STUDY PRESENTS ESTIMATES ON THE PREVALENCE AND CORRELATES OF INTERNALIZING MENTAL HEALTH SYMPTOMS AMONG CSHCN

"Our findings on comorbidity [of internalizing mental health symptoms] with other physical and mental health conditions and symptoms extend what is known to a nationally representative sample of CSHCN [children with special health care needs]," state the authors of an article published in Pediatrics online (ahead of print) on January 18, 2010.

One-fifth to one-fourth of children in the United States experience a mental disorder before age 18. Mental conditions among children and adults have been associated with co-occurring or future health and behavior problems. To date, research on mental problems among CSHCN has focused primarily on those with specific conditions or used broad measures that do not distinguish between different types of symptoms.

The article provides estimates of internalizing mental health symptoms among CSHCN with a range of physical and mental health symptoms and mental conditions and identifies significant covariates of these symptoms.

As part of the 2005-2006 National Survey of Children with Special Health Care Needs, the researchers interviewed parents or guardians of CSHCN (ages 3-17) in all 50 states and the District of Columbia and used affirmative answers to either or both of the following items to identify CSHCN with internalizing mental health symptoms: (1) depression, anxiety, disordered eating, or other emotional problems at the time of the survey and (2) difficulty with feeling depressed or anxious, compared with other children of the same age. The analyses estimated the prevalence of internalizing mental health symptoms among CSHCN according to selected sociodemographic characteristics, examined the relationships between covariates of interest and internalizing mental health symptoms, and explored whether factors associated with internalizing mental health symptoms were consistent across age groups and among CSHCN with and without externalizing symptoms.

The authors found that:

* Almost one-third of CSHCN ages 3-17 experienced internalizing mental health symptoms.

* Girls were 16 percent more likely than boys to experience internalizing mental health symptoms.

* Compared with younger children (ages 3-5), older children were two to three times more likely to experience internalizing mental health symptoms.

* Children with behavioral problems were nearly six times more likely to experience internalizing mental health symptoms and those with attention deficit hyperactivity disorder (ADHD) nearly twice as likely to experience internalizing mental health symptoms, compared with those who had neither ADHD nor behavior problems. The next-strongest condition-related association was observed for autism spectrum disorder, followed by frequent headaches or migraines.

* CSHCN who were moderately affected by their conditions were 1.6 times more likely to experience internalizing mental health symptoms, and those whose daily activities were always or usually affected were more than twice as likely to experience internalizing mental health symptoms, compared with those who were never affected.

* CSHCN whose care caused financial problems for the family or whose condition caused a family member to stop or to cut back on work were at increased risk for internalizing mental health symptoms.

"The identification of sociodemographic and other correlates of internalizing symptoms, which may be underidentified in CSHCN, may help clinicians and families to focus screening and prevention efforts on high-risk subgroups of this heterogeneous population, including CSHCN with preexisting externalizing symptoms and conditions with a behavioral component," conclude the authors.

Ghandour RM, Kogan MD, Blumberg SJ, et al. 2010. Prevalence and correlates of internalizing mental health symptoms among CSHCN.

Pediatrics [published online ahead of print on January 18, 2010].

Abstract available at

http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-0622v1?papetoc

Readers: More information is available from the following MCH Library resources:

- Children and Youth with Special Health Care Needs: Knowledge Path at http://mchlibrary.info/KnowledgePaths/kp_CSHCN.html

- Mental Health Challenges in Children and Adolescents: Knowledge Path at http://mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html