differences between children with and without multimorbidity and limits the generalisability of the findings. Placing the finding in the context of previous work is difficult, given the absence of studies examining sociodemographic correlates of multimorbidity.
Previous population-based studies conducted in Canada also showed no socioeconomic differences between children with and without physical conditions. Contrary to expectation, no effect of multimorbidity on parental outcomes was found. Nevertheless, information related to parental psychopathology and family environment may be important control variables used to isolate the effects of multimorbidity on child outcomes.
Such family processes may also be implicated in complex pathways linking physical and mental health in children. As a result, these variables will be included in the large-scale study. Of interest is the finding that the magnitude of effect seen for physical well-being, psychological well-being and school environment was approximately half an SD.
This metric has been validated as the minimal clinically important difference for measures of quality of life 68 and provides evidence to support the perception that changes in child quality of life due to multimorbidity are clinically relevant. Given the early onset of multimorbidity, health professionals in the paediatric setting should consider engaging children and families in discussions about mental health soon after the diagnosis of a physical condition is made and discussion surrounding the physical condition completed.
Within a holistic family-centred approach, health professionals are encouraged to apply brief screening tools to identify at-risk children and provide referrals to supportive services on a case-by-case basis. This is a critical window of opportunity given that mental disorder is strong predictor of youth suicide 69 and that risk for suicide is highest soon after an adolescent is diagnosed with a physical condition. There is one noteworthy limitation: the study was likely underpowered to detect differences between children with and without multimorbidity, and the small sample size may limit the generalisability of findings.
However, our sample size was consistent with considerations for implementing pilot studies, 40 and our coverage of eligible families was good. If these results are replicated in a subsequent larger study, health professionals should be aware of the burden of multimorbidity and prepare themselves to discuss mental health with children and their parents.
Findings from this pilot study have been used to implement a large-scale study that will examine child multimorbidity in greater depth and provide more definitive clinical implications. The authors gratefully acknowledge the children, parents and health professionals and their staff without whose participation this study would not have been possible. We especially thank Jessica Zelman for coordinating the study and Jane Terhaerdt for assisting with ethical approval.
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Contributors MAF led the study. AB and MAF analysed and interpreted data and drafted the manuscript. All authors critically reviewed and revised and then approved the final manuscript as submitted. Provenance and peer review Not commissioned; externally peer reviewed.
Family members play important role in managing chronic illness
Email alerts. Article Text. Article menu. Mental health. Mental disorder in children with physical conditions: a pilot study. Abstract Objectives Methodologically, to assess the feasibility of participant recruitment and retention, as well as missing data in studying mental disorder among children newly diagnosed with chronic physical conditions ie, multimorbidity.
Mental disorder in children with physical conditions: a pilot study | BMJ Open
Statistics from Altmetric. All outcomes were parent-reported. Methods Sample Data come from a multisite, prospective, pilot study aimed at examining mental disorder s in children with physical conditions. Data collection After the medical encounter, eligible families were invited by clinic nurses to speak with research staff about the study. Quality of life Child quality of life between the two visits was measured using the KIDSCREEN, 43 a item child and parent-reported generic measure that assesses five domains: physical well-being five items; examines physical activity and energy , psychological well-being seven items; examines emotional balance and life satisfaction , autonomy and parent relations seven items; examines family dynamics and age-appropriate freedoms , social support and peers four items; examines nature of peer relationships and school environment four items; examines perception of cognition, learning and feelings about school.
Parental stress The Parental Stress Scale PSS measures parental stress across the domains of rewards, stressors, loss of control and satisfaction. Parental depression Parental symptoms of depression were measured with the Center for Epidemiological Studies Depression Scale CES-D , a item scale designed to assess depressive symptomatology in the general adult population over the past week. Demographic characteristics Sociodemographic data were collected on child and parent age, sex and immigrant status, parent marital status and educational attainment, as well as annual household income.
View this table: View inline View popup. Table 1 Baseline sample characteristics. Table 2 Prevalence of multimorbidity. Correlates of multimorbidity Results showed no differences in child and parent characteristics between children with and without parent-reported multimorbidity with two exceptions table 1 : children with multimorbidity had lower KIDSCREEN psychological well-being Table 3 Longitudinal effects of multimorbidity on child quality of life.
Table 4 Longitudinal effects of multimorbidity on parental outcomes. Acknowledgments The authors gratefully acknowledge the children, parents and health professionals and their staff without whose participation this study would not have been possible. References 1. Dynamics of obesity and chronic health conditions among children and youth. JAMA ; : — Definitions and measurement of chronic health conditions in childhood: a systematic review. Comorbidity of physical and mental disorders in the neurodevelopmental genomics cohort study.
Pediatrics ; : e — Dobbie M , Mellor D. Chronic illness and its impact: considerations for psychologists. Psychol Health Med ; 13 : — OpenUrl PubMed. Arch Gen Psychiatry ; 69 : — Ferro MA. Major depressive disorder, suicidal behaviour, bipolar disorder, and generalised anxiety disorder among emerging adults with and without chronic health conditions.
Epidemiol Psychiatr Sci ; 25 : — Quach J , Barnett T. Impact of chronic illness timing and persistence at school entry on child and parent outcomes: Australian longitudinal study. Acad Pediatr ; 15 : 89 — Mental disorders in chronically ill children: parent-child discrepancy and physician identification.
Pediatrics ; 90 : — 6. Pinquart M , Shen Y. Behavior problems in children and adolescents with chronic physical illness: a meta-analysis. J Pediatr Psychol ; 36 : — Anxiety in children and adolescents with chronic physical illnesses: a meta-analysis. Acta Paediatr ; : — Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. Risks of psychiatric disorders and suicide attempts in children and adolescents with type 1 diabetes: a population-based cohort study.
Diabetes Care ; 38 : — 9. Chronic physical health conditions and emotional problems from early adolescence through midadolescence. Acad Pediatr ; 17 : — Ascertainment of chronic diseases using population health data: a comparison of health administrative data and patient self-report. Furthermore, the children may not be receiving quality care, as recent studies indicate that public payers including Medicaid may have worse coordinated care for chronic disease management than private payers. Coordinated care and medical home models proved effective at reducing healthcare spending for childhood chronic disease management.
However, these strategies have been difficult to replicate in a hospital setting on a large scale. The University of Illinois study found that a coordinated care program did effectively lower inpatient healthcare costs for chronically ill children and young adults, more specifically for their emergency department ED care. However, the decreases were nearly matched by the decreases in the control group which did not receive coordinated care intervention.