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

Abstract

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).

Physical-mental multimorbidity in children and youth: a scoping review

“…Much of the existing literature relates to prevalence of mental disorder among children with some physical illness, while there appeared to be less evidence relating to health service utilisation. In light of these gaps, additional research is needed; the Multimorbidity in Children and Youth Across the Life-course 19 prospective study, for example, will address several of the recommendations and limitations cited among studies included in our present scoping review.…”

“…10 15 18 An estimated 15% of all children will experience the co-occurrence of at least one physical illness and at least one mental disorder-defined as physical-mental multimorbidity. 19 Physical-mental multimorbidity is often chronic and has been shown to be…”

“…An estimated 15% of all children will experience the co-occurrence of at least one physical illness and at least one mental disorder—defined as physical-mental multimorbidity . 19 Physical-mental multimorbidity is often chronic and has been shown to be associated with significant negative impacts on daily functioning, 20 21 increases in mental health service use 22 and greater likelihood of suicidality 23 and risky substance use 24 25 among youth. However, despite increased interest in child mental health in recent decades as well as modern advancements in healthcare for children with physical illnesses, research on child physical-mental multimorbidity remains limited.…”

<p>Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology</p>

“…12 Studies such as the prospective Canadian MYLIFE study will be particularly informative in this regard. 114 The evidence continues to sadly suggest that there remains a gap which still needs to be bridged between mental and physical health, never mind between pediatric and adult rheumatology. In future national and international standards for care and training curricula, mental health needs of young people with RMD will require greater prominence in order to improve service provision and workforce competency in this area.…”

Identifying multimorbidity patterns of non-communicable diseases in paediatric inpatients: a cross-sectional study in Shanghai, China

“… 2 Worse, early-onset multimorbidity has the potential to complicate and even worsen health conditions, because it lengthens and compounds the time spent with a poor health status with age. 10 Ferro et al 13 focused on multimorbidity in a population with mental health conditions and analysed how multimorbidity in childhood and youth influences interactions with the healthcare system based on a sample of 250 children. Dunbar et al ’s 14 study assessed variations across complex chronic diseases and the likelihood of readmission with increasing age in adolescents and young adults.…”