Mental health disorders, participation, and bullying in children with cerebral palsy

Aim To examine how social factors might mitigate the elevated risk of mental health disorders in children with cerebral palsy (CP). Method This cross‐sectional study included 6‐ to 17‐year‐olds with (n=111; 40.4% 6–11y, 59.6% 12–17y) and without (n=29 909; 50.2% 6–11y, 49.8% 12–17y) CP from the 2016 National Survey of Children's Health. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention‐deficit/hyperactivity disorder. Social factors included participation in activities, bully victimization, and difficulty with friendships. Results After adjusting for sociodemographic factors and the presence of chronic pain, children with CP had higher odds of anxiety (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.9–8.5), behavior/conduct problems (OR 3.9; 95% CI 1.4–11.3), and multimorbidity (OR 2.8; 95% CI 1.1–7.0), but not depression (OR 1.4; 95% CI 0.6–3.8) or attention‐deficit/hyperactivity disorder (OR 1.7; 95% CI 0.6–4.6), compared to controls. With adjustment for participation in activities, the odds of anxiety, behavior/conduct problems, and multimorbidity remained increased in children with CP. With adjustment for difficulty with friendships, the odds of anxiety, behavior/conduct problems, and multimorbidity were no longer increased in children with CP. With adjustment for bully victimization, the odds of behavior/conduct problems and multimorbidity were attenuated in children with CP; however, the odds of anxiety remained increased. Interpretation The elevated prevalence of certain mental health disorders in children with CP is partly associated with modifiable social factors. What this paper adds Difficulty with friendships predicts an elevated prevalence of psychiatric conditions in children with cerebral palsy (CP). Bully victimization predicts an elevated prevalence of behavior/conduct problems in children with CP. Low participation does not predict mental health disorders in this population. Resumen Enfermedades de salud mental, participación y bullying en niños con parálisis cerebral Objetivos Examinar cómo los factores sociales podrían mitigar el riesgo elevado de trastornos de salud mental en niños con parálisis cerebral (PC). Metodo Este estudio transversal incluyo niños de 6 a 17 años de edad con PC (n=11; 40,4% 6‐11 años, 59,6% 12‐17 años) y sin PC (n= 29.909; 50,2% 6‐11 años, 49,8% 12‐17 años) de la Encuesta Nacional de Salud Infantil 2016. Los trastornos de la salud mental incluyeron depresión, ansie