Health Functioning Moderates the Association Between Chronic Conditions and Mental Illness in Childhood.

Abstract

Objectives This study aimed to quantify associations between chronic conditions and mental illness; investigate potential moderating effects of child age, sex, health functioning, mental health service contact and household income on these associations; and explore the potential mediating effect of family functioning. Methods This study conducted secondary data analyses on a sample of 6242 children aged 4-17 years from the 2014 Ontario Child Health Study (OCHS). Chronic conditions were assessed using a standard list of conditions developed by the Statistics Canada. Mental illness was assessed with the Emotional Behavioural Scales (EBS). The Health Utility Index Mark III measured health functioning. Logistic regression models quantified associations between chronic conditions and mental illness. Moderating effects were tested with product-term interactions in logit models and interpreted using average marginal effects. Mediating effects were explored using the product of coefficients method. Results Having a chronic condition was associated with mood disorder (OR = 2.25 [95% CI: 1.36-3.74]). For children who have better health functioning, average marginal effects indicated that children with chronic conditions are 29% more likely to have any mental illness (p Conclusion The association between chronic conditions and mental illness in children is nuanced, with health functioning moderating this association for any mental illness, anxiety disorders and attention-deficit hyperactivity disorder specifically. Mental health screening programs should ensure children with chronic conditions who have better health functioning are routinely assessed and upstream interventions initiated early to reduce the incidence of physical-mental multimorbidity.