Children and adolescents with chronic physical conditions have a 51% greater risk of developing mental health conditions compared to children and adolescents without chronic physical conditions — yet mental health support for chronically ill kids is lacking, according to the author of an op-ed published Sept. 8 in MedPageToday.
“The medical field puts extensive resources into treating these conditions. However, fewer resources are invested in addressing young patients’ mental health, which is suffering in the aftermath of the COVID-19 pandemic,” wrote Jordyn J. Williams, an M.D./Master of Public Health candidate at the University of Miami Miller School of Medicine.
Williams called on the medical establishment to do better:
“As healthcare workers and advocates, our job is to consistently explore ways to improve the holistic care of every person we are privileged to care for. There is no time to waste when it comes to instituting promising hospital initiatives to better meet the mental health needs of children and adolescents experiencing chronic illness.”
Williams pulled the 51% greater risk statistic from a 2019 study, published in Pediatrics. She also cited a 2010 study, also published in Pediatrics, that concluded the risk of self-harm is significantly higher among young people suffering from chronic physical conditions.
According to that study, “youth with co-occurring chronic physical and mental conditions … had significantly higher odds of self-harm … suicidal ideation … and suicide attempts … than healthy peers.” Youths with chronic physical conditions alone were at slightly elevated risk for all three outcomes.
Other recent studies have also drawn a link between chronic illness in youth and mental health disorders.
A systematic review and meta-analysis published Monday in JAMA Pediatrics identified a prevalence of anxiety and depression among youth with chronic illness “more than 3 times greater than what is seen in the community setting.”
“Anxiety and depression are common clinical comorbidities and should be considered when assessing and treating youth with chronic pain,” the study noted.
And a 2019 systematic review published in the Journal of the American Academy of Child and Adolescent Psychiatry found “the prevalence of anxiety disorder was increased in youths with CMCs [chronic medical conditions] compared to the general population.”
The review presented evidence linking conditions such as asthma, diabetes and inflammatory bowel disease with a higher incidence of anxiety.
Williams suggested that decreased school participation and less social interaction with friends are significant contributors to the decline in mental health of pediatric patients, “as these activities are crucial for social and cognitive development.”
Citing her own experience in pediatric wards, Williams said:
“From my experiences on the wards, I found that the interactions of young patients with chronic illness were often limited to their family, if present, and the health professionals caring for them. Rarely did I see interaction with peers their own age.
“Notably, there are children of similar age around — in the rooms next to, across, and down the hall from them. Though, even with available community spaces, I noticed that the kids seldom used them together.”
Incidence of chronic illness in youth: The elephant in the room?
Experts who spoke with The Defender agreed that young people suffering from chronic illness need increased mental health support. However, they also said more should be done to prevent chronic disease.
Dr. Michelle Perro, a pediatrician, praised Williams for “tackling a difficult, but prescient issue regarding the emotional well-being of our youth suffering with chronic diseases.”
However, Perro said, “There still exists a major educational gap in the understanding of the drivers of why our children have fallen victim under the burden of chronic health challenges.”
For Perro, there are several additional contributors to the incidence of mental health challenges in youth with chronic illness — and for the incidence of chronic illness in these children in the first place.
“While no doubt school absenteeism and decreased social engagement exacerbated mental health” during the COVID-19 pandemic, “without addressing the root cause, the true drivers of chronic health precipitants, the mental health tolls will continue to escalate,” Perro said.
According to Perro, some factors that contribute to the onset of chronic disorders in children include “environmental toxicants that are found in our food (GMOs and their associated pesticides), air pollution, EMFs/5G/ experimental gene therapies, and contaminated water from toxic metals such as lead and fluoride.”
Williams’ op-ed was published just days before a study in the Proceedings of the National Academy of Sciences concluded that COVID-19 lockdowns accelerated the aging of teenagers’ brains. Adolescents experiencing mental health challenges were not included in that study’s cohort.
Op-ed calls for school programs, social sessions for pediatric patients
Williams referenced several peer-reviewed studies showing that increased social interaction among individuals with chronic illness can have a positive impact on their mental and physical well-being — noting, though, that these studies did not specifically study a pediatric population.
For instance, Williams cited a 2012 meta-analysis published in Diabetic Medicine, which found that among diabetic adults, peer support led to decreased depression and increased physical markers.
Williams also cited a 2011 Nephrology Dialysis Transplantation study, which found that among people with chronic kidney disease, those who received self-management support and peer support “experienced fewer hospitalizations and slowed progression of disease.”
Williams proposed the development of hospital school programs, which she said are common in some countries, such as Italy, but are only available to a limited extent in the U.S., despite a decades-old recommendation by the American Academy of Pediatrics for such programs.
Williams cited a 2021 article in the International Journal of Environmental Research and Public Health describing Italy’s Hospital School Program as “a national flagship system in education” that has been active since the 1950s and served over 40,000 students during the 2019-2020 school year.
“The Hospital School Program is part of a broad therapeutic process that aims to overcome the fear once hospitalization ended, in order to prevent the school drop out risk,” the article states.
Williams also suggested that daily group social sessions may help pediatric patients with chronic illness, as they “actively facilitate conversation, game play, and camaraderie between chronic inpatient peers.”
“The faltering mental health of pediatric patients with chronic disease is something health professionals and health systems should address with vigor,” Williams wrote.
However, Williams acknowledged that while such programs may contribute to mental well-being for youth with chronic illness, they “are not the only solutions for addressing [their] multifactorial mental health challenges” and “may not be feasible for every child or adolescent with chronic disease.”
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‘Lack of nutrients’ in children’s diets tied to the mental health crisis
Perro called Williams’ suggestions “a good first step” and “overdue,” but also “distinctly short-sighted.” She highlighted children’s nutrition as a factor that was overlooked in Williams’ op-ed and the journal articles she cited.
“Our children are overfed and undernourished,” Perro said. “The lack of nutrients in their diets is tied to the mental health crisis. Want to heal the emotional upheaval in our children? Feed them real food. There is extensive data supporting this relationship between real food and brain health.”
Perro cited a 2014 systematic review published in the American Journal of Public Health that “found evidence of a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents.”
“We observed a consistent trend for the relationship between good-quality diet and better mental health and some evidence for the reverse,” the study noted.
