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. 2019 Aug;61(8):937-942.
doi: 10.1111/dmcn.14175. Epub 2019 Feb 1.

Mental health disorders, participation, and bullying in children with cerebral palsy

Daniel G Whitney  1 , Mark D Peterson  1 , Seth A Warschausky  1
Affiliations

Mental health disorders, participation, and bullying in children with cerebral palsy

Daniel G Whitney et al. Dev Med Child Neurol. 2019 Aug.

Abstract
in English, Spanish, Portuguese

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.

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.

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.

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