Psychological morbidity among adults with cerebral palsy and spina bifida

Abstract

Background Very little is known about the risk of developing psychological morbidities among adults living with cerebral palsy (CP) or spina bifida (SB). The objective of this study was to compare the incidence of and adjusted hazards for psychological morbidities among adults with and without CP or SB. Methods Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth revision, Clinical Modification diagnostic code for CP or SB (n = 15 302). Adults without CP or SB were also included (n = 1 935 480). Incidence estimates of common psychological morbidities were compared at 4-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. Results Adults living with CP or SB had a higher 4-year incidence of any psychological morbidity (38.8% v. 24.2%) as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with CP or SB had a greater hazard for any psychological morbidity [hazard ratio (HR): 1.60; 95% CI 1.55–1.65], and all but one psychological disorder (alcohol-related disorders), and ranged from HR: 1.32 (1.23, 1.42) for substance disorders, to HR: 4.12 (3.24, 5.25) for impulse control disorders. Conclusions Adults with CP or SB have a significantly higher incidence of and risk for common psychological morbidities, as compared to adults without CP or SB. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce the risk of disease onset/progression in these higher-risk populations.

Commentary on ‘Psychological morbidity among adults with cerebral palsy and spina bifida’: how can we support adults with cerebral palsy or spina bifida to achieve better psychological outcomes?

“…The Peterson et al (2020) longitudinal analysis confirms a previous report about higher risk within a cross-sectional sample (Whitney, Warschausky, & Peterson, 2019). Adults with CP or SB or severe disability have provided reports of high quality of life, life satisfaction, and happiness (Albrecht & Devlieger, 1999;Gannotti et al, 2019a;Hergenroder & Blank, 2009); yet, these reports are not from large population-based samples.…”

“…'Happiness, therefore, is the best, noblest, and most pleasant thing …' (Bartlett & Collins, 2011, p. 161) For people who also have cerebral palsy (CP) or spina bifida (SB), the pursuit of happiness is just as important as it is for people with no motor disability (Gannotti, Blanchard, Blumberg, & LaRocco, 2019a). Peterson et al (2020) provide conclusive evidence that risk for adults with CP or SB of longitudinal psychological morbidity is higher than age-matched controls. Given the importance of psychological well-being for all (Bartlett & Collins, 2011), the mental health needs of adults with CP or SB are compelling.…”

“…Peterson et al (2020) provide conclusive evidence that risk for adults with CP or SB of longitudinal psychological morbidity is higher than age-matched controls. Given the importance of psychological well-being for all (Bartlett & Collins, 2011), the mental health needs of adults with CP or SB are compelling.…”

“…Adults with CP or SB or severe disability have provided reports of high quality of life, life satisfaction, and happiness (Albrecht & Devlieger, 1999; Gannotti et al, 2019a; Hergenroder & Blank, 2009); yet, these reports are not from large population-based samples. Peterson et al (2020) identified hazard ratios ranging from 1.32 to 4.12 for impulse control, delirium/dementia/amnestic/other cognitive disorders, personality disorders, central pain, mood disorders, post-traumatic stress syndrome (PTSD), and insomnia for adults with CP or SB as compared to those without. This is very strong evidence that disparities in psychological outcomes exist.…”

“…What are the biological characteristics of adults with CP or SB who have central pain v. those who do not? Mood disorders, PTSD, and insomnia have reported hazard ratios of 1.72–1.5 (Peterson et al, 2020). Why is the risk of PTSD so high?…”