青少年的慢性身体疾病与精神疾病。

Mental Illness Among Youth With Chronic Physical Conditions.

机构信息

Department of Pediatrics, Cambridge Health Alliance, Cambridge, Massachusetts;

Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and.

出版信息

Pediatrics. 2019 Jul;144(1). doi: 10.1542/peds.2018-1819. Epub 2019 Jun 14.

DOI:10.1542/peds.2018-1819

PMID:31201229

Abstract

BACKGROUND AND OBJECTIVES

Youth with chronic physical conditions (CPCs) may be at greater risk for developing chronic mental health conditions (MHCs), and limitations in the ability to engage in developmentally appropriate activities may contribute to the risk of MHCs among youth with CPCs. We compared the risk of incident MHCs in youth with and without CPCs and explored whether activity limitations contribute to any such association.

METHODS

The 2003-2014 Medical Expenditure Panel Survey provided a nationally representative cohort of 48 572 US youth aged 6 to 25 years. We calculated the 2-year cumulative incidence of MHCs overall and by baseline CPC status. Cox proportional hazard models were used to estimate the association between CPCs and incident MHCs, adjusting for sociodemographic characteristics. Stepwise models and the Sobel test evaluated activity limitations as a mediator of this relationship.

RESULTS

The 2-year cumulative incidence of MHCs was 7.8% overall, 11.5% in youth with CPCs (14.7% of sample), and 7.1% in those without. The adjusted risk of incident MHCs was 51% greater (adjusted hazard ratio 1.51; 95% confidence interval 1.30-1.74) in youth with CPCs compared with those without. Activity limitations mediated 13.5% of this relationship ( < .001).

CONCLUSIONS

This nationally representative cohort study supports the hypotheses that youth with CPCs have increased risk for MHCs and that activity limitations may play a role in MHC development. Youth with CPCs may benefit from services to bolster their ability to participate in developmentally important activities and to detect and treat new onset MHCs.

摘要

背景与目的

患有慢性躯体疾病（CPC）的青少年可能面临更大的发展为慢性心理健康疾病（MHC）的风险，而在发展适当活动方面的能力受限可能会增加患有 CPC 的青少年 MHC 的风险。我们比较了患有和不患有 CPC 的青少年发生 MHC 的风险，并探讨了活动受限是否会导致这种关联。

方法

2003-2014 年医疗支出调查提供了一个全国代表性的 48572 名年龄在 6 至 25 岁之间的美国青少年队列。我们计算了总体和基线 CPC 状态下 MHC 事件的 2 年累积发生率。使用 Cox 比例风险模型来估计 CPC 与 MHC 事件之间的关联，调整了社会人口统计学特征。逐步模型和 Sobel 检验评估了活动受限作为这种关系的中介。

结果

MHC 的 2 年累积发生率总体为 7.8%，患有 CPC 的青少年为 11.5%（占样本的 14.7%），而没有患有 CPC 的青少年为 7.1%。与没有患有 CPC 的青少年相比，患有 CPC 的青少年发生 MHC 的风险增加了 51%（调整后的危险比为 1.51；95%置信区间为 1.30-1.74）。活动受限解释了这种关系的 13.5%（<0.001）。