The prevalence of mental illness among young people living ... · The prevalence of mental illness among young people living with chronic illness: A systematic review Ann Marie Brady

The prevalence of mental illness among

young people living with chronic illness:

A systematic review

Ann Marie Brady

(CLAHRC North Thames Doctoral Candidate)

NIHR CLAHRC North Thames

Chronic Illness

“…a condition that cannot, at

present, be cured but is controlled

by medication and/or other

treatment/therapies.”

Department of Health (May, 2012)


Chronic Illness

“The incidence and prevalence of

chronic conditions is rising in most

developed and developing countries

and will constitute the main cause of

death by 2020.”

World Health Organisation (2007)


Chronic Illness

“Around 70% of the total annual

health care spend in England could be

attributed to people living with long-

term conditions, a proportion

representing 30% of the total

population.”

Department of Health (2012)


Chronic Illness

“The increasing prevalence of long

term conditions is the biggest

challenge facing the NHS now and

for the future.”

Miles Ayling, Director of Innovation and

Service Improvement, Department of

Health


High Rates of Co-Morbidity

“Research evidence consistently

demonstrates that people with long-

term conditions are two to three times

more likely to experience mental

health problems than the general

population….”

Naylor, Parsonage, McDaid, Knapp, Fossey, & Galea,

(2012). Long-Term Conditions and Mental Health: The

Cost of Co-Morbidities


When Mental Illness Occurs in

the Context of Chronic Illness…

Recovery from the physical condition is

impeded.

Pain can become more difficult to

control.

Increase in psychosomatic symptoms.

Confidence to participate in

rehabilitation programmes is reduced.

Source: Academy of Medical Royal Colleges (July 2009)


Increased Focus on Mental

Healthcare…


Young People Poorly Understood…

“… we have remarkably little

understanding of how the functional needs

of the young change across childhood,

through adolescence, let alone how young

people respond to such changes or how

they can best be supported.”

Sawyer, Drew, Yeo, & Britto (2007). Adolescents with a

chronic condition: challenges living, challenges

treating. The Lancet


Existing Evidence…

2007 United Kingdom National Survey of

Children’s Mental Health and Wellbeing

(e.g. Perry-Langdon, 2008)

Physical illness one of the major predictors

of mental health outcomes

However, no information gathered on onset,

severity or chronicity


Existing Evidence …

Lavigne and Faier-Routman (1992)

“The major contribution of understanding of the

adjustment of children with chronic disorder…”

(Wallander, 1998)

Increase in:

Emotional Symptomatology

Behavioural symptomatology

Overall Adjustment Problems


Existing Evidence…

Series of meta-analyses by Pinquart & Shen

(2011)

Young People with chronic illness rated as having

relatively higher levels of:

Anxiety (Pinquart & Shen, 2011a)

Depression (Pinquart & Shen, 2011b)

Conduct-related Issues (Pinquart & Shen, 2011c)


However, there were limitations…

Assumption of Common Outcomes of

Chronic Illness

Focus on Relative Levels of Mental

Illness Symptoms


This Systematic Review…

Specific Focus on:

• Prevalence of Mental Health

Disorders

• Inter-Condition Variations


Eligibility Criteria…

I. Original Study measuring any mental health

outcome in a sample aged between birth and

19 years living with any condition that could be

defined as chronic under Department of Health

guidelines

II. Studies must have had a comparative group

III. Examinations must have been conducted in

the year 2000 or later


Search

Search Terms:

“chronic illness” OR “chronic disease” OR “long term physical” OR

asthma OR diabetes OR “musculoskeletal disorder” OR epilepsy OR

anaemia OR anemia

AND

“conduct disorder” OR “conduct problem” OR emotional and behav*

difficulties OR emotional and behav* problems OR “mental health” OR

depress* OR anxiety OR internali* AND externali*

Age Group: 0-19 Years/Child and Adolescent

Timespan: Year 2000 Onwards

Language: English

Document Type: Journal Article


Search Process


Breakdown of Eligible Studies

0 20 40 60 80 100 120 140

Single Studies

Non-Alcoholic Fatty Liver Disease

Haemophilia

Chronic Kidney Disease

Inflammatory Bowel Disease

Juvenile Arthritis

Thalassemia

Sickle Cell Disease

Comparative Studies

Non-Categorical Study of Chronic Illness

Diabetes

Asthma

Epilepsy and other Neurological Conditions

No. of Studies


Quality Ranking

Newcastle-Ottawa Quality Assessment Scale

for Cohort Studies

Preference Given To:

• Longitudinal Studies, with appropriate

adjustments for confounding factors

• Representative exposed samples and

comparative controls

• Measures with Minimal Subjectivity


Results Broken into Three Sections

1. Studies of Individual Diagnostic

Categories (n=220)

2. Studies that Studied Chronic Illness Non-

Categorically (n=26)

3. Comparative Studies (n=9)


Studies of Individual Diagnostic

Categories

Epilepsy and other Neurological

Disorders

- Clear increase in Prevalence of Mental

Health Disorders

- Mainly a Function of Neurobiological

Functioning



Categories

Condition

Increased

Prevalence of

Emotional

Disorders

Increased

Prevalence of

Behavioural

Disorders

Key Moderating

Factors

Asthma Unexamined • Gender

• Socio-Economic

Status

• Severe, On-going

Symptoms

• Comorbid Conduct

Disorder

Diabetes ?

(Trends,

Prevalence not

examined)

• Glycaemic Control

• Functional

Impairment

• Family Climate

• Age



Categories

Condition

Increased

Prevalence of

Emotional

Disorders

Increased

Prevalence of

Behavioural

Disorders

Key Moderating

Factors

Sickle Cell

Disease

X X • Gender

• Low Family Income

• Frequent Painful

Crisis

Thalassemia Severe Symptoms

Juvenile Arthritis X X Active Symptoms

Inflammatory

Bowel Disease

?

(Clinical

Significance not

examined)

X Adolescent Onset

Haemophilia X

(Trend)

X Severe Symptoms



Categories

Condition

Increased

Prevalence of

Emotional

Disorders

Increased

Prevalence of

Behavioural

Disorders

Key Moderating

Factors

Chronic Kidney

Disease

X X Dialysis

(Emotional

Symptoms Only)

Non-Alcoholic

Fatty Liver

Disease

?

(Clinical

Significance not

Examined)

X BMI (Conflicting

Evidence)


Condition

Increased

Prevalence of

Emotional

Disorders

Increased

Prevalence of

Behavioural

Disorders

Key Moderating

Factors

Cystic Fibrosis X X Socio-Economic Status

Epidermolysis Bullosa X X -

Oesophageal Atresia X X -

Familial Mediterranean

Fever

(Depression Only)

Unknown -

Juvenile Fibromyalgia

Syndrome

X

(Trend)

X -

Lupus X X -

Primary Ciliary

Dyskinesia

X X -

Eosinophil-Associated

Gastrointestinal Disorders?

(Mother’s Ratings Only)

X -


Categories



Categories

Conclusions:

• Mental Health Outcomes are Diverse

• Severity within Conditions may be

Important Moderating Factor

Needed: - Longitudinal Data

- Representative Samples

- Adjustment for Confounding Factors


Non-Categorical Examinations of

Chronic Illness

Note: Significant Variations in Definitions of

Chronic Illness

Conclusions:

I. Increased Prevalence of Emotional and

Behavioural Disorders – HOWEVER, Inter-

Disease Variation

II. Functional Impairments, rather than

severity, key moderating factor

III. Role of Socio-Economic Variables


Non-Categorical Examinations of

Chronic Illness

Limitations:

- Cross-Sectional Data

- Lack of Objective Physical Health

Indicators

- Issues Regarding Measures of Mental

Health


Comparative Studies

Severe Quality Issues

- Explanatory Value of at least 5/9 studies could be

viewed as extremely compromised

Supported Link with Psychological

Adjustment

Supported Inter-Disease Variations

Suggested Role of BMI


Overall Conclusions

• Consistent Evidence of Variations in

Mental Health Outcomes

• Severity within Conditions could be

Important Moderating Factor

• Suggested Role of Socio-Economic

Factors and Obesity


Significant Limitations

• Small Quantity of Studies

• Lack of Longitudinal Measurement

• Bias Within Mental Health Measures

• Lack of Representative Samples

Thank You

Acknowledgements:

Professor Stephen Stansfeld (Wolfson

Institute of Preventive Medicine)

Dr. Jessica Deighton (Anna Freud Centre)

Further Information: [email protected]

Documents

The prevalence of mental illness among young people living ... · The prevalence of mental illness among young people living with chronic illness: A systematic review Ann Marie Brady