Activity limitations increase risk for mental health conditions

1. Youth aged 6 to 25 with chronic physical conditions were found to have more than 50% greater risk for developing mental health conditions on 2-year follow-up in a national survey.

2. Activity limitations mediated some of this risk, and were independently associated with increased risk for developing mental health conditions.

Evidence Rating Level: 2 (Good)

Study Rundown: Youth with chronic physical conditions have been shown to be at greater risk for developing mental health conditions. However, less is known about the potential mechanisms for increased risk, and few studies have followed incidence over time. In this retrospective cohort study, researchers used national medical survey data to compare 2-year incidence of mental health conditions in youth with and without chronic physical conditions and/or activity limitations. Participants were aged 6 to 25 years and had no mental health conditions or developmental delay at baseline. Having chronic physical conditions was associated with a 51% greater risk for developing mental health conditions in the subsequent 2 years, after adjusting for demographic and socioeconomic factors. Activity limitations mediated 13.5% of this relationship.

These findings are limited by the length of study as mental health conditions may manifest later in life. Furthermore, researchers relied on proxy report from parents rather than from participants themselves. Nonetheless, the study is strengthened by a large, nationally representative sample. For physicians, these findings highlight the importance of monitoring the mental health of youth with chronic physical conditions and to address activity limitations as potential avenues for preventing chronic mental illness.

Click to read the study, published today in Pediatrics

Relevant reading: Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity – A National Representative Survey of Adolescents

In-Depth [retrospective cohort]: Researchers used data from the Medical Expenditure Panel Survey, a nationally representative survey of the US population on health information, to identify 48 572 youth aged 6 to 25 years between 2003 and 2014. Participants had no mental health conditions or developmental delay at baseline. Survey responses were coded to identify chronic physical conditions. The study compared incidence of mental health conditions between participants with and without chronic physical conditions using Cox proportional hazard, with activity limitations as a mediator of this relationship. All analyses adjusted for demographic, income, educational, and insurance factors.

Overall, 14.7% of the sample had chronic physical conditions at baseline. Among these youth, 11.5% developed mental health conditions in the subsequent 2 years of follow-up, compared with 7.1% of youth without baseline chronic physical conditions (adjusted hazard ratio [aHR] 1.51; 95% confidence interval [CI] 1.30-1.74). Youth with chronic physical conditions had greater odds of reporting activity limitations, and youth reporting activity limitations had a nearly 4-fold increased risk of developing incident mental health conditions (aHR 3.60; 95%CI 2.83-4.57). Adding activity limitations to the model modified the association between chronic physical conditions and incident mental health conditions from 51% to 43% greater risk (aHR 1.43; 95%CI 1.23-1.66).

Image: PD

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