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Wong TJ, Yu T. Association Between Socioeconomic Status and Prevalence of Hypersensitivity Diseases and Autism: A Nationwide Study of Children. Matern Child Health J 2023; 27:2194-2202. [PMID: 37823989 DOI: 10.1007/s10995-023-03789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Prior research suggests that children with a low socioeconomic status (SES) background are at an increased risk for special healthcare needs. Conversely, for hypersensitivity-related diseases, many studies reported a lower risk among children with lower SES according to the hygiene hypothesis. We aimed to evaluate the association between SES and several hypersensitivity diseases and autism in a representative American sample. METHODS We used data from the 2016, 2017 and 2018 US National Survey of Children's Health. A total of 102,341 children aged 0-17 years were included. The dependent variables were doctor-diagnosed allergies, arthritis, asthma, diabetes, and autism. The main SES indicators were family poverty levels, highest education of the reported adults and difficulty in family income. Our analysis used logistic regression that accounted for the survey sampling design. RESULTS The sample had a mean age of 9.4 ± 5.3 years. The weighted prevalence for allergies was 24.4%, 0.3% for arthritis, 11.9% for asthma, 0.5% for diabetes and 2.6% for autism. Children with adults reporting higher educational levels had greater odds of allergies (adjusted odds ratio and 95% CI: 1.48, 1.23-1.78) than those with lower educational levels. But for all other diseases, most findings suggested that a higher odds of disease was associated with lower SES instead of higher SES. CONCLUSIONS A low SES background remains an important risk factor for hypersensitivity diseases in children. Most of our results suggested that children with low SES were associated with a higher risk of hypersensitivity diseases and autism.
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Affiliation(s)
- Tzu-Jung Wong
- Department of Healthcare Information and Management, School of Health Technology, Ming Chuan University, Taoyuan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Arrué AM, Hökerberg YHM, Jantsch LB, da Gama SGN, de Oliveira RDVC, Okido ACC, Cabral IE, de Lima RAG, Neves ET. Prevalence of children with special healthcare needs: An epidemiological survey in Brazil. J Pediatr Nurs 2022; 67:95-101. [PMID: 36058190 DOI: 10.1016/j.pedn.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to estimate the prevalence and delineate the profile of children with special healthcare needs (CSHCN) in the three municipalities of Brazil's southern and southeastern regions from 2015 to 2017. DESIGN AND METHODS This cross-sectional study included 6853 children aged 0-11 years. Participants were selected through complex sampling in 32 primary healthcare units. The Brazilian version of the Children with Special Healthcare Needs Screener© and a questionnaire were used to identify sociodemographic and family characteristics, health status, and health services utilization. Simple and multiple logistic regression models were used to evaluate the association between family and child characteristics and prevalence (P < 0.05). RESULTS The prevalence of CSHCN was 25.3% (95% confidence interval: 21.0-30.0). Most participants required health services or were on long-term medication for a current chronic condition; approximately 53% of CSHCN had no formally recorded diagnoses. The most frequent health problems were respiratory conditions, asthma, and allergies. Approximately 60% of the CSHCN patients underwent follow-up examinations of the specialties pneumology, pediatrics, otorhinolaryngology, speech therapy, neurology, and psychology. Children of school age, of male sex, with premature birth, with a history of recurrent hospitalization, from non-nuclear families, and from underprivileged social classes were identified as risk factors for classification as CSHCN. PRACTICE IMPLICATION These results contribute to the unprecedented mapping of these children in healthcare networks in Brazil. CONCLUSION The high prevalence of CSHCN in medium and large municipalities in the southern and southeastern regions was associated with the child's previous health conditions and family structure.
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Affiliation(s)
- Andrea Moreira Arrué
- Sergio Arouca National School of Public Health, Fiocruz and Federal Institute of Paraná, Paraná, Brazil.
| | - Yara Hahr Marques Hökerberg
- Sergio Arouca National School of Public Health, Fiocruz and Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
| | | | | | | | | | - Ivone Evangelista Cabral
- Anna Nery School of Nursing, Federal University of Rio de Janeiro and State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Ghandour RM, Hirai AH, Kenney MK. Children and Youth With Special Health Care Needs: A Profile. Pediatrics 2022; 149:188226. [PMID: 35642877 DOI: 10.1542/peds.2021-056150d] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The National Survey of Children's Health (NSCH) is the nation's primary source for data on children and youth with special health care needs (CYSHCN) and the only source for state-level estimates. We provide the latest estimates of CYSHCN in the United States, describe population characteristics, as well as the proportion that are served in a well-functioning system of care. METHODS Data from the 2016, 2017, 2018, and 2019 NSCH were appended, resulting in a final analytic sample of 30 301 CYSHCN. Bivariate associations between the covariates and SHCN status as well as the 6 core outcomes that comprise a well-functioning system of care were examined using χ2 tests. Multivariable logistic regression was used to identify factors independently associated with SHCN status and a well-functioning system of care. RESULTS The overall prevalence of CYSHCN was 18.8% and ranged from 13.6% in Hawaii to 24% of individuals included in the NSCH in West Virginia. The most reported type of SHCN was prescription medication use (29.3%), whereas 25.9% of CYSHCN had functional limitations. Over one-third reported no daily activity impacts, whereas 18.9% reported consistent or significant daily impacts. CYSHCN were more likely than non-CYSHCN to be male, older, non-Hispanic Black, live in poverty, and have public insurance but disparities by race and ethnicity and income were no longer significant after adjustment. Only 14.9% of CYSHCN were reported to receive care in a well-organized system. Rates were substantially lower among older and more heavily affected children with adjusted rate ratios for access to a well-functioning system of care, indicating a 72% reduction for adolescents (12-17), compared with young children (0-5) and a 24% to 53% reduction for those with more than a prescription medication qualifying need. CONCLUSIONS CYSHCN remain a sizable and diverse population with distinct challenges in accessing well-functioning systems of care, particularly for those with the greatest needs. Our results provide a profile of the population designed to inform future surveillance, research, program, and policy priorities showcased in this Special Issue.
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Li F, Cui Y, Li Y, Guo L, Ke X, Liu J, Luo X, Zheng Y, Leckman JF. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals. J Child Psychol Psychiatry 2022; 63:34-46. [PMID: 34019305 DOI: 10.1111/jcpp.13445] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND To date, no national-scale psychiatric epidemiological survey for children and adolescents has been conducted in China. In order to inform government officials and policymakers and to develop a comprehensive plan for service providers, there was a clear need to conduct an up-to-date systematic nationwide psychiatric epidemiological survey. METHODS We conducted a two-stage large-scale psychiatric point prevalence survey. Multistage cluster stratified random sampling was used as the sampling strategy. Five provinces were selected by comprehensively considering geographical partition, economic development, and rural/urban factors. In Stage 1, the Child Behavior Checklist was used as the screening tool. In Stage 2, Mini-International Neuropsychiatric Interview for Children and Adolescents and a diagnostic process based on the Diagnostic and Statistical Manual were used to make the diagnoses. Sampling weights and poststratification weights were employed to match the population distributions. Exploratory analyses were also performed using socio-demographic factors. Prevalence in socio-demographic factor subgroups and overall were estimated. Rao-Scott adjusted chi-square tests were utilized to determine if between-group differences were present. Factor interactions were checked by logistic regression analyses. RESULTS A total of 73,992 participants aged 6-16 years of age were selected in Stage 1. In Stage 2, 17,524 individuals were screened and diagnosed. The weighted prevalence of any disorder was 17.5% (95% CI: 17.2-18.0). Statistically significant differences in prevalence of any psychiatric disorder were observed between sexes [χ2 (1, N = 71,929) = 223.0, p < .001], age groups [χ2 (1, N = 71,929) = 18.6, p < .001] and developed vs. developing areas [χ2 (1, N = 71,929) = 2,129.6, p < .001], while no difference was found between rural and urban areas [χ2 (1, N = 71,929) = 1.4, p = .239]. Male, younger individuals, children, and adolescents from developed areas had higher prevalence of any psychiatric disorder. The prevalence of any psychiatric disorder was found to decrease with the age in the male group, while the female group increased with the age. Individuals diagnosed with attention-deficit hyperactivity disorder, oppositional defiant disorder, a tic disorder, conduct disorder, and major depression disorder had the highest rates of comorbidity. CONCLUSIONS The prevalence of any psychiatric disorder we found is the highest ever reported in China. These results urgently need to be addressed by public mental health service providers and policymakers in order to provide access to the necessary treatments and to reduce the long-term negative impact of these conditions on families and the society as a whole.
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Affiliation(s)
- Fenghua Li
- Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yonghua Cui
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Li
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lanting Guo
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | | | - Jing Liu
- Sixth hospital, Peking University, Beijing, China
| | - Xuerong Luo
- Mental Health Institute, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Dong Y. RETRACTED: Comprehensive evaluation analysis of mental health status of poverty-stricken college students at present age with interval-valued intuitionistic fuzzy information. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-179265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article has been retracted, and the online PDF has been watermarked “RETRACTED”. A retraction notice is available at https://doi.org/10.3233/IFS-219217.
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Affiliation(s)
- Yile Dong
- College of Tourism, HuaQiao University, Quanzhou, Fujian, P. R. China
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Moeenuddin Z, Kim-Kupfer C, Owchar E, Baker J, Duffield A, Santoro T. The Influence of Care Coordination on Patients With Special Health Care Needs in a Pediatric Residency Continuity Clinic. Glob Pediatr Health 2019; 6:2333794X19848677. [PMID: 31106252 PMCID: PMC6507326 DOI: 10.1177/2333794x19848677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022] Open
Abstract
This study evaluates the influence of comprehensive health care coordination for children with special health care needs (CSHCN) in a resident continuity clinic. CSHCN patients were identified from 2 resident continuity panels. Patients were eligible with a score of 2 or greater on the CSHCN screener. Interventions included extended appointment times, a binder, and direct phone access to the social worker who facilitated follow-up appointment scheduling. Data measured included completed and no-show visits for primary care and subspecialty appointments, hospitalization and emergency department visits, use of binders, and parent satisfaction surveys. Patients with a baseline CSHCN screener score ≥4 were 15.6 times more likely to keep their appointment after enrollment (P = .0035). Mental health no-show visits decreased significantly (P < .0001). The utilization of components of comprehensive team-based care coordination, even with limited resources, can improve the delivery of health care for children with complex medical needs and mental health disorders in a resident-based clinic.
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Lehti V, Gyllenberg D, Suominen A, Sourander A. Finnish-born children of immigrants are more likely to be diagnosed with developmental disorders related to speech and language, academic skills and coordination. Acta Paediatr 2018; 107:1409-1417. [PMID: 29505120 DOI: 10.1111/apa.14308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/24/2018] [Accepted: 02/28/2018] [Indexed: 01/22/2023]
Abstract
AIM We examined the association between having at least one parent born abroad and being diagnosed with a developmental disorder related to speech and language, academic skills or coordination. METHODS This nested case-control study was based on Finnish population records for 1996-2007. Cases from the Finnish Hospital Discharge Register were diagnosed with developmental disorders of speech and language, academic skills and coordination by the end of 2012. We identified 28 192 cases and 106 616 matched controls. RESULTS Children were more likely to be diagnosed with developmental disorders if they had an immigrant mother than children with two Finnish-born parents, with an adjusted odds ratio (aOR) of 1.3 and 95% confidence interval (95% CI) of 1.2-1.4, an immigrant father (aOR 1.2, 95% CI 1.1-1.3) or two immigrant parents (aOR 1.5, 95% CI 1.3-1.6). The level of development of the parental country of origin was not associated with receiving a diagnosis. CONCLUSION Children of immigrant parents were more likely to be diagnosed with developmental disorders and the association was strongest with regard to speech and language disorders. There were similar adjusted odds ratios for mothers, fathers and both parents. The development level of the country of origin was irrelevant.
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Affiliation(s)
- Venla Lehti
- Research Center for Child Psychiatry; University of Turku; Turku Finland
- Department of Psychiatry; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - David Gyllenberg
- Research Center for Child Psychiatry; University of Turku; Turku Finland
- Children, Adolescents and Family Unit; National Institute for Health and Welfare; Helsinki Finland
| | - Auli Suominen
- Research Center for Child Psychiatry; University of Turku; Turku Finland
| | - Andre Sourander
- Research Center for Child Psychiatry; University of Turku; Turku Finland
- Department of Child Psychiatry; University of Turku and Turku University Hospital; Turku Finland
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Differential Outcomes of Sleep Problems in Children with and Without Special Health Care Needs: Australian Population Study. J Dev Behav Pediatr 2016; 37:415-23. [PMID: 26982245 DOI: 10.1097/dbp.0000000000000274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In a nationally representative sample of Australian children at ages 4 to 5, 6 to 7, 8 to 9, 10 to 11, and 12 to 13 years, we aim to examine the (1) prevalence of sleep problems in children with and without special health care needs (SHCN); (2) association of sleep problems with child behavior, health-related quality of life, learning and parent mental health outcomes; and (3) whether associations between sleep problems and outcomes among children with SHCN are larger in magnitude than among children without SHCN. METHOD Biennial data from 5 waves of the Growing Up in Australia Study. EXPOSURES Child SHCN as defined by the Children Special Health Care Needs Screener and parent report of child sleep problem. OUTCOMES Child: parent-reported health-related quality of life; parent-reported and teacher-reported behavior; nonverbal and verbal cognition and teacher-reported learning. Parent: self-report mental health. ANALYSIS Logistic and linear regression, adjusted for family socioeconomic position. RESULTS Children with SHCN were more likely to have sleep problems, odds ranging from 2.0 (95% confidence interval [CI], 1.6-2.5) at 4 to 5 years to 3.9 (95% CI, 3.0-5.2) at 8 to 9 years. Compared with children who had neither condition, those with either sleep problems or SHCN had similarly poor child and maternal outcomes. Children with both SHCN and sleep problems had the poorest outcomes at every age (all p < .001). Tests of interaction found sleep problems are more strongly associated with poorer behavior and health-related quality of life among children with SHCN than those without during the preschool and early school years. CONCLUSION Sleep problems in children with SHCN are common and are associated with poorer child and maternal outcomes. These associations are stronger for poorer behavior and health-related quality of life among children with SHCN than those without during the preschool and early school years.
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Measuring parents' perspective on continuity of care in children with special health care needs. Int J Integr Care 2015; 15:e046. [PMID: 27118963 PMCID: PMC4843181 DOI: 10.5334/ijic.2202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents' perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this population. METHODS SpeNK-Q was derived from a previous qualitative study and was based on Haggerty's constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child's hospital discharge. Principal component analysis was used to examine the structure of the instrument. RESULTS Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family-paediatrician relationship; family support; information on care plan. CONCLUSIONS AND DISCUSSION SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services.
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Abstract
OBJECTIVE Attention-deficit hyperactivity disorder (ADHD) can impair child health and functioning, but its effects on the family's economic burden are not well understood. The authors assessed this burden in US families of children with ADHD, and the degree to which access to a patient-centered medical home (PCMH) might reduce this burden. METHODS We conducted cross-sectional analyses of 2005-2006 and 2009-2010 National Surveys of Children with Special Health Care Needs, focusing on families of children with ADHD. They defined family economic burden as (1) family financial problems (annual expenses for the child's health care or illness-related financial problems for the family) and/or (2) family employment problems (job loss, work time loss, or failure to change jobs to avoid insurance loss). Relative risk models assessed associations between PCMH and family economic burden, adjusted for child age, sex, ethnicity, ADHD severity, poverty status, caregiver education, and insurance. RESULTS In 2009, 26% of families reported financial problems because of the child's ADHD, 2.1% reported out-of-pocket expenses >5% of income, and 36% reported employment problems. Only 38% reported care that met all 5 criteria for a PCMH (similar to rates in 2005-2006). In multivariable analysis, care in a PCMH was associated with 48% lower relative risk (RR) of financial problems (RR = 0.52, p < .001) and 36% lower relative risk of employment problems (RR = 0.64, p < .001). Among PCMH components, family-centered care and care coordination were more strongly associated with lower burden. CONCLUSIONS The economic burdens of families with ADHD are significant but may be alleviated by family-centered care and care coordination in a medical home.
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Prevalence of mental disorders in 6-16-year-old students in Sichuan province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5090-107. [PMID: 25985310 PMCID: PMC4454956 DOI: 10.3390/ijerph120505090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 02/05/2023]
Abstract
To investigate the point prevalence of mental disorders in school students, multistage cluster stratified random sampling and two-phase survey methods were used to identify 40 primary and middle schools. The students were screened using the Chinese version of the Child Behavior Checklist and diagnosed using the Mini International Neuropsychiatric Interview. The prevalence of behavioral problems was 19.13%. The prevalence of behavioral problems significantly differed by sex, age, city of residence, and caretaker. The six-month prevalence of any mental disorder was 15.24% (95% CI: 15.49%-16.97%). Psychiatric disorders were more prevalent in boys (17.33%) relative to girls (13.11%; p < 0.01). The prevalence of mental disorders significantly differed by community and caretaker, and 36.46% of students exhibited comorbidity. Results demonstrated important mental health issues, with a high incidence of comorbidities, in this population. Students' mental health requires increased attention, particularly in poverty-stricken areas and left-behind children and adolescents.
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Quach J, Jansen PW, Mensah FK, Wake M. Trajectories and outcomes among children with special health care needs. Pediatrics 2015; 135:e842-50. [PMID: 25780064 DOI: 10.1542/peds.2014-2431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Outcomes for children with special health care needs (SHCN) can vary by their patterns and persistence over time. We aimed to empirically establish typical SHCN trajectories throughout childhood and their predictive relationships with child and parent outcomes. METHODS The 2 cohorts of the nationally representative Longitudinal Study of Australian Children were recruited in 2004 at ages 0 to 1 (n = 5107, B cohort) and 4 to 5 years (n = 4983, K cohort). The parent-reported Children With SHCN Screener (Short Form) was completed at each of 4 biennial waves. Wave 4 outcomes were parent-reported behavior and health-related quality of life, teacher-reported learning, and directly assessed cognition. Both parents self-reported mental distress. We derived intracohort trajectories by using latent class analysis in Mplus. We compared mean outcome scores across trajectories by using linear regression, adjusting for socioeconomic position. RESULTS Four distinct SHCN trajectories were replicated in both cohorts: persistent (B 6.8%, K 8.7%), emerging (B 4.1%, K 11.5%), transient (B 7.9%, K 4.2%), and none (B 81.3%, K 75.6%). Every outcome was adversely affected except fathers' mental health. From infancy to age 6 to 7 years, the persistent and emerging groups had similarly poor outcomes. From age 4 and 5 to 10 and 11 years, outcomes were incrementally poorer on moving from none to transient to emerging and to persistent SHCN. Effect sizes were largest for behavior, learning, and psychosocial outcomes. CONCLUSIONS Adverse outcomes are shaped more by cumulative burden than point prevalence of SHCNs. In addition to providing care according to a child's need at any given time, prioritizing care toward persistent SHCNs may have the biggest benefits for children and parents.
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Affiliation(s)
- Jon Quach
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Carlton, Victoria, Australia;
| | - Pauline W Jansen
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Erasmus Medical Center, Rotterdam, Netherlands; Erasmus University, Rotterdam, Netherlands; and
| | - Fiona K Mensah
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Carlton, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Melissa Wake
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Carlton, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia
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Butler AM, Kowalkowski M, Jones HA, Raphael JL. The relationship of reported neighborhood conditions with child mental health. Acad Pediatr 2012; 12:523-31. [PMID: 23009865 PMCID: PMC3640259 DOI: 10.1016/j.acap.2012.06.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 06/13/2012] [Accepted: 06/17/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although in many studies authors have documented the relationship between neighborhood socioeconomic status and child mental health, few have examined the association between neighborhood conditions and mental health disorders. The objective of this study was to determine whether parent-reported neighborhood conditions are associated with common child mental health disorders. METHODS We analyzed data on children ages 6 to 17 (N = 64,076) collected through the 2007 National Survey of Children's Health. Primary outcome variables were a child being reported to have a diagnosis of (1) anxiety and/or depression and (2) attention-deficit-hyperactivity disorder (ADHD) and/or disruptive behavior. Main independent variables were parent-reported neighborhood amenities (eg, recreation center), poor physical characteristics (eg, dilapidated housing), social support/trust, neighborhood safety, and school safety. Multivariate logistic regression analyses were conducted to examine associations between neighborhood conditions and (1) anxiety/depression and (2) ADHD/disruptive behavior. RESULTS Children living in a neighborhood with 3 poor physical characteristics had greater odds of anxiety/depression (adjusted odds ratio [AOR] 1.58, 95% confidence interval [95% CI] 1.01-2.46) and ADHD/disruptive behavior (AOR 1.44, 95% CI 1.04-1.99) compared with children living in a neighborhood with no poor physical characteristics. Children of parents who reported living in a neighborhood with low social support/trust had greater odds of depression/anxiety (AOR 1.71, 95% CI 1.28-2.30) and ADHD/disruptive behavior (AOR 1.47, 95% CI 1.19-1.81) than children living in a neighborhood with greater social support/trust. CONCLUSIONS Parent perception of neighborhood social support/trust and physical characteristics may be important to assess in clinical settings and should be examined in future study of child mental health burden.
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Affiliation(s)
- Ashley M Butler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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State-level income inequality and family burden of U.S. families raising children with special health care needs. Soc Sci Med 2011; 74:399-407. [PMID: 22192773 DOI: 10.1016/j.socscimed.2011.10.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 10/20/2011] [Accepted: 10/25/2011] [Indexed: 11/24/2022]
Abstract
Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden.
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Houtrow AJ, Okumura MJ. PEDIATRIC MENTAL HEALTH PROBLEMS AND ASSOCIATED BURDEN ON FAMILIES. VULNERABLE CHILDREN AND YOUTH STUDIES 2011; 6:222-233. [PMID: 22135697 PMCID: PMC3225084 DOI: 10.1080/17450128.2011.580144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Approximately 20% of children in the United States have mental health problems. The factors associated with childhood mental health problems and the associated burdens on families are not well understood. Therefore, our goals were to profile mental health problems in children to identify disparities, and to quantify and identify correlates of family burden. We used the National Survey of Children's Health, 2003 (N=85,116 children aged 3-17 years) for this analysis. The prevalence, unadjusted and adjusted odds ratios of mental health problems and family burden were calculated for children by child-, family- and health systems- level characteristics. The prevalence of mental health problems among children aged 3-17 years was 18%. The odds of mental health problems were higher for boys, older children, children living in or near relative poverty, those covered by public insurance, children of mothers with fair or poor mental health, children living in homes without two parents, children without a personal doctor or nurse, and children with unmet health care needs. Among families with children with mental health problems, 28% reported family burden. Correlates of family burden included White race, severity, older age, higher income, non-two parent family structure, and having a mother with mental health problems. In conclusion, childhood mental health problems are common and disproportionally affect children with fewer family and health care resources. Families frequently report burden, especially if the mental health problem is moderate to severe, but the correlates of family burden are not the same correlates associated with mental health problems. Understanding those highest at risk for mental health problems and family burden will help assist clinicians and policy makers to ensure appropriate support systems for children and families.
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Affiliation(s)
- Amy J. Houtrow
- Department of Pediatrics, University of California at San Francisco
| | - Megumi J. Okumura
- Departments of Pediatrics and Internal Medicine, University of California at San Francisco
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Nguyen DD, Ho KH, Williams JH. Social determinants and health service use among racial and ethnic minorities: findings from a community sample. SOCIAL WORK IN HEALTH CARE 2011; 50:390-405. [PMID: 21614731 DOI: 10.1080/00981389.2011.567130] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Multiple models conceptualizing the relationship between social determinants and health exist, but little research has examined the relationship between social determinants and health service use. Using previously collected survey data from racial and linguistic minorities from high-crime communities in a Midwestern urban area, this study uses the Commission on Social Determinants of Health framework to test the structural and intermediary determinants of health service use. The results indicate that perceived discrimination and neighborhood cohesion increase the likelihood of a person using health services. Implications for social work practice, advocacy, and research to address intermediary social determinants are discussed.
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Affiliation(s)
- Duy D Nguyen
- Silver School of Social Work, New York University, New York, New York, USA.
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Norlin C, Crawford MA, Bell CT, Sheng X, Stein MT. Delivery of well-child care: a look inside the door. Acad Pediatr 2011; 11:18-26. [PMID: 21272820 DOI: 10.1016/j.acap.2010.12.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 12/08/2010] [Accepted: 12/08/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the delivery of well-child care and its components; to compare that delivery with recommendations in Bright Futures; and to compare delivery of well-child care for children with special health care needs with that for children without special needs. METHODS Over a 10-week period, 2 medical students observed and documented characteristics of well-child care visits by general pediatricians and midlevel pediatric providers. Parents completed a demographic questionnaire and a screener for children with special health care needs. RESULTS A total of 483 visits by 43 pediatricians and 9 midlevel providers with patients from 0 to 19 years of age were observed. Adjusted mean visit duration was 20.3 minutes; 38.9% of visits began with an open-ended question about parent/child concerns. A mean of 7.2 health supervision/anticipatory guidance topics were addressed per visit. Clinicians addressed a mean of 42% of Bright Futures-recommended age-specific health supervision/anticipatory guidance topics. Topics addressed less frequently than recommended included family support, parental well-being, behavior/discipline, physical activity, media screen time, risk reduction/substance use, puberty/sex, social-peer interactions, and violence. Shorter visits were associated with asking about parent/child concerns and with addressing greater proportions of recommended health supervision/anticipatory guidance topics. Well-child care visits with children with special health care needs were 36% longer than those with children without special needs and addressed similar numbers of age-specific health supervision/anticipatory guidance topics. More time was spent with children with special health care needs addressing health supervision/anticipatory guidance topics, other conditions (usually their chronic condition), and testing, prescriptions, and referrals. CONCLUSIONS Utilizing direct observation of visits with pediatric clinicians, we found that solicitation of parent/child concerns occurred less frequently than recommended. Fewer than half of recommended visit-specific health supervision/anticipatory guidance topics were addressed, and there was little congruence with some Bright Futures age group-specific recommendations. Notably, both solicitation of patient/parent concerns and greater adherence to health supervision/anticipatory guidance recommendations were associated with shorter visits. Well-child care visits with children with special health care needs were longer than those with children without special needs; more time was spent addressing similar numbers of health supervision/anticipatory guidance topics as well as their chronic conditions.
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Affiliation(s)
- Chuck Norlin
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah 84158, USA.
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Looman WS, Thurmes AK, O'Conner-Von SK. Quality of life among children with velocardiofacial syndrome. Cleft Palate Craniofac J 2010; 47:273-83. [PMID: 20426676 DOI: 10.1597/09-009.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To explore the health-related quality of life (QoL) among children with velocardiofacial syndrome (VCFS) and to compare QoL by gender and with samples of chronically ill and healthy children. DESIGN AND SETTING Cross-sectional design, comparing data obtained from a survey of parents of children with VCFS to previously published data from comparison groups of children who are healthy or who have other chronic conditions. PARTICIPANTS Parents of 45 children aged 2 to 18 years with VCFS participated in this study. Results were compared with published data on the same measures from samples of parents of healthy children (n = 10,343) and children with a variety of chronic conditions (n = 683). MAIN OUTCOME MEASURES Quality of life, including fatigue, was measured using the PedsQL(TM) Measurement Model. Strengths were assessed by parent report from a list of character traits developed from the Values in Action Classification System. RESULTS Quality of life was lower across all domains compared with healthy children. Boys with VCFS scored significantly lower than girls on school functioning (p < .05) and cognitive fatigue (p < .01). Compared with children with chronic conditions, children with VCFS scored lower on emotional (p < .01), social (p < .01), and school functioning (p < .001) but not on physical health. Parents described their children's strengths as humor, caring, kindness, persistence, and enthusiasm. CONCLUSIONS Quality of life among children with VCFS is characterized by significant challenges in the cognitive, social, and emotional domains. These children have strengths that may be useful in coping with the daily challenges of this condition.
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Barnes AJ, Eisenberg ME, Resnick MD. Suicide and self-injury among children and youth with chronic health conditions. Pediatrics 2010; 125:889-95. [PMID: 20385631 DOI: 10.1542/peds.2009-1814] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Chronic conditions may be associated with suicide risk. This study aimed to specify the extent to which youth chronic conditions are at risk for suicidality and self-harm. METHODS Logistic regression was used to estimate odds of self-harm, suicidal ideation, and suicide attempts in 10- to 19-year-olds with and without chronic physical and/or mental health conditions. RESULTS Independent of race, socioeconomic status, absent parent, special education status, substance use, and emotional distress, youth with co-occurring chronic physical and mental conditions (n = 4099) had significantly higher odds of self-harm (odds ratio [OR]: 2.5 [99% confidence interval (CI): 2.3-2.8), suicidal ideation (OR: 2.5 [99% CI: 2.3-2.8), and suicide attempts (OR: 3.5 [99% CI: 3.1-3.9]) than healthy peers (n = 106,967), as did those with chronic mental conditions alone (n = 8752). Youth with chronic physical conditions alone (n = 12,554) were at slightly elevated risk for all 3 outcomes. Findings were similar among male and female youth, with a risk gradient by grade. CONCLUSIONS Chronic physical conditions are associated with a slightly elevated risk for self-harm, suicidal thinking, and attempted suicide; chronic mental conditions are associated with an increased risk for all 3 outcomes. Co-occurring chronic physical and mental conditions are associated with an increased risk for self-harm and suicidal ideation that is similar to the risk in chronic mental conditions and with an attempted suicide risk in excess of that predicted by the chronic mental health conditions alone. Preventive interventions for these youth should be developed and evaluated.
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Affiliation(s)
- Andrew J Barnes
- University of Minnesota, Department of Pediatrics, Division of Academic General Pediatrics, Minneapolis, MN 55414, USA.
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Bujarski SJ, Klanecky AK, McChargue DE. The relationship between alexithymia and alcohol-related risk perceptions: The moderating effect of general trauma in a college population. Addict Behav 2010; 35:363-6. [PMID: 19926402 DOI: 10.1016/j.addbeh.2009.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 10/07/2009] [Accepted: 10/23/2009] [Indexed: 11/17/2022]
Abstract
The current study explored the moderating influence of general trauma exposure (GTE) on the relationship between alexithymia and alcohol-related risk perceptions. Undergraduate college students (N=237) completed a battery of self-report measures. After controlling for relevant variables, results indicated that the interaction between alexithymia and GTE significantly predicted alcohol-related risk perception. Simple effects revealed that for students who reported higher rates of GTE, alexithymia positively predicted risk perception; this relationship did not exist among students with lower GTE. Exploratory analyses indicated that despite increased risk perception, individuals with GTE also reported greater alcohol-related problems compared to students with low trauma exposure. The current study highlights the importance of examining risk perception abilities in individuals with alexithymia and GTE as well as the impact of risk perception on alcohol-related risk behaviors.
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Affiliation(s)
- Sarah J Bujarski
- Department of Psychology, University of Nebraska-Lincoln, 68588-0308, USA
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Fobil J, May J, Kraemer A. Assessing the relationship between socioeconomic conditions and urban environmental quality in Accra, Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:125-45. [PMID: 20195437 PMCID: PMC2819780 DOI: 10.3390/ijerph7010125] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 01/07/2010] [Indexed: 11/16/2022]
Abstract
The influence of socioeconomic status (SES) on health inequalities is widely known, but there is still poor understanding of the precise relationship between area-based socioeconomic conditions and neighborhood environmental quality. This study aimed to investigate the socioeconomic conditions which predict urban neighbourhood environmental quality. The results showed wide variation in levels of association between the socioeconomic variables and environmental conditions, with strong evidence of a real difference in environmental quality across the five socioeconomic classes with respect to total waste generation (p < 0.001), waste collection rate (p < 0.001), sewer disposal rate (p < 0.001), non-sewer disposal (p < 0.003), the proportion of households using public toilets (p = 0.005). Socioeconomic conditions are therefore important drivers of change in environmental quality and urban environmental interventions aimed at infectious disease prevention and control if they should be effective could benefit from simultaneous implementation with other social interventions.
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Affiliation(s)
- Julius Fobil
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, D-20359 Hamburg, Germany; E-Mail:
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany; E-Mail:
- Department of Biological, Environmental, Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Legon, Ghana
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +49-(0)40-42818503-111; Fax: +49-(0)40-42818512
| | - Juergen May
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, D-20359 Hamburg, Germany; E-Mail:
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany; E-Mail:
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Waldman HB, Perlman SP, Rader R. Hardships of raising children with special health care needs (a commentary). SOCIAL WORK IN HEALTH CARE 2010; 49:618-629. [PMID: 20711942 DOI: 10.1080/00981381003635189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Providing health care services for youngsters with special health care needs (SHCN) requires understanding of the medical circumstances that impact on the particular youngster, as well as an increased awareness and sensitivity to their particular family setting, and the issues that impact on the child, his/her parents, and siblings. To this end a review was carried out regarding the variable affects on these youngsters, such as poverty, parental, and family issues, as well as considerations of who is at risk for SHCN and demographics of individuals with SHCN who have unmet health needs. The particular need for dental services, the health service most commonly reported as needed, but not received, is highlighted.
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Affiliation(s)
- H Barry Waldman
- Department of General Dentistry, Stony Brook University, Stony Brook, New York, USA.
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Faravelli C, Lo Sauro C, Castellini G, Ricca V, Pallanti S. Prevalence and correlates of mental disorders in a school-survey sample. Clin Pract Epidemiol Ment Health 2009; 5:1-8. [PMID: 20498695 PMCID: PMC2858519 DOI: 10.2174/1745017900905010001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 10/05/2009] [Accepted: 10/05/2009] [Indexed: 11/30/2022]
Abstract
Background: Most of the adult mental disorders have their origins early in life. As the epidemiology of childhood psychiatric disorder in Italy has not been extensively investigated, we have evaluated the prevalence of mental disorders and their association with socio-familiar variables in a representative sample of children aged 6 to 11. Method: The study was conducted on a school- sample of 1028 children, aged 6 to 11, attending 12 primary schools in Florence (Italy). The diagnoses were made according to DSM IV diagnostic criteria, integrated by the description of each symptom, using specially trained teachers as lay-interviewers. Odds ratios with 95% C.I. chi squares and a stepwise binary logistic analysis have been performed. Results: Nine hundred ninety nine children (506 males; 493 females) were studied. Of them, 10.5% received a psychiatric diagnosis, with a higher prevalence in males (66.7% vs.33.3, p<0.01). The most prevalent groups of mental disorders were the behavioural/impulse control (7.2%) and anxiety (6.4%) disorders. Attention Deficit with Hyperactivity Disorder was the most represented diagnosis (5.6% of the children). All the other mental disorders were relatively rare, with only separation anxiety and overanxious disorder exceeding 1% prevalence. Male gender, organic disease, having mother divorced, not present or dead, attending school full-time, cohabitation in the family were associated with an increased risk for any childhood mental disorder. Conclusions: About one in ten children aged 6-11 suffers from a mental disorder. Male gender, loss of mother and lower socio-economic status are associated with mental disorders in children. Further long-term prospective studies are needed, in order to clarify the epidemiological and psychopathological relationships between childhood and adult mental disorders.
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Affiliation(s)
- Carlo Faravelli
- Department of Psychology, Florence University, S. Salvi, Padiglione 16, Firenze, Italy
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