Mental health and school absenteeism in children with long-term physical conditions: A secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007

Long-term physical health conditions and youth anxiety and depression: Is there a causal link?

BACKGROUND

The prevalence of youth anxiety and depression has increased globally, with limited causal explanations. Long-term physical health conditions (LTCs) affect 20-40% of youth, with rates also rising. LTCs are associated with higher rates of youth depression and anxiety; however, it is uncertain whether observed associations are causal or explained by unmeasured confounding or reverse causation.

METHODS

Using data from the Norwegian Mother, Father, and Child Cohort Study (MoBa) and Norwegian National Patient Registry, we investigated phenotypic associations between childhood LTCs, and depression and anxiety diagnoses in youth (<19 years), defined using ICD-10 diagnoses and self-rated measures. We then conducted two-sample Mendelian Randomization (MR) analyses using SNPs associated with childhood LTCs from existing genome-wide association studies (GWAS) as instrumental variables. Outcomes were: (i) diagnoses of major depressive disorder (MDD) and anxiety disorders or elevated symptoms in MoBa, and (ii) youth-onset MDD using summary statistics from a GWAS in iPSYCH2015 cohort.

RESULTS

Having any childhood LTC phenotype was associated with elevated youth MDD (OR = 1.48 [95% CIs 1.19, 1.85], p = 4.2×10-4) and anxiety disorder risk (OR = 1.44 [1.20, 1.73], p = 7.9×10-5). Observational and MR analyses in MoBa were consistent with a causal relationship between migraine and depression (IVW OR = 1.38 [1.19, 1.60], pFDR = 1.8x10-4). MR analyses using iPSYCH2015 did not support a causal link between LTC genetic liabilities and youth-onset depression or in the reverse direction.

CONCLUSIONS

Childhood LTCs are associated with depression and anxiety in youth, however, little evidence of causation between LTCs genetic liability and youth depression/anxiety was identified from MR analyses, except for migraine.

Rates of School Absences in Pediatric Scoliosis Patients and Work Absences in Their Parents/Caregivers: A Retrospective Analysis

Background/Objectives: The burden of scoliosis care extends beyond treatment costs and includes missed school for patients and lost income for parents. Chronic absenteeism, defined as more than 18 days of missed school, can have a significant impact on a child's educational progression, but missed school and work due to scoliosis treatment are not well quantified in the literature. This study investigates absenteeism among scoliosis patients and their caregivers. Methods: We conducted a retrospective comparative study of survey results based on surgery timing and surgery type. Patients and caregivers presenting for clinic visits for scoliosis treatment at a single large tertiary care center from 2014 to 2022 were queried. Results: We collected 2772 surveys from 1104 unique patients. Of these, 223 surveys from 132 patients were within one year of surgery: 140 post-fusion surveys, 71 post-nonfusion surveys, and 11 post-halo/multistage surgery surveys. A total of 2280 surveys were from 1022 nonoperatively treated patients. School absenteeism was significantly higher for surgeries during the school year compared to summer in both the fusion and nonfusion groups, though work absenteeism showed no significant differences. Halo/multistage surgery patients had the highest rates of absenteeism. Conclusions: This study highlights the impacts of scoliosis surgery timing and type on absenteeism among patients and their caregivers. Surgery during summer breaks reduces school absenteeism and academic disruption. Halo/multistage surgery patients face the greatest risk of chronic absenteeism from school, indicating a need for targeted interventions. Optimized surgical timing and planning can help families navigate the educational and financial challenges of scoliosis treatment.

Early detection of students' mental health issues from a traditional daily health observation scheme in Japanese schools and its digitalization

Objective

The implementation of school-based mental health screening offers promise for early detection of mental health issues in children; however, various barriers hinder its widespread adoption. This study aimed to investigate the predictive value of digital data obtained from an established daily health observation scheme in Japanese schools to identify later mental health issues in children.

Methods

Data for the analysis were obtained from 2,433 students enrolled in five public schools. The data acquisition period spanned 76 school days, from September 1, 2022, to December 23, 2022, and student absences were recorded during this period. Depressive and anxiety symptoms were assessed in January 2023. The students' daily physical and emotional health status was recorded as "daily health issue" scores and group-based trajectory modeling was employed to classify the long-term trends in these scores. Additionally, rolling z-scores were utilized to capture variability in daily health issue scores, with z-scores above +1 considered unusual responses.

Results

After 4 months of daily health observations, students' response trends were classified into five trajectory groups. The group experiencing the highest number of daily health issues (Group 5; 5.4% of the sample) exhibited more subsequent depressive and anxiety symptoms compared to the group with fewer issues (Group 1; 47.5%) (incident rate ratio [IRR] = 5.17; 95% confidence interval [CI]: 3.82, 6.99). Group 5 also demonstrated significantly more days of absence than Group 1 (IRR = 2.14, 95% CI: 1.19, 3.85). The average daily health issue scores for the entire period were associated with both depressive/anxiety symptoms and the number of days absent from school (IRR = 1.59, 95% CI: 1.45, 1.73; IRR = 1.18, 95% CI: 1.04, 1.35, respectively). Furthermore, a higher number of unusual responses during the entire period was also associated with more depressive/anxiety symptoms (IRR = 1.10, 95% CI: 1.07, 1.12).

Conclusion

The current study is the first to demonstrate the predictive capability of a traditional daily health observation scheme to identify mental health issues in children. This study highlights the scheme's potential to screen and safeguard children's mental health, emphasizing the importance of digitalization and collaboration with various stakeholders.

Suicidal Ideation and Attempts Among Youth With Physical-Mental Comorbidity in Canada: Proposal for an Epidemiological Study

BACKGROUND

Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation or attempts) among youth. Less is known about the mechanisms linking CPI and suicidality. Some evidence suggests that mental illness (eg, depression and anxiety) or neurodevelopmental disorder (eg, attention-deficit/hyperactivity disorder) mediates or moderates the CPI-suicidality association. Missing from the knowledge base is information on the association between having co-occurring CPI and mental illness or neurodevelopmental disorder (MIND) on youth suicidality.

OBJECTIVE

This study uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of CPI, MIND, and suicidality in youth. We will estimate prevalence, identify predictors, and investigate psychosocial and service use outcomes for youth with CPI-MIND comorbidity versus other morbidity groups (ie, healthy, CPI only, and MIND only).

METHODS

Conducted by Statistics Canada, the CHSCY collected data from 47,850 children (aged 1-17 years) and their primary caregiving parent. Measures of youth CPI, MIND, family environment, and sociodemographics are available using youth and parent informants. Information on psychiatric services use is available via parent report and linkage to national administrative health data found in the National Ambulatory Care Reporting System and the Discharge Abstract Database, which allow the investigation of hospital-based mental health services (eg, emergency department visits, hospitalizations, and length of stay in hospital). Questions about suicidality were restricted to youths aged 15-17 years (n=6950), which form our analytic sample. Weighted regression-based analyses will account for the complex survey design.

RESULTS

Our study began in November 2023, funded by the American Foundation for Suicide Prevention (SRG-0-008-22). Access to the linked CHSCY microdata file was granted in May 2024. Initial examination of CHSCY data shows that approximately 20% (1390/6950) of youth have CPI, 7% (490/6950) have MIND, 7% (490/6950) seriously considered suicide in the past year, and 3% (210/6950) had attempted suicide anytime during their life.

CONCLUSIONS

Findings will provide estimates of suicidality among youth with CPI-MIND comorbidity, which will inform intervention planning to prevent loss of life in this vulnerable population. Modeling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels-information needed to target prevention efforts and services. Understanding patterns of psychiatric service use is vital to understanding access and barriers to services. This will inform whether use matches need, identifying opportunities to advise policy makers about upstream resources to prevent suicidality. Importantly, findings will provide robust baseline of information on the link between CPI-MIND comorbidity and suicidality in youth, which can be used by future studies to address questions related to the impact of the COVID-19 pandemic and associated countermeasures in this vulnerable population of youth.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57103.

Pediatric Migraine and Visual Cortical Excitability: A Prospective Observational Study with Sound-Induced Flash Illusions

The pathophysiological mechanisms underlying migraine are more difficult to investigate in children than in the adult population. Abnormal cortical excitability turns out to be one of the most peculiar aspects of migraine, accounting for the manifestations of migraine attacks. Recently, visual cortical excitability has been explored effectively in adult migraineurs with a technique based on cross-modal audio-visual illusions (with sound-induced flash illusions (SIFIs) being reduced in migraineurs compared to non-migraineur subjects). On such a basis, in this study, we investigated visual cortical excitability in children with migraine using SIFIs using combinations of visual and sound stimuli presented randomly. We evaluated 26 children with migraine without aura and 16 healthy children. Migraineurs did not differ from the age-matched healthy subjects regarding fission or fusion illusions but perceived more flashes in trials of multiple flashes with or without beeps. The higher number of SIFIs in migraineur children compared to adults may be due to a greater propensity of visual stimulation to be driven by auditory stimuli (i.e., acoustic dominance). The increased ability to perceive flashes reveals a hyperfunctional visual cortex, demonstrating that the use of SIFIs is a valid tool for assessing visual cortical responsiveness even in pediatric migraine.

Risk of new onset and persistent psychopathology in children with long-term physical health conditions: a population-based cohort study

Children and young people (CYP) with long-term physical health conditions (pLTCs) have increased risk of psychopathology compared to physically healthier peers. We explored risk factors for new onset and persistent psychiatric disorders in CYP with pLTCs compared to CYP without pLTCs. This 3-year follow-up study involved a UK representative sample of CYP from the British Child and Adolescent Mental Health Surveys (N = 7804). We examined potential baseline predictors of new onset and persistent psychiatric disorders at follow-up in four groups of children based on the presence of any physical and/or any psychiatric conditions at baseline. Psychiatric disorders were assessed using standardised multi-informant diagnostic assessment. Separate multivariable binary logistic regressions were conducted for each group. In CYP with pLTCs, rented housing (aOR = 1.42, 95% CI  1.01 to 1.99), non-traditional family structure (aOR = 2.08, 95% CI  1.42 to 3.05), increased parental distress (aOR = 1.09, 95% CI  1.04 to 1.14), and greater peer relationship difficulties (aOR = 1.29, 95% CI  1.19 to 1.39) predicted future psychiatric disorder. Only peer relationship difficulties predicted persistent disorder (aOR = 1.27, 95% CI  1.17 to 1.38) in this group. A greater number of factors predicted the onset of psychiatric disorder in CYP with pLTCs compared to physically healthier peers and similarly, a higher number of factors predicted persistent disorder in CYP without pLTCs. CYP with pLTCs might comprise a group with different vulnerabilities, some of which are potentially tractable and may be useful indicators of patients who require preventable or management interventions.

Association Between Area-Level Income Inequality and Health-Related School Absenteeism: Evidence From the COMPASS Study

BACKGROUND

Income inequality is theorized to impact health. However, evidence among adolescents is limited. This study examined the association between income inequality and health-related school absenteeism (HRSA) in adolescents.

METHODS

Participants were adolescents (n = 74,501) attending secondary schools (n = 136) that participated in the 2018-2019 wave of the COMPASS study. Chronic (missing ≥3 days of school in the previous 4 weeks) and problematic (missing ≥11 days of school in the previous 4 weeks) HRSA was self-reported. Income inequality was assessed via the Gini coefficient at the census division (CD) level. Multilevel modeling was used.

RESULTS

Greater income inequality was associated with a higher likelihood of chronic and problematic HRSA (chronic: OR = 1.17, 95% CI: 1.06, 1.30; problematic: OR = 1.29, 95% CI 1.11 to 1.50). Increased predicted probabilities for Problematic HRSA were observed at greater degrees of income inequality among students who identified as either white, black, Latinx, or mixed, while protective associations were observed among students who identified as Asian or other. No associations were modified by gender.

CONCLUSION

Income inequality demonstrated unfavorable associations with HRSA, which was modified by racial identity.

Predictors of contact with services for mental health problems among children with comorbid long-term physical health conditions: a follow-up study

Children with long-term physical health conditions (pLTCs) are at increased risk of developing mental health comorbidities, although most do not access services for their mental health. No previous studies have examined the determinants of contact with services for mental health concerns among this group of children. This 3-year longitudinal study involved a population-based sample of children aged 5-16 years from the British Child and Adolescent Mental Health Surveys conducted in 1999 and 2004. In children with comorbid pLTCs and mental health disorders at baseline (N = 397), we examined associations between several child-, family- and service-related factors and (a) contact with primary health care, (b) contact with paediatrics and (c) contact with child and adolescent mental health services over 3-year follow-up (2002 and 2007). Separate multivariable binary logistic regressions were conducted for each service. The impact of mental health difficulties on the child and contact with the teacher predicted contact with all three services. Adolescent age, female gender, larger family size, some or marked academic difficulties, and having parents with educational qualification(s) were specific predictors of contact with primary health care. Male gender, stressful life events, and contact with primary health care were specific predictors of contact with child and adolescent mental health services. No other factors predicted contact with paediatrics. Our findings highlight the role of child-, family-, and service-related factors in accessing mental health care in children with comorbid pLTCs and mental health disorders which could inform planning and provision of services to reduce unmet mental health needs.

Trends in comorbid physical and mental health conditions in children from 1999 to 2017 in England

INTRODUCTION

Children with long-term physical health conditions (pLTCs) are at increased risk of mental health conditions but less is known about time trends in the mental health of this group of children.

METHODS

We used data from three comparable, population-based surveys of children conducted in 1999, 2004, and 2017. We examined whether the proportion of children aged 5-15 years old with comorbid mental health conditions (measured using the multi-informant Development and Well-being Assessment tool) and pLTCs (measured using parental report) in England increased from 1999 to 2017 using linear regression analysis.

RESULTS

Our analysis used data from 8662 (1999), 6401 (2004) and 6219 (2017) children, respectively. The proportion of children with comorbid pLTCs and psychiatric disorders was 0.050 (95% CI = 0.045, 0.055) in 1999, 0.054 (95% CI = 0.049, 0.060) in 2004, and 0.059 (95% CI = 0.053, 0.065) in 2017. The linear regression model revealed a non-significant effect of time on the proportion of children with comorbid pLTCs and psychiatric disorders from 1999 to 2017 (B = 0.0004785; SE = 0.0001256; p = 0.163).

CONCLUSION

The estimated prevalence of school-aged children with comorbid pLTCs and mental health conditions in England remained stable since 1999, highlighting the need to prioritize mental health resources for children with physical health comorbidities.

More Than a Headache: Lived Experience of Migraine in Youth

BACKGROUND

Migraine is the leading cause of disability among adolescents and young adults. We aimed to characterize the impact of migraine on the experience of children, adolescents, and caregivers.

METHODS

This descriptive qualitative study recruited youth aged four to 18 years with migraine and their caregivers from the multicenter, prospective Pediatric Migraine Registry between 2020 and 2021. Participants completed semistructured interviews targeting the lived experience of migraine. A conventional content analysis approach was used to analyze data.

RESULTS

Thirty enrolled dyads (n = 30 children and adolescents, n = 29 caregivers) completed 59 interviews (n = 29 child and adolescent interviews, n = 30 caregiver interviews). Children and adolescents had a median age of 15 years and experienced a median of 13.5 headache days per month. Caregivers had a median age of 44 years and predominantly identified as mothers (n = 28). We identified three themes: (1) Impact on emotional well-being: participants described how their migraine experience included feelings of isolation, depression, and irritability alongside the need for social support; (2) Impact on daily life: participants described how symptoms and unpredictability impacted their ability to perform activities of daily living; and (3) Impact on school: participants described how migraine impacted their school experience, including threatened attendance and worsened performance.

CONCLUSIONS

In this cohort of youth and their caregivers, we identified salient themes to characterize the experience of migraine. Our findings underscore the urgent need for effective migraine treatments and interventions targeting co-occurring mental health conditions, peer relationships, and school support.

Psychosocial outcomes in Chinese survivors of pediatric cancers or bone marrow failure disorders: A single-center study

BACKGROUND/OBJECTIVES

Most of the studies on functional outcomes in pediatric survivors of cancers and bone marrow failure disorders have been conducted in North American, European, and Oceanian populations, with few studies having been performed in China. The objective of this study was to evaluate psychosocial outcomes in a cohort of Chinese pediatric survivors diagnosed with cancer or conditions requiring hematopoietic stem cell transplantation (HSCT), and to identify clinical and behavioral factors associated with adverse psychosocial outcomes.

METHODS

This was a cross-sectional survey study. We recruited pediatric survivors of cancer or inherited disorder requiring HSCT at ≤18 years old and were ≥6 months post-treatment. Parents completed the St. Jude Children's Research Hospital After Completion of Therapy questionnaire to report their child's emotional functioning, social functioning, attention/concentration and behavior. Multivariable general linear modeling was used to identify clinical, treatment and behavioral factors associated with psychosocial outcomes, adjusting for sex, age and cancer diagnoses.

RESULTS

Ninety-five pediatric survivors were recruited (62.1% male; mean [standard deviation] age 9.7 [3.4] years; 4.1 [2.6] years post-diagnosis). They were diagnosed with bone marrow failure disorders (23.2%), hematological malignancies (45.3%) or solid tumors (23.2%). Compared with survivors with no current health problems, those with more than one current health problem performed worse in emotional functioning (Estimate = 2.42, SE = 0.88, P = 0.008) and social functioning (Estimate = 2.90, SE = 1.64, P = 0.03). Higher pain interference was significantly associated with worse emotional functioning (Estimate = 0.19, SE = 0.08, P = 0.03) and attention functioning (Estimate = 0.26, SE = 0.11, P = 0.03). Compared with survivors who reported less sleep problems, those who had more sleep problems demonstrated poorer emotional functioning (Estimate = 0.30, SE = 0.08, P = 0.001). Survivors who had a longer duration of screen usage per day reported more impairment on attention and behavior functioning than those who had a shorter duration of screen usage per day (both P<0.5).

CONCLUSION

Survivors who were diagnosed at a younger age or had unaddressed/untreated health problems may require additional psychological evaluation. The implementation of psychosocial assessments during routine long-term follow-up care may help to identify high-risk patients during the early phase of survivorship. Rehabilitation interventions should address modifiable behavioral factors (e.g. sleep habits, screen time and chronic pain).