Mediated moderation of the relation between maternal and adolescent depressive symptoms: role of adolescent physical health

Validating the 12-item proxy-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in young children with chronic physical illness in Canada

PURPOSE

This study investigated the psychometric properties of the 12-item proxy-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in young children with chronic physical illness in Canada.

MATERIALS AND METHODS

Data come from the Multimorbidity in Youth across the Life-course, a longitudinal study of Canadian youth with physical illnesses (n = 263). Baseline parent-reported data from children (2-9 years, n = 143) and adolescents (10-16 years, n = 117) were analyzed. Wilcoxon's tests examined differences in WHODAS 2.0 scores between subgroups. Internal consistency was estimated, and confirmatory factor analysis modeled the WHODAS 2.0 factor structure. Regression modeling examined if the WHODAS 2.0 could discriminate between children with vs. without mental comorbidity.

RESULTS

Differences were found between children and adolescents regarding self-care and getting along, and for the item on emotional affect. Inter-item correlations were similar between subgroups and internal consistency was strong for children (α = 0.90) and adolescents (α = 0.93). The factor structure of the WHODAS 2.0 was confirmed; parameter estimates were similar between subgroups. The association between mental comorbidity and disability did not differ by age - comorbidity was associated with greater disability (β = 5.87, p < 0.01).

CONCLUSIONS

The 12-item proxy-administered WHODAS 2.0 appears valid and reliable in young children with physical illness and can be used in this population.Implications for rehabilitationThe 12-item proxy-administered WHODAS 2.0 has acceptable inter-item correlations and internal consistency in young Canadian children with chronic physical illness, and its factor structure is consistent with previous reportsExpansion of its use in measuring disability in young children provides the opportunity to use the WHODAS 2.0 across the life-course, facilitating the interpretation of changes in disability over time or in response to treatmentAdditional research is needed to determine responsiveness to change and the minimal clinically important difference of the WHODAS 2.0 in this population.

Mental health of siblings of children with physical illness or physical-mental comorbidity

OBJECTIVES

This study examined the mental health of siblings of children with physical illness (PI), with or without co-occurring mental illness.

METHODS

The sample included children aged 2 to 16 years with a chronic PI and their aged-matched healthy siblings (n = 169 dyads). Physical-mental comorbidity (PM) was present if children screened positive for ≥1 mental illness on the Mini International Neuropsychiatric Interview for Children and Adolescents. Parents completed the Strengths and Difficulties Questionnaire (SDQ) to measure child and sibling mental health.

RESULTS

Within child-sibling dyads, siblings of children with PI had significantly worse mental health related to conduct problems (d = 0.31), peer problems (d = 0.18) and total difficulties (d = 0.20). Siblings of children with PM had significantly better mental health related to emotional problems (d = 0.42), hyperactivity/inattention (d = 0.23) and total difficulties (d = 0.32). Siblings of children with PI had similar mental health compared with child population norms used in the development of the SDQ. In contrast, siblings of children with PM had significantly worse mental health across all SDQ domains, with the exception of prosocial behaviour. After adjusting for parent psychopathology and family functioning, no statistically significant differences between siblings of children with PM versus siblings of children with PI were found.

CONCLUSIONS

Differences in mental health exist between children with PI or PM versus their healthy siblings. However, differences between siblings of children with PI versus siblings of children with PM can be explained by parental and family factors (e.g. marital status, education and income). Findings reinforce family-centred care approaches to address the needs of children with PI or PM and their families.

Correlates of Mental Health in Adolescents and Young Adults with Cerebral Palsy: A Cross-Sectional Analysis of the MyStory Project

Background: It is important to gain a better understanding of mental health issues in adolescents and young adults (AYA) with cerebral palsy (CP). In this cross-sectional study, we explore if demographics, social and clinical questionnaire scores, and cortisol levels in hair samples from AYA with CP are associated with higher scores on anxiety and/or depression questionnaires. Methods: Data from a community-based sample of 63 AYA with CP (30 females; ages 16 to 30 (median age of 25)) were analyzed. Forty-one (65%) participants (20 females) provided a hair sample. Outcomes were assessed using bivariate linear regression analyses and hierarchical regression analyses. Results: Clinical depressive and anxiety symptoms were present in 33% and 31% of participants, respectively. Family functioning, B = 9.62 (95%CI: 5.49–13.74), fatigue, B = 0.15 (95%CI: 0.05–0.25), and pain, B = 1.53 (95%CI: 0.48–2.58) were statistically significant predictors of depressive symptoms. Fatigue, B = 0.24 (95%CI: 0.12–0.35) and pain, B = 1.63 (95%CI: 0.33–2.94) were statistically significant predictors of anxiety. Cortisol levels from hair samples were not found to be associated with depressive symptoms or anxiety. Conclusions: A high prevalence of mental health problems and co-occurring physical problems was found in AYA with CP. Integrating mental support into regular care for AYA with CP is recommended.

Clinical Measures of Allostatic Load in Children and Adolescents with Food Allergy, Depression, or Anxiety

PURPOSE

Sustained high stress exposure results in chronic activation of the stress response system, dysregulated stress responses, high allostatic load, and poor later-life health. Children and adolescents with chronic health conditions face stressors related to their condition in addition to those typical of childhood and adolescence, placing them at risk of high allostatic load. The purpose of this secondary analysis was to examine whether youth with chronic health conditions differ from controls on clinical measures of allostatic load.

DESIGN AND METHODS

A secondary analysis of two datasets, the electronic health record of a tertiary children's hospital and data from the Survey of the Health of Wisconsin, compared youth with chronic health conditions to controls on clinical measures of allostatic load. Additional analyses explored whether parental stress and mental health influenced these relationships.

RESULTS

Analyses identified differences in BMI, blood pressure, and waist circumference between youth with food allergy, anxiety, or depression, and controls. These relationships differed for males and females and for those with comorbid mental and physical conditions, and were influenced by parent stress and mental health.

CONCLUSIONS

Results support future studies exploring whether high stress in youth with chronic health conditions leads to increased allostatic load. Incorporating biomarkers as well as genetic and epigenetic factors will provide critical insights.

PRACTICE IMPLICATIONS

Youth with mental and physical CHCs may be at increased risk of high allostatic load, reflected in clinical measures of metabolism, and should have regular assessments of their metabolic health.

Cohort Profile: Multimorbidity in Children and Youth Across the Life-course (MY LIFE) Study

OBJECTIVE

This manuscript serves to provide an overview of the methods of the Multimorbidity in Children and Youth across the Life-course (MY LIFE) study, profile sample characteristics of the cohort, and provide baseline estimates of multimorbidity to foster collaboration with clinical and research colleagues across Canada.

METHOD

MY LIFE is comprised of 263 children (2-16 years) with a physical illness recruited from McMaster Children's Hospital, their primary caregiving parent, and their closest-aged sibling. Participants are followed with data collection at recruitment, 6, 12, and 24 months which includes structured interviews, self-reported measures, and biological samples and occur in a private research office or at participants' homes. Post-COVID-19, data collection transitioned to mail and telephone surveys.

RESULTS

At recruitment, children were 9.4 (4.2) years of age and 52.7% were male. The mean duration of their physical illness was 4.5 (4.1) years; 25% represent incident cases (duration <1 year). Most (69.7%) had healthy body weight and intelligence in the average range (73.5%). Overall, 38.2% of children screened positive for ≥1 mental illness according to parent report (24.8% screened positive based on child self-report). Compared to 2016 Census data, the MY LIFE cohort overrepresents families of higher socioeconomic status.

CONCLUSIONS

Multimorbidity is common among children and these baseline data will serve to measure relative changes in the mental health of children with physical illness over time. MY LIFE will provide new information for understanding multimorbidity among children, though underrepresentation of lower socioeconomic families may have implications for the generalizability of findings.

Hair Cortisol Concentration and Mental Disorder in Children With Chronic Physical Illness

Background

To examine changes in hair cortisol concentrations (HCC) in children with chronic physical illness and identify patterns of association between HCC and mental comorbidity.

Methods

A sample of 50 children aged 6 to 16 years were recruited within six months of being diagnosed with a chronic physical illness. Data were collected via hair samples, structured interviews, and behavioral checklists.

Results

There was no change in HCC over six months. Baseline HCC was associated with internalizing—odds ratio (OR) = 1.29 (90% confidence interval (CI): 1.01–1.66)—and externalizing disorders—OR = 1.32 (90% CI: 1.07–1.64). Externalizing disorder at six months was associated with elevated baseline—OR = 1.25 (90% CI: 1.02–1.53)—and six-month HCC—OR = 1.25 (90% CI: 1.02–1.54). Associations between HCC and mental disorder weakened over time, and for internalizing disorders, changed direction (i.e., inverse association), albeit not significantly.

Conclusion

Results provide preliminary evidence that physiological stress, measured using HCC, may be implicated in the relationship between physical and mental illness, and these associations align with attenuated stress responses over time.

Multimorbidity in Children and Youth Across the Life-course (MY LIFE): protocol of a Canadian prospective study

INTRODUCTION

Multimorbidity, the co-occurrence of a chronic physical condition and mental disorder, affects a substantial number of children and youth and can lead to compromised quality of life, hardship for families, and an increased burden on the healthcare system. We are conducting a study to document the course of mental disorder in children and youth diagnosed with a chronic physical condition; identify predictors of child and youth multimorbidity; examine whether the effects of these predictors are moderated by relevant psychosocial and biological factors; explore potential inflammatory and stress biomarkers that mediate the onset of child and youth multimorbidity; and, assess whether multimorbidity in children and youth alters patterns of mental health service use.

METHODS AND ANALYSIS

Multimorbidity in Children and Youth Across the Life-course (MY LIFE) is a prospective study. Two hundred and fifty children and youth aged 2-16 years diagnosed with a chronic physical condition along with one parent will be recruited from the outpatient clinics at a paediatric tertiary care centre. Data will be collected using a multi-informant, multimethod design at four time-points (at recruitment, and at 6, 12 and 24 months postrecruitment). Parents will provide reports for all children/youth. In addition, youth ≥10 years will self-report. Mental disorder will be assessed using structured interviews. On completion of data collection, participant-reported data will be linked to provincial health records to identify mental health services use. Multilevel analyses (survival, proportional hazard, structural equation modelling) will be used to address MY LIFE objectives.

ETHICS AND DISSEMINATION

This study has been approved by the University of Waterloo Human Research Ethics Board and the Hamilton Integrated Research Ethics Board. Findings will be disseminated to key stakeholders using a number of outlets (peer-reviewed publications and conferences, lay informational pamphlets, social media).

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

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.

Multimorbidity in children and youth: a scoping review protocol

INTRODUCTION

Multimorbidity (co-occurring physical and mental illness) is an important issue for clinicians and researchers with combined efforts aimed at promoting the health and well-being of individuals across the life course. In children and youth, experience of any chronic physical illness leads to a substantial increase in risk for mental illness. As a growing field of interest, research is needed to map the current state of the literature in child and youth multimorbidity in order to identify existing gaps and inform the direction of future investigations.

METHODS AND ANALYSIS

We are proposing the conduct of a scoping review to explore the depth and breadth of existing evidence in the field of child and youth multimorbidity. The scoping review will follow the methodological framework developed by Arksey and O'Malley, and will incorporate additional scoping review recommendations made by Levac et al . A systematic search of the following four key databases will be conducted: (1) PubMed; (2) EMBASE; (3) PsycINFO; and (4) Scopus, using combinations of Medical Subject Headings (MeSH) and Emtree terms. We will also consult grey literature sources and hand-search reference lists of included studies to identify additional studies of relevance. For eligible studies that meet all identified inclusion and exclusion criteria, a data extraction tool will be used to collect and store key study characteristics that will be relevant for collating, summarising and reporting the results of the scoping review. This scoping review also presents a novel use of quality index scoring, which we anticipate will contribute to strengthening the rigour of the scoping review methodology.

ETHICS AND DISSEMINATION

The proposed scoping review does not require ethical approval. Final study results will be disseminated via conference presentations, publication in a peer-reviewed journal and knowledge translation activities with relevant stakeholders.

Early Adversity, Psychopathology, and Latent Class Profiles of Global Physical Health From Preschool Through Early Adolescence

OBJECTIVE

The purpose of the present report was to describe the longitudinal trajectories of physical health beginning during preschool and continuing into early adolescence; explore whether these trajectories were predicted by psychosocial adversity, family income-to-needs ratio, and psychiatric disorders occurring during the preschool period; and determine whether psychiatric disorders mediated these relations.

METHODS

Participants included 296 children participating in a longitudinal study of early-onset psychopathology spanning 10 years. Semistructured clinical interviews were conducted with caregivers to determine children's psychiatric diagnoses between ages 3 and 6 years. Caregivers also completed annual assessments of their child's physical health problems (ages 3-13) and reported on the family's income and indicators of psychosocial adversity.

RESULTS

Growth mixture modeling revealed 2 trajectories of physical health problems: a stable, low group (n = 199) and a high, increasing group (n = 57) indicating linear increases in physical health problems from ages 3 to 13. Preschool psychiatric diagnoses (Estimate [Est] = 0.05, p < .001), family income-to-needs ratio (Est = -0.01, p = .012), and psychosocial adversity (Est = 0.02, p = .015) predicted membership in the high, increasing trajectory of physical health problems. Early-onset psychopathology mediated relations between psychosocial adversity and physical health problems (αβ = 0.31, p = .050) and between income-to-needs ratio and physical health problems (αβ = -0.29, p < .021).

CONCLUSIONS

These findings indicate the importance of early indicators of risk: low income-to-needs ratios, high psychosocial adversity, and psychiatric disorders occurring during the preschool period for contributing to increasing physical health problems from preschool through early adolescence. Early-onset psychiatric disorders also mediated relations between psychosocial adversity, income-to-needs ratio, and physical health problems.