Children with Cerebral Palsy Have More Anxiety Than Those Without this Disorder

Surbhi Bhatnagar, PhD

Credit: Cincinnati Children's

A new study revealed children and young adults with cerebral palsy had more anxiety diagnoses and fewer depression diagnoses than children or young adults who have typical development or a different chronic condition. This indicates depression and suicidal ideation may be underdiagnosed among individuals with cerebral palsy.¹

“This case-control study offers a novel characterization of [mental health] diagnosis rates in children and young adults with [cerebral palsy] within a large [electronic health record]-based study, providing insights into [mental health] burden and diagnostic patterns,” wrote investigators, led by Surbhi Bhatnagar, PhD, from the division of biomedical informatics at Cincinnati Children’s Hospital Medical Center in Ohio.

Research suggests children with chronic physical conditions, such as cerebral palsy, are more likely to have a co-existing mental health diagnosis, with the most common ones being anxiety and depression.² Yet, little information is on the mental health of children with cerebral palsy compared to other pediatric disorders.

Investigators sought to explore mental health in children and young adults with cerebral palsy, curious if the rate of mental health diagnoses varied significantly between pediatric patients with or without cerebral palsy.¹ The team compared the mental health diagnosis code assignment between these 2 pediatric populations.

Bhatnagar and colleagues conducted a case-control study to evaluate the incidence rates of mental health Clinical Classifications Software Refined categories. Using the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, they created a case set for cerebral palsy and the 2 controls: chronic conditions and typical development. Investigators leveraged electronic health record data of children and young adults from a large tertiary care children’s hospital in the midwestern United States between 2010 and 2022.

Investigators used case-control matching to control for demographic factors. The mental health diagnosis codes were mapped to ICD-10-CM and categorized with the Clinical Classification Software Refined. The data was analyzed from June to December 2023.

The study included 216,794 participants with 55% male and a mean age of 4.3 years. In total, 3544 participants had cerebral palsy, 142,160 participants had a chronic condition, and 71,080 were typically developed. Participants with cerebral palsy group were categorized into the Gross Motor Function Classification System levels: 1 (28%; n = 981), II (18%; n = 645), III (10%; n = 345), IV (14%; n = 502), and V (17% n = 618).

Investigators observed anxiety rates significantly varied for patients with cerebral palsy (23%), typically developed (18%), and had a chronic condition (9%). The depression rates also significantly varied, with typically developed participants having the greatest rate (9%) and participants with cerebral palsy having the lowest rate (3%).

Among participants with cerebral palsy, a chronic condition, and typical development, the rates also significantly varied for ADHD (15%, 9%, 16%, respectively), conduct or impulse disorder (14%, 5%, 9%), trauma or stress disorders (10%, 8%, 13%), obsessive-compulsive disorder (7%, 1%, 3%), mood disorders (2%, 2%, 3%), and suicidal ideation (2%, 5%, 5%). Out of all these disorders, patients with cerebral palsy had the greatest diagnoses of conduct or impulse disorder (14%) and obsessive-compulsive disorder (7%).

Additionally, investigators observed a significant variation in the odds of a mental health diagnosis based on the Gross Motor Function Classification System between levels 1 – 2 vs 3 – 5 (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.09 – 1.40; P = .001).

Moreover, males with cerebral palsy were more likely than females to have diagnosis codes for conduct or impulsive disorders (OR, 1.41; 95% CI, 1.16 – 1.73) and ADHD (OR, 1.41; 95% CI, 1.15 – 1.73). Black individuals were more likely than White individuals to have diagnoses for OCD (OR, 1.57; 95% CI, 1.41 – 2.16), other mood disorders (OR, 1.85; 95% CI, 1.01 – 3.38), and trauma or stress disorders (OR, 1.94; 95% CI, 1.44 – 2.63). Individuals who identified as other races were also more likely than White individuals to have trauma or stress disorders (OR, 2.80; 95% CI, 2.03 – 3.87).

“These findings suggest that [mental health] diagnoses were prevalent in [cerebral palsy], varied based on [cerebral palsy] motor function and other demographic factors, and may have been underrecognized or overrecognized, depending on the [mental health] diagnosis,” investigators concluded. Acknowledging the signs of [mental health] issues in children is crucial, as early intervention can significantly improve both mental health] and [cerebral palsy] treatment engagement and lead to better outcomes.”

References

1. ^{Bhatnagar S, Mitelpunkt A, Rizzo JJ, et al. Mental Health Diagnoses Risk Among Children and Young Adults With Cerebral Palsy, Chronic Conditions, or Typical Development. JAMA Netw Open. 2024;7(7):e2422202. doi:10.1001/jamanetworkopen.2024.22202}
2. ^{Cerebral Palsy & Mental Health. Cerebral Palsy Research Network. https://cprn.org/cerebral-palsy-mental-health/. Accessed July 23, 2024.}