儿童脑瘫的精神健康障碍、参与和欺凌。
Mental health disorders, participation, and bullying in children with cerebral palsy.
机构信息
Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
出版信息
Dev Med Child Neurol. 2019 Aug;61(8):937-942. doi: 10.1111/dmcn.14175. Epub 2019 Feb 1.
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.
目的
探讨社会因素如何减轻脑瘫（CP）儿童心理健康障碍的风险。
方法
本横断面研究纳入了来自 2016 年全国儿童健康调查的 6 至 17 岁 CP 患儿（n=111；6-11 岁 40.4%，12-17 岁 59.6%）和非 CP 儿童（n=29909；6-11 岁 50.2%，12-17 岁 49.8%）。心理健康障碍包括抑郁、焦虑、行为/品行问题和注意缺陷/多动障碍。社会因素包括参与活动、被欺凌和交友困难。
结果
在校正社会人口因素和慢性疼痛的存在后，CP 患儿出现焦虑（优势比[OR]4.4；95%置信区间[CI]1.9-8.5）、行为/品行问题（OR 3.9；95% CI 1.4-11.3）和多种合并症（OR 2.8；95% CI 1.1-7.0）的可能性更高，但抑郁（OR 1.4；95% CI 0.6-3.8）和注意缺陷/多动障碍（OR 1.7；95% CI 0.6-4.6）的可能性则不然。在调整参与活动后，CP 患儿的焦虑、行为/品行问题和多种合并症的可能性仍然增加。在调整交友困难后，CP 患儿的焦虑、行为/品行问题和多种合并症的可能性不再增加。在调整被欺凌后，CP 患儿的行为/品行问题和多种合并症的可能性减弱；然而，焦虑的可能性仍然增加。
结论
脑瘫儿童某些心理健康障碍的高发率部分与可改变的社会因素有关。
本文的意义
交友困难预测脑瘫儿童精神疾病的高发率。被欺凌预测脑瘫儿童行为/品行问题的高发率。参与度低不能预测该人群的心理健康障碍。
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