Mental health disorders, participation, and bullying in children with cerebral palsy. (1st February 2019)

• Record Type: Journal Article
• Authors: Whitney, Daniel G; Peterson, Mark D; Warschausky, Seth A
• Is Part Of: Developmental medicine & child neurology. Volume 61:Number 8(2019)
• Page Start: 937
• Page End: 942
• Publication Date: 2019-02-01
• Subjects: Child development -- Periodicals; Pediatric neurology -- Periodicals; 616.8
• DOI: 10.1111/dmcn.14175
• Languages: English
• ISSNs: 0012-1622

Abstract

Abstract : Aim: To examine how social factors might mitigate the elevated risk of mental health disorders in children with cerebral palsy (CP). Method: This cross‐sectional study included 6‐ to 17‐year‐olds with ( n =111; 40.4% 6–11y, 59.6% 12–17y) and without ( n =29 909; 50.2% 6–11y, 49.8% 12–17y) CP from the 2016 National Survey of Children's Health. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention‐deficit/hyperactivity disorder. Social factors included participation in activities, bully victimization, and difficulty with friendships. Results: After adjusting for sociodemographic factors and the presence of chronic pain, children with CP had higher odds of anxiety (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.9–8.5), behavior/conduct problems (OR 3.9; 95% CI 1.4–11.3), and multimorbidity (OR 2.8; 95% CI 1.1–7.0), but not depression (OR 1.4; 95% CI 0.6–3.8) or attention‐deficit/hyperactivity disorder (OR 1.7; 95% CI 0.6–4.6), compared to controls. With adjustment for participation in activities, the odds of anxiety, behavior/conduct problems, and multimorbidity remained increased in children with CP. With adjustment for difficulty with friendships, the odds of anxiety, behavior/conduct problems, and multimorbidity were no longer increased in children with CP. With adjustment for bully victimization, the odds of behavior/conduct problems and multimorbidity were attenuated in children with CP; however, the odds of anxiety remained increased. Interpretation: The elevated prevalence of certain mental health disorders in children with CP is partly associated with modifiable social factors. What this paper adds: Difficulty with friendships predicts an elevated prevalence of psychiatric conditions in children with cerebral palsy (CP). Bully victimization predicts an elevated prevalence of behavior/conduct problems in children with CP. Low participation does not predict mental health disorders in this population. What this paper adds: Difficulty with friendships predicts an elevated prevalence of psychiatric conditions in children with cerebral palsy (CP). Bully victimization predicts an elevated prevalence of behavior/conduct problems in children with CP. Low participation does not predict mental health disorders in this population. Editor's Choice My Editor's Choice for the August 2019 issue is this study of factors associated with mental health problems in children with cerebral palsy. This is a particularly important but overlooked issue, with a great potential for both prevention and specific management. The study also highlights bullying, as does Kathy Zebracki in her editorial on social media (p. 856 ), and resilience factors such as friendships – an 'F‐word' previously identified by Peter Rosenbaum and Jan Willem Gorter as an essential social factor for the development of personhood. These new results call for urgent action to promote mental health, and reduce peer exclusion and bullying victimization. This article is commented on by Paulus on page 862 of this issue. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the abstract to view the translations. Resumen: Enfermedades de salud mental, participación y bullying en niños con parálisis cerebral: Objetivos: Examinar cómo los factores sociales podrían mitigar el riesgo elevado de trastornos de salud mental en niños con parálisis cerebral (PC). Metodo: Este estudio transversal incluyo niños de 6 a 17 años de edad con PC (n=11; 40, 4% 6‐11 años, 59, 6% 12‐17 años) y sin PC (n= 29.909; 50, 2% 6‐11 años, 49, 8% 12‐17 años) de la Encuesta Nacional de Salud Infantil 2016. Los trastornos de la salud mental incluyeron depresión, ansiedad, problemas de conducta/comportamiento, y déficit de atención/hiperactividad. Los factores sociales incluyeron participación en actividades, victimización de Bullying y dificultades con amistades. Resultados: Luego de ajustar con los factores sociodemográficos y la presencia de dolor crónico, los niños con PC tuvieron mayores probabilidades de presentar ansiedad (odds ratio [OR] 4, 4; 95% intervalo de confianza [IC] 1, 9‐8, 5), problemas de conducta/comportamiento (OR 3, 9; 95%IC 1, 4‐11, 3), y multimorbilidad (OR 2, 8; 95% CI 1, 1‐7, 0), pero no mayor depresión (OR 1, 4; 95% CI 0, 6‐3, 8) o déficit de atención/hiperactividad (OR 1, 7; 95%CI 0, 6‐4, 6), comparado con los controles. Con el ajuste para participación en actividades, la probabilidad de ansiedad, problemas de conducta/comportamiento, y multimorbilidad permanecieron más alta en niños con PC. Ajustando para dificultades con amistades, la probabilidad de ansiedad, problemas de conducta/comportamiento, y multimorbilidad no fueron más altas en niños con PC. Ajustando para la victimización de Bullying, la probabilidad de problemas de comportamiento/conducta y multimorbilidad se atenuaron en niños con PC; sin embargo la probabilidad de presentar ansiedad permaneció aumentada. Interpretacion: La elevada prevalencia de ciertos trastornos de salud mental en niños con PC se asocia en parte con factores sociales modificables. Resumo: Transtornos de saúde mental, participação e bullying em crianças com paralisia cerebral: Objetivo: Examinar como fatores sociais podem mitigar o elevado risco de transtornos de saúde mental em crianças com paralisia cerebral (PC). Método: Este estudo transversal incluiu pessoas entre 6 e 17 anos de idade com ( n =111; 40, 4% 6–11a, 59, 6% 12‐17a) e sem ( n =29.909; 50, 2% 6–11a; 49, 8% 12–17a) PC do Levantamento Nacional de Saúde da Criança de 2016. Transtornos de saúde mental incluíram depressão, ansiedade, problemas de comportamento/conduta, e transtorno de déficit de atenção e hiperatividade. Fatores sociais incluíram participação em atividades, ser vítima de bullying e dificuldade com amizades. Resultados: Após ajustar para fatores sócio‐demográficos e presença de dor crônica, crianças com PC tiveram maior risco de ansiedade (odds ratio [OR] 4, 4; intervalo de confiança [IC] a 95% 1, 9–8, 5), problemas de comportamento/conduta (OR 3, 9; IC 95% 1, 4–11, 3), e multimorbidade (OR 2, 8; IC 95% 1, 1–7, 0), mas não depressão (OR 1, 4; IC 95% 0, 6–3, 8) ou transtorno do déficit de atenção e hiperatividade (OR 1, 7; IC 95% 0, 6–4, 6), em comparação com controles. Ajustando para participação em atividades, os riscos de ansiedade, problemas de comportamento/conduta, e multimorbidade permaneceram aumentados em crianças com PC. Ajustando para a dificuldade com amizades, o risco de ansiedade, problemas de comportamento/conduta, e multimorbidade não foram mais aumentados em crianças com PC. Com ajuste para a presença de bullying, os riscos de problemas de comportamento/conduta e multimorbidade foram atenuados em crianças com PC; no entanto, os riscos de ansiedade permaneceram aumentados. Interpretação: A elevada prevalência de certos transtornos de saúde mental em crianças com PC é parcialmente associado a fatores sociais modificáveis.