The Impact of Medical Comorbidity on Mental Health and Functional Health Outcomes Among Children with Anxiety Disorders

Abstract

Objective-Medical comorbidity is common among children with anxiety disorders; however, little is known about the impact of such comorbidity on mental and functional health outcomes. Even less is known about these problems in high-risk samples of youth.Method-Participants in this study were youth with at least one DSM-IV anxiety disorder with a physical illness (N=77) and without a physical illness (N=73), as well as youth with at least one physical illness (but no anxiety disorder) (N = 438). These youth were recruited as part of the Patterns of Care study in which the original set of participants (N = 1715) were randomly sampled from one of five public sectors of care (e.g., juvenile justice, child welfare, mental health, alcohol and substance use services, school services for children with serious emotional disturbance) in San Diego County. Psychiatric diagnoses were assessed with a structured interview and three standardized measures were used to assess child health, emotional, and behavior functioning.Results-At least half of children with anxiety disorders had a comorbid physical illness. Allergies and asthma were the most common comorbid physical illnesses. Children with anxiety disorders who had a comorbid physical illness exhibited greater levels of emotional problems, more somatic complaints, and more functional impairment than anxious children without a physical illness as well as than children with physical illness alone. Parents of children in the comorbid group also reported greater caregiver strain than the other two groups.Conclusions-Children with anxiety disorders have high rates of chronic illnesses such as asthma and allergies. These children experience considerable impairment and likely have unique needs that may complicate usual care. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptData from clinical and community studies suggest that children with anxiety disorders frequently present with chronic illnesses and physical health problems including asthma, 1-3 respiratory problems, 4-5 gastrointestinal disorders, 6 and headaches 7 . The nature of these relationships is likely bidirectional with anxiety contributing directly to physical illness through a general weakening of the immune system or as a byproduct of stress and less directly through unhealthy behaviors that are often exhibited by anxious youth (e.g., alcohol and drug use, poor sleeping and eating habits, and less exercise). 8-9 Furthermore, physical illness can often trigger the onset or exacerbate existing anxiety symptoms, such as by increasing the presence of somatic sensations which through misinterpretation may lead to panic attacks or by providing stimuli for additional worries.In general, symptoms of child anxiety are associated with educational underachievement, 10-11 low-self esteem and loneliness, 12 and increased risk for later psychiatric disorders including depression, substance use, and suicide attempts. 13-15 Chronic physical illnesses are also associated with significant impairment ...

Point Prevalence of Co-Occurring Behavioral Health Conditions and Associated Chronic Disease Burden Among Adolescents

“…This finding is consistent with other studies that have found high rates of medical and psychiatric comorbidity among children and adolescents. 9,16,24,25 We found a particularly strong association between irritable bowel syndrome and anxiety, which is not surprising, as anxiety and stress are thought to exacerbate the symptoms of irritable bowel syndrome. 31 Similarly, migraine has been found to be related to a number of psychiatric comorbidities, 32,33 which could represent some shared vulnerability or emotional distress resulting from dealing with the chronic pain of migraine.…”

“…[4][5][6][7][8] The pediatric literature on the co-occurrence of mental health, substance use, and medical conditions is less robust, but has begun to document comorbidity between BHCs and some common chronic medical conditions. [9][10][11] A recent national population survey found that among 18-year-olds, 31.9% reported having an anxiety disorder, 14.3% a mood disorder, 19.6% a behavioral disorder, including attention-deficit/hyperactivity disorder (ADHD), and 11.4% a SUD at some point in their lives. 12 High rates of mental health and SUD comorbidity have also been documented, particularly in clinical samples.…”

To be or Not to be; the Choice will Always be ours, Percussions of Chronic Physical Illnesses on Pediatric Mental Health

“…On one hand, clinical anxiety increases the risk of development of medical complaints and or exaggeration of physical symptoms via either biological mediators (as hormonal or autonomic changes), psychological mechanisms (as biased symptom perception or defective coping), or a combination of both (as impaired immunity in cases of chronic worry and or excessive avoidance behaviors). On the other hand, the physical manifestations of chronic illnesses and or associated pain, dependence on medications, and or repeated hospital admissions may result in extreme fear about safety or separation from parents that eventually ends with school refusal or may lead to increased scanning and obsessions concerning physical symptoms ending with increased anxiety and panic responses to both physiological body changes and manifestations of physical diseases [15,16].…”

Pediatric and Adolescent Mental Health Emergencies in the Emergency Medical Services System

“…[95][96][97] For example, children with asthma and allergies are especially prone to having anxiety disorders. 98 Obesity is also associated with problems such as depression, especially in Hispanic and black children. 99 The Emergency Information Form (EIF), developed jointly by the AAP and ACEP (www.aap.org/ advocacy/blankform.pdf), allows providers to include psychiatric and behavioral diagnoses for children with special health care needs and also includes information about their health care professionals, medications, and significant medical history.…”