Mental–Physical Multimorbidity in Youth: Associations with Individual, Family, and Health Service Use Outcomes

Ferro, Mark A.; Lipman, Ellen L.; Lieshout, Ryan J. Van; Boyle, M H; Gorter, Jan Willem; MacMillan, Harriet L.; González, Andrea; Georgiades, Katholiki

doi:10.1007/s10578-018-0848-y

Cited by 24 publications

(20 citation statements)

References 60 publications

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“…Multinomial logistic regression was used to compute odds ratios (ORs) and associated 95% confidence intervals for characteristics associated with the chronicity of multimorbidity. Characteristics that were statistically significant were then included in multivariable models that adjusted for participant age and household income, as these factors are known to confound estimates of child psychopathology (Butler et al, ; Ferro & Boyle, ; Ferro et al, ). Parsimonious models with a minimum set of confounders were preferred given the relatively small sample size, which was based on previous guidelines for pilot studies (Hertzog, ).…”

Section: Methodsmentioning

confidence: 99%

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

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Ferro

2019

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Background: Evidence suggests that physical and mental illnesses are strongly correlated in children. This study examined patterns of the chronicity of multimorbidity (co-occurring physical and mental illness); estimated homotypic continuity; and modelled factors associated with chronicity in children newly diagnosed with a chronic physical illness.Methods: Children aged 6-16 years diagnosed with one of asthma, diabetes, epilepsy, food allergy, or juvenile arthritis were recruited from two children's hospitals and followed for 6 months. Child mental illness was measured using the parentreported Mini International Neuropsychiatric Interview and Ontario Child Health Study Emotional Behavioural Scales at baseline and 6 months later. Children were stratified into three groups: no multimorbidity, acute (multimorbidity at only one assessment), and persistent (multimorbidity at both assessments).Results: Forty-nine children were available for analysis: no multimorbidity (n = 18), acute (n = 13), and persistent (n = 18). Homotypic continuity was highest for conduct disorder (67.5%) and lowest for major depression (16.7%). Unadjusted analyses showed positive associations between child and parent behavioural symptoms, as well as family functioning with persistent multimorbidity. These associations remained after adjustment, ranging from odds ratio (OR) = 1.29 [1.01, 1.64] for depression to OR = 1.61 [1.11, 2.33] and OR = 1.61 [1.10, 2.35] for attentiondeficit hyperactivity and oppositional defiant, respectively, in child models. In parent models, associations remained for parental anxiety (OR = 1.18 [1.04, 1.34]) and stress (OR = 1.15 [1.02, 1.31]).Conclusions: Multimorbidity is persistent in children newly diagnosed with physical illnesses, regardless of the mental comorbidity experienced. Integrating familycentred mental health services soon after the diagnosis of a physical illness should be prioritized in pediatric settings.

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Section: Methodsmentioning

confidence: 99%

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

Reaume

Ferro

2019

Child

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“…The major challenge facing healthcare services worldwide in the coming decades is the increasing burden of multimorbidity and chronic diseases 1‐6 . A large cross‐sectional study of primary care patients across all age groups reported a prevalence of multimorbidity, defined as two or more long‐term disorders, of 23% 7 .…”

Section: Introductionmentioning

confidence: 99%

Complex care pathways for children with multiple referrals demonstrated in a retrospective population‐based study

et al. 2020

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The major challenge facing healthcare services worldwide in the coming decades is the increasing burden of multimorbidity and chronic diseases. 1-6 A large cross-sectional study of primary care patients across all age groups reported a prevalence of multimorbidity, defined as two or more long-term disorders, of 23%. 7 Multimorbidity greatly increases with age. However, similar prevalences have been found in the paediatric population. 8 In a pilot study of children in tertiary care hospitals, Butler et al suggested that "mental disorder in children with a physical condition is very common and has a negative impact on quality of life over time". 9 Patients with multi-system health disorders pose a significant challenge to specialist health services that usually are organised according to the single-disease concept. Thus, patients with multimorbidity are prone to experiencing healthcare fragmentation.

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“…Population-based studies report prevalence estimates of 20%–30%,8–10 clinical studies ≥50% 11 12. Most extant studies report that multimorbidity has a negative impact on the quality of life of young people11 13–15 (for an exception see Ferro et al 16. Impact on the family environment appears more mixed, with some studies reporting closer parent–child relationships in those with (vs without) multimorbidity 16 17.…”

Section: Introductionmentioning

confidence: 99%

“…Emerging evidence implicates biological mechanisms that link physical and mental disorder, including immunological, inflammatory and stress-related mechanisms 18–20. Findings regarding mental health services use among children and youth with multimorbidity are also mixed; clinical studies reporting less use of acute mental health services, whereas population studies reporting more overall and acute mental health services use 16 21. Despite this nascent literature on child and youth multimorbidity, many important gaps in knowledge remain.…”

Section: Introductionmentioning

confidence: 99%

“…Fourth, use of mental healthcare has increased dramatically for children and youth in recent years,45 but knowledge as to whether multimorbidity influences service use or help-seeking behaviour is limited. The few studies that exist have reported inconsistent findings: a population study found increased mental healthcare use among youth with a physical condition and bipolar disorder,21 whereas a clinical study found that youth with multimorbidity were less likely to receive inpatient mental healthcare and had shorter hospital stays 16. Through data linkage activities with administrative health records, MY LIFE will contribute to the field by identifying how children and youth with multimorbidity access and use mental health services.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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IntroductionMultimorbidity, the co-occurrence of a chronic physical condition and mental disorder, affects a substantial number of children and youth and can lead to compromised quality of life, hardship for families, and an increased burden on the healthcare system. We are conducting a study to document the course of mental disorder in children and youth diagnosed with a chronic physical condition; identify predictors of child and youth multimorbidity; examine whether the effects of these predictors are moderated by relevant psychosocial and biological factors; explore potential inflammatory and stress biomarkers that mediate the onset of child and youth multimorbidity; and, assess whether multimorbidity in children and youth alters patterns of mental health service use.Methods and analysisMultimorbidity in Children and Youth Across the Life-course (MY LIFE) is a prospective study. Two hundred and fifty children and youth aged 2–16 years diagnosed with a chronic physical condition along with one parent will be recruited from the outpatient clinics at a paediatric tertiary care centre. Data will be collected using a multi-informant, multimethod design at four time-points (at recruitment, and at 6, 12 and 24 months postrecruitment). Parents will provide reports for all children/youth. In addition, youth ≥10 years will self-report. Mental disorder will be assessed using structured interviews. On completion of data collection, participant-reported data will be linked to provincial health records to identify mental health services use. Multilevel analyses (survival, proportional hazard, structural equation modelling) will be used to address MY LIFE objectives.Ethics and disseminationThis study has been approved by the University of Waterloo Human Research Ethics Board and the Hamilton Integrated Research Ethics Board. Findings will be disseminated to key stakeholders using a number of outlets (peer-reviewed publications and conferences, lay informational pamphlets, social media).

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Mental–Physical Multimorbidity in Youth: Associations with Individual, Family, and Health Service Use Outcomes

Cited by 24 publications

References 60 publications

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

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

Complex care pathways for children with multiple referrals demonstrated in a retrospective population‐based study

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

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