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Bhatnagar S, Mitelpunkt A, Rizzo JJ, Zhang N, Guzman T, Schuetter R, Vargus-Adams J, Bailes AF, Greve K, Gerstle M, Pedapati E, Aronow B, Kurowski BG. Mental Health Diagnoses Risk Among Children and Young Adults With Cerebral Palsy, Chronic Conditions, or Typical Development. JAMA Netw Open 2024; 7:e2422202. [PMID: 39028671 DOI: 10.1001/jamanetworkopen.2024.22202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Importance Mental health (MH) issues in children with cerebral palsy (CP) are poorly understood compared with other pediatric populations. Objective To examine MH diagnosis code assignment among children and young adults with CP and compare with typically developing (TD) and chronic condition (CC) pediatric populations. Design, Setting, and Participants This case-control study used International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to create a CP case set and CC and TD control sets using electronic health record data of children and young adults from a large tertiary care children's hospital in the midwestern United States between 2010 and 2022. Case-control matching was performed to control for demographic factors. Data were analyzed from June to December 2023. Exposures All MH diagnosis codes were mapped to ICD-10-CM and categorized using Clinical Classifications Software Refined (CCSR). Main Outcomes and Measures The incidence rates of MH CCSR categories were calculated. Descriptive and comparative statistics were used to evaluate the significance and odds associated with factors. Results Data from 216 794 individuals (mean [SD] baseline age, 4.3 [5.1] years; 118 562 [55%] male) were analyzed, including 3544 individuals with CP, 142 160 individuals with CC, and 71 080 TD individuals. The CP cohort spread across Gross Motor Function Classification System (GMFCS) levels I (981 individuals [28%]), II (645 individuals [18%]), III (346 individuals [10%]), IV (502 individuals [14%]), and V (618 individuals [17%]). Rates varied significantly for anxiety (824 individuals with CP [23%]; 25 877 individuals with CC [9%]; 6274 individuals with TD [18%]), attention-deficit/hyperactivity disorder (534 individuals with CP [15%]; 22 426 individuals with CC [9%]; 6311 individuals with TD [16%]); conduct or impulse disorder (504 individuals with CP [14%]; 13 209 individuals with CC [5%]; 3715 individuals with TD [9%]), trauma or stress disorders (343 individuals with CP [10%]; 18 229 individuals with CC [8%]; 5329 individuals with TD [13%]), obsessive-compulsive disorder (251 individuals with CP [7%]; 3795 individuals with CC [1%]; 659 individuals with TD [3%]), depression (108 individuals with CP [3%]; 12 224 individuals with CC [5%]; 4007 individuals with TD [9%]), mood disorders (74 individuals with CP [2%]; 4355 individuals with CC [2%]; 1181 individuals with TD [3%]), and suicidal ideation (72 individuals with CP [2%]; 7422 individuals with CC [5%]; 3513 individuals with TD [5%]). There was significant variation in odds of MH diagnoses by GMFCS level (I-II vs III-V: odds ratio [OR], 1.23; 95% CI, 1.09-1.40; P = .001). Among individuals with CP, males were more likely than females to have diagnosis codes for conduct or impulse disorders (OR, 1.41; 95% CI, 1.16-1.73) and attention-deficit/hyperactivity disorder (OR, 1.41 [95% CI, 1.15-1.73]). Black individuals, compared with White individuals, were more likely to have diagnoses for obsessive-compulsive disorder (OR, 1.57 [95% CI, 1.14-2.16]), other mood disorders (OR, 1.85 [95% CI, 1.01-3.38]), and trauma or stress disorders (OR, 1.94 [95% CI, 1.44-2.63]). Odds for trauma or stress disorders were elevated for individuals who identified as other races compared with White individuals (OR, 2.80 [95% CI, 2.03-3.87]). Conclusions and Relevance In this case-control study of children and young adults with CP and matched comparisons, anxiety and conduct or impulse diagnoses were higher in individuals with CP. The lower diagnosis rates of depression and suicidal ideation may indicate underdiagnosis among individuals with CP. There is likely a need for assessment tools that are more suitable for children with CP.
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Affiliation(s)
- Surbhi Bhatnagar
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexis Mitelpunkt
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pediatric Rehabilitation, Dana-Dwek Children's Hospital, Tel Aviv Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juliana J Rizzo
- College of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tess Guzman
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ryan Schuetter
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jilda Vargus-Adams
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy F Bailes
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Kelly Greve
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Melissa Gerstle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ernest Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bruce Aronow
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brad G Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Cooper MS, Imms C. Editorial Highlights from the Comorbidities and Complications of Cerebral Palsy Special Issue. J Clin Med 2023; 12:5329. [PMID: 37629371 PMCID: PMC10455945 DOI: 10.3390/jcm12165329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Cerebral palsy is a life-long condition and the most common cause of physical disability in childhood [...].
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Affiliation(s)
- Monica S Cooper
- Department of Neurodevelopment & Disability, Royal Children’s Hospital, 50 Flemington Road, Melbourne, VIC 3052, Australia
- Neurodisability and Rehabilitation, Clinical Sciences, Murdoch Children’s Research Institute, 50 Flemington Road, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, 50 Flemington Road, Melbourne, VIC 3052, Australia
| | - Christine Imms
- Department of Neurodevelopment & Disability, Royal Children’s Hospital, 50 Flemington Road, Melbourne, VIC 3052, Australia
- Neurodisability and Rehabilitation, Clinical Sciences, Murdoch Children’s Research Institute, 50 Flemington Road, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, 50 Flemington Road, Melbourne, VIC 3052, Australia
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Silberg T, Kapil N, Caven I, Levac D, Fehlings D. Cognitive behavioral therapies for individuals with cerebral palsy: A scoping review. Dev Med Child Neurol 2023; 65:1012-1028. [PMID: 36725690 DOI: 10.1111/dmcn.15507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/07/2022] [Indexed: 02/03/2023]
Abstract
AIM To synthesize the evidence about the main intervention characteristics of cognitive behavioral therapies (CBTs) for individuals with cerebral palsy and identify barriers and facilitators to their success, focusing on aspects of feasibility and markers of success. METHOD A scoping review methodology informed a literature search for papers published between 1991 and 2021. Articles were screened, reviewed, and categorized using the DistillerSR systematic review software, and critically appraised for quantitative and/or qualitative criteria. RESULTS Out of 1265 publications identified, 14 met the inclusion criteria. Elements associated with the specific study participant characteristics (46% female; aged 6-65 years), type of CBT techniques used (third-wave [n = 6], cognitive [n = 3], cognitive and behavioral [n = 2], biofeedback training [n = 2]), and features of the study context and methodological quality (two randomized clinical trials and small sample sizes [n ≤ 12]), were identified. Most studies had psychological targets of intervention (n = 10) and secondary physiological (n = 3) or social (n = 2) objectives. Feasibility indicators were described in nearly one-third of the papers. INTERPRETATION This study highlights the high flexibility within CBT interventions, enabling their adaptation for individuals with cerebral palsy. However, relatively little, and only low-certainty evidence was identified. More high-quality research in terms of specific CBT techniques, optimal treatment doses, and detailed population characteristics are needed.
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Affiliation(s)
- Tamar Silberg
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Department of Pediatric Rehabilitation, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Department of Paediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
| | - Nisha Kapil
- Department of Paediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
| | - Isabelle Caven
- Department of Paediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Danielle Levac
- Faculty of Medicine, School of Rehabilitation, University of Montreal, QC, Canada
| | - Darcy Fehlings
- Department of Paediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
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Amalfi A, Li JY, Théberge-Lamoureux V, Tang C, Rinaldi E, Khayargoli P, Anaby D. Mental health problems among transition-aged youth with physical disabilities: an initial evaluation. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1069464. [PMID: 37214127 PMCID: PMC10196478 DOI: 10.3389/fresc.2023.1069464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/14/2023] [Indexed: 05/24/2023]
Abstract
Aim Decreased participation and complex transitions into adulthood among youth with disabilities may impede their well-being. To advance knowledge on the co-occurrence of mental health problems and physical disability, this brief report describes the frequency of mental health problems, measured by the Behavior Assessment System of Children (BASC-3), among transition-aged youth (14-25 years) with physical disabilities and examines the association between mental health problems and sex, age, and number of functional issues. Methods Thirty-three participants completed a demographic questionnaire and the BASC-3. Frequency of BASC-3 scales falling within 3 categories: "within norms", "at risk", and "clinically significant" were described. Crosstabs and Chi-square tests were used to examine the association between BASC-3 scales and sex, age (< and ≥ 20), and number of functional issues (< and ≥ 6). Results Overall, "somatization", "self-esteem", "depression" and "sense of inadequacy" were the most common subscales being at risk. Participants with a higher number of functional issues (≥6) were more likely to fall within "at risk" or "clinically significant" categories across 20 (out of 22) BASC-3 scales, and female participants tended to fall more within "at risk" or "clinically significant" categories for 8 of BASC-3 scales. Younger participants (<20) were ranked in the "at risk" or "clinically significant" categories for 7 scales. Conclusions Findings lend further support for the occurrence of mental health problems emerging in youth with physical disabilities and highlight initial trends especially across functional levels. Further investigation of such co-occurrences and the factors that affect their development is needed.
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Affiliation(s)
- Amanda Amalfi
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jia Yin Li
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | | | - Carmen Tang
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Emilie Rinaldi
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Pranamika Khayargoli
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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