Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug;21(8):800-810.
doi: 10.1007/s12519-025-00945-z. Epub 2025 Jul 31.

Longitudinal associations between chronic physical conditions, play behavior, and mental health problems in children

Emmie W Koevoets  1 , Sanne L Nijhof  2 , Maartje D Stutvoet  2 , Remco C Veltkamp  3 , Liesbeth Duijts  4   5 , Manon H J Hillegers  6 , Pauline W Jansen  6   7   8
Affiliations

Longitudinal associations between chronic physical conditions, play behavior, and mental health problems in children

Emmie W Koevoets et al. World J Pediatr. 2025 Aug.

Abstract

Background: Children and adolescents with chronic physical conditions have an increased probability of mental health problems, which may be partly attributed to the variations in play behavior. This study explores the associations between having a chronic physical condition, play behavior, and having mental health problems.

Methods: Data from the Generation R Study were analyzed, a population-based, prospective cohort in the Netherlands. Chronic physical conditions were typically identified before six years of age. Play behavior was assessed at ages 6 and 10. Mental health problems were measured with the Child Behavior Checklist at 14 years of age. Logistic, ranked-order, and linear regression analyses were used to examine direct associations, and mediation analyses were used to investigate indirect paths. P values were false discovery rate adjusted.

Results: Of the 4043 included participants, 691 (17%) had a chronic physical condition. Having a chronic physical condition was associated with more mental health problems and limited activity at the age of six years. Playing sports and engaging in social interactions at age 10 were related to fewer mental health problems at age 14. Limited activity mediated the relationship between having a chronic physical condition and mental health problems (social: mediatedproportion = 8.33%, 95% CI = 2.02%; 15.7%, Padj < 0.001; physical: mediatedproportion = 7.72%, 95% CI = 1.73%; 19.1%, Padj = 0.040).

Conclusions: Health-related limitations in social and physical activities mediate the relationship between having a chronic physical condition and mental health problems in children. Participation in social and physical activities early in life may be crucial for the mental well-being of children with a chronic physical condition.

Keywords: Activity limitations; Chronic condition; Mental health; Pediatrics; Play behavior; Population-based cohort.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. Ethical approval: The study protocol was approved by the medical ethical committee of the Erasmus MC (University Medical Center Rotterdam, Rotterdam, the Netherlands; MEC 217.595/2002/20), and parents (or legal representatives) of all participants provided written informed consent.

Figures

Fig. 1
Fig. 1
Flow chart of study inclusion
Fig. 2
Fig. 2
Results of the mediation analyses. The values represent the estimates and 95% confidence intervals (CI) unless indicated otherwise. Note: mediation analyses were performed in two separate models. Both models were adjusted for age at the measuring point of the outcome variable, sex, ethnicity, maternal educational level, and maternal psychopathology. OR odds ratio
See this image and copyright information in PMC

References

    1. van Hal LBT, van Rooijen M, van der Hoff M. An up-to-date perspective on Dutch children with a chronic condition: extent, composition and participation. 2019. https://www.verwey-jonker.nl/publicatie/een-actueel-perspectief-op-kinde.... Accessed 25 April 2024.
    1. Law M, King G, King S, Kertoy M, Hurley P, Rosenbaum P, et al. Patterns of participation in recreational and leisure activities among children with complex physical disabilities. Dev Med Child Neurol. 2006;48:337–42. - PubMed
    1. Pinquart M, Teubert D. Academic, physical, and social functioning of children and adolescents with chronic physical illness: a meta-analysis. J Pediatr Psychol. 2012;37:376–89. - PubMed
    1. Wise PH. The future pediatrician: the challenge of chronic illness. J Pediatr. 2007;151:S6–10. - PubMed
    1. Maurice-Stam H, Nijhof SL, Monninkhof AS, Heymans HSA, Grootenhuis MA. Review about the impact of growing up with a chronic disease showed delays achieving psychosocial milestones. Acta Paediatr Intern J Paediatr. 2019;108:2157–69. - PubMed

LinkOut - more resources