Chronic illness in childhood and adolescence: A longitudinal exploration of co-occurring mental illness

Abstract

Chronic health problems are hypothesised to be a risk factor to child and adolescent mental health, due the consistent and continuing stress these health problems pose to normative patterns of development. However, this theory remains to be substantiated by empirical research. Moreover, a systematic review conducted as part of this research indicated that the empirical body is not one on which the validity of this theory can be adequately tested. The major question posed is whether the lack of high quality epidemiological data in the field is obscuring a true psychiatric risk associated with chronic illness in childhood and adolescence, or whether, in contrast, the theory of chronic health problems as a particular risk factor to child and adolescent mental health, is based on false premises.

In order to provide a stronger insight into the association of chronic health problems to mental ill[health across the late childhood and adolescent period, this study used data from a large, representative British sample (the Avon Longitudinal Study of Parents and Children (ALSPAC)) and sensitive measures of mental health outcomes. Mediating factors in these associations were also identified, and a model of the association of chronic health problems to poor mental health outcomes in early adolescence was developed. In order to ensure that all findings were applicable across chronic health conditions, outcomes over this period for children with chronic illness more generally were compared to outcomes for children with asthma diagnoses.

Children with chronic health problems presented with a disproportionate rate of psychiatric illness at 10 years, and these chronic health problems continued to be associated with poor mental health outcomes across the early to mid[adolescent period. The outcomes at 10 and 13 years were suggested to be mediated by factors non[specific to any diagnosis, specifically peer victimisation and health[related school absenteeism.

Limitations to external validity in the research, and implications for public health and future research are discussed.