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Mental disorder in children with physical conditions: a pilot study
  1. Alexandra Butler1,
  2. Ryan J Van Lieshout2,
  3. Ellen Louise Lipman2,
  4. Harriet L MacMillan2,
  5. Andrea Gonzalez2,
  6. Jan Willem Gorter3,
  7. Kathy Georgiades2,
  8. Kathy N Speechley4,5,
  9. Michael H Boyle2,
  10. Mark A Ferro1
  1. 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  2. 2 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  3. 3 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  4. 4 Department of Paediatrics, Western University, London, Ontario, Canada
  5. 5 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
  1. Correspondence to Dr Mark A Ferro; mark.ferro{at}


Objectives Methodologically, to assess the feasibility of participant recruitment and retention, as well as missing data in studying mental disorder among children newly diagnosed with chronic physical conditions (ie, multimorbidity). Substantively, to examine the prevalence of multimorbidity, identify sociodemographic correlates and model the influence of multimorbidity on changes in child quality of life and parental psychosocial outcomes over a 6-month follow-up.

Design Prospective pilot study.

Setting Two children’s tertiary-care hospitals.

Participants Children aged 6–16 years diagnosed in the past 6 months with one of the following: asthma, diabetes, epilepsy, food allergy or juvenile arthritis, and their parents.

Outcome measures Response, participation and retention rates. Child mental disorder using the Mini International Neuropsychiatric Interview at baseline and 6 months. Child quality of life, parental symptoms of stress, anxiety and depression, and family functioning. All outcomes were parent reported.

Results Response, participation and retention rates were 90%, 83% and 88%, respectively. Of the 50 children enrolled in the study, the prevalence of multimorbidity was 58% at baseline and 42% at 6 months. No sociodemographic characteristics were associated with multimorbidity. Multimorbidity at baseline was associated with declines over 6 months in the following quality of life domains: physical well-being, β=−4.82 (–8.47, –1.17); psychological well-being, β=−4.10 (–7.62, –0.58) and school environment, β=−4.17 (–8.18, –0.16). There was no association with parental psychosocial outcomes over time.

Conclusions Preliminary evidence suggests that mental disorder in children with a physical condition is very common and has a negative impact on quality of life over time. Based on the strong response rate and minimal attrition, our approach to study child multimorbidity appears feasible and suggests that multimorbidity is an important concern for families. Methodological and substantive findings from this pilot study have been used to implement a larger, more definitive study of child multimorbidity, which should lead to important clinical implications.

  • multimorbidity
  • mental disorder
  • chronic disease
  • pilot study

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  • Contributors MAF led the study. MAF, MHB, KNS, KG, JWG, AG, HLM, ELL and RJVL conceptualised and designed the study and were responsible for acquiring funding. MHB, KNS, KG and AG provided methodological insights. JWG, HLM, ELL and RJVL provided clinical insights. KNS and HLM helped facilitate clinic participation. AB and MAF analysed and interpreted data and drafted the manuscript. All authors critically reviewed and revised and then approved the final manuscript as submitted.

  • Funding This work was supported by the Canadian Institutes of Health Research (MOP-133645). At the time of the study, MAF was supported by a Research Early Career Award from Hamilton Health Sciences. MAF currently holds the Canada Research Chair in Youth Mental Health, MHB holds the Canada Research Chair in the Social Determinants of Child Health, KG holds the Dan Offord Chair in Child Studies, JWG holds the Scotiabank Chair in Child Health Research, AG is supported by a Canadian Institutes for Health Research New Investigator Award, HLM holds the Chedoke Health Chair in Child Psychiatry and RJVL holds the Canada Research Chair in the Perinatal Programming of Mental Disorders and Albert Einstein/Irving Zucker Chair in Neuroscience.

  • Competing interests None declared.

  • Ethics approval The study protocol received ethical approval from the Hamilton Integrated Research Ethics Board (14-130) and Research Ethics Board (105505).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data will not be shared in order to protect the confidentiality of participants. This was a multisite study, and we do not have approval to make the data publicly available.

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