Surviving or Thriving? Lifelong mental health in children with chronic physical illness

Chronic physical illness affects large numbers of children and families. Worldwide, 1 in 5 children has a chronic physical illness, including arthritis, asthma, cancer, chronic renal failure, congenital heart disease, cystic fibrosis, type-1 diabetes, and epilepsy. With the advances of medical therapies in the last decades, more and more children with chronic conditions live for a long time (Perrin, Bloom, & Gortmaker, 2007; van der Lee, Mokkink, Grootenhuis, Heymans, & Offringa, 2007). But how do these chronic conditions effect children in their adulthood? Does having a childhood chronic physical condition enhance the chance of mental health problems in adulthood? A recently published meta-analysis conducted by our research group (Secinti et al, 2017) focused on this question.

Having a chronic physical illness during childhood is a serious burden on its own. This is because the illness affects normal activities, may limit the child’s ability to function, or result in needing help from others or long periods of hospitalization (Stein, Bauman, Westbrook, Coupey, & Ireys, 1993). But having a physical condition also impacts mental health because these children face serious challenges in their daily lives due to their physical conditions (Ferro, Boyle, & Avison, 2015). A child with a chronic physical illness is more likely to have emotional problems than a healthy child. For example, children with chronic conditions are more likely to have emotional problems, such as anxiety and depression, as well as have behavioral problems (Pinquart & Shen, 2011a, 2011b, 2011c).

So, what happens to these children when they grow up?

We wanted to understand what happens, as children with chronic physical illnesses grow older. Do their emotional problems decrease, or persist and become more severe? To answer this question, we reviewed the literature on multiple childhood chronic physical illnesses (i.e., arthritis, asthma, cancer, chronic renal failure, congenital heart disease, cystic fibrosis, type-1 diabetes and epilepsy,) and found 37 studies that had been conducted in multiple regions across the world to assess the link between childhood chronic physical illness and adult emotional problems. We then analyzed the data provided by these studies, combining the information from more than 45,000 participants.

What did our study find?

The main analyses revealed that individuals with a childhood chronic physical illness were more likely to experience anxiety and depression in adulthood. Specifically, the odds of having depression was 1.31 higher and the odds of having anxiety was 1.47 higher in those with childhood chronic illness than in those without. This is an important finding, as it suggests that the effects of having a childhood chronic physical illness on the risk of emotional problems persist beyond childhood and adolescence into adulthood.

Our study also looked at a range of possible factors that might influence the strength of this association. Our findings indicated that factors related to childhood chronic illness, such as age at diagnosis and illness duration, and participant related factors, such as age and sex, did not change the effects. We also examined the association between childhood chronic physical illness and adult mental health separately for asthma, type-1 diabetes, and cancer. Our findings revealed that patients or survivors of childhood cancer were more likely to experience depression during adulthood. We also found the similar trends for childhood asthma and type-1 diabetes, but these results were inconclusive due to small number of studies and participants.

What do our findings mean?

Overall, this study, which is the most comprehensive analysis to date, provides evidence that individuals with a childhood chronic physical illness are at greater life-long risk of emotional problems. This finding is critically important in clinical care. Mental health assessment and treatment should be an integral component of comprehensive care of chronically ill children and adolescents. In addition, we would advocate implementing interventions to improve psychological well-being and resilience for children with chronic physical illnesses as a way to reduce the risk of emotional problems in adulthood.

Last week (8-14th of May) was a Mental Health Awareness Week. May is also a month marked for awareness around mental health issues. As stated by the Mental Health Foundation: ‘Good mental health is an asset that helps us to thrive’. This is indeed the case for children who experience many challenges in coping with and adapting to life with a chronic disease. Although a good progress has been achieved in the life expectancy of these children, we now need to achieve the same for the good health of their minds.

Author: Ekin Secinti (former MSc in Foundations of Clinical Psychology and Mental Health student and EDGE Lab researcher, Ekin is now undertaking clinical psychology doctorate training at Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA)

 

References

Ferro, M.A., Boyle, M.H., & Avison, W.R. (2015). Association between trajectories of maternal depression and subsequent psychological functioning in youth with and without chronic physical illness. Health Psychology, 34, 820–828.

Perrin, J.M., Bloom, S.R., & Gortmaker, S.L. (2007). The increase of childhood chronic conditions in the United States. Journal of the American Medical Association, 297, 2755–2759.

Pinquart, M., & Shen, Y. (2011a). Anxiety in children and adolescents with chronic physical illnesses: A meta-analysis. Acta Paediatrica, 100, 1069–1076.

Pinquart, M.,&Shen, Y. (2011b). Behavior problems in children and adolescents with chronic physical illness: A meta-analysis. Journal of Pediatric Psychology, 36, 1003–1016.

Pinquart, M., & Shen, Y. (2011c). Depressive symptoms in children and adolescents with chronic physical illness: An updated meta-analysis. Journal of Pediatric Psychology, 36, 375–384.

Secinti, E., Thompson, E. J., Richards, M., & Gaysina, D. (2017). Research Review: Childhood chronic physical illness and adult emotional health–a systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry. Published online: doi:10.1111/jcpp.12727

Stein, R.E., Bauman, L.J., Westbrook, L.E., Coupey, S.M., & Ireys, H.T. (1993). Framework for identifying children who have chronic conditions: The case for a new definition. Journal of Pediatrics, 122, 342–347.

van der Lee, J.H., Mokkink, L.B., Grootenhuis, M.A., Heymans, H.S., & Offringa, M. (2007). Definitions and measurement of chronic health conditions in childhood: A systematic review. Journal of the American Medical Association, 297, 2741–2751.

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