Chronic Illness and Internalizing Symptomology in Youth

This week we will be reviewing and briefly discussing an article published this month in the Journal of Pediatric Psychology. The article, titled “Chronic Illness and Internalizing Symptomology in a Transdiagnostic Clinical Sample of Youth” was written by authors Wolock, Queen, Rodriguez, and Weisz who sought to investigate the relationship between chronic illness and internalizing symptoms among children who enroll in outpatient mental health treatment. 

What did they do?

At a very high level, the authors recruited children between the ages of 7 and 15 and their parents to participate in a screening using two self report questionnaires to explore whether children with chronic physical illness(es) would exhibit higher self-reported and parent-reported anxiety and depressive symptoms.

Why did they do it?

As the authors highlight, there is a large body of literature examining the relationship between physical illnesses and internalizing symptoms, specifically in children. Across previous studies, researchers have found that there is generally a positive relationship between chronic illness and anxiety symptoms. Existing literature also suggests that children are at highest risk for developing anxiety within the first year of a chronic illness diagnosis. Much of the previous research has examined the relationship between physical and mental illness in samples of children recruited due to existing chronic illness diagnoses. Alternatively, the authors of this study took a slightly different approach in examining whether children with diagnosed emotional and behavioral disorders who are seeking treatment are at an elevated risk for having comorbid physical illnesses.

How did they do it?

In total, 262 children/adolescents (aged 7 to 15 years) and their parents completed a screening assessment. Demographic information, as well as the presence and/or number of chronic physical illnesses for each child was collected at baseline. Additionally, participants' parents completed the Child Behavior Checklist (CBCL), and the child participants completed the Youth Self-Report (YSR). 

What did they find?

The authors compared scale scores across children with and without chronic health conditions. No significant between-group differences were observed when comparing the CBCL Internalizing Subscale, CBCL Affective or Anxiety Subscale, or the YSR Internalizing Subscale. 

However, the authors did identify a statistically significant relationship between the number of chronic conditions (i.e., 0 or 1 versus 2 or more) and CBCL Affective scores, whereby the presence of more chronic conditions was associated with higher CBCL Affective scores. The same relationship was also identified between the number of chronic illnesses and YSR subscale scores.

What does it all mean (our take)?

This article provides fantastic incremental evidence supporting the importance of evaluating the mental wellbeing of children/adolescents who are experiencing chronic physical illnesses. As it has been demonstrated that this is a particularly high risk population, it appears that the complex relationship between physical and mental health becomes increasingly substantial for those experiencing a multitude of chronic physical conditions. 

So what can we do about that? We think an appropriate solution continues to lie in the hands of the integrated care model. Continuously evaluating the mental wellbeing of child/adolescent patients, not just at primary care annual visits, but also at specialty care visits for those who experience chronic health problems, is critical. Creating a connection (using technology) between physical and mental health providers can help increase the likelihood that children with chronic health conditions are appropriately cared for. Further, we suspect that an integrated care approach will likely have a substantial impact on the rates at which children experience improvement in overall wellbeing.