乌鸦传媒

Adults with cerebral palsy, relative to those without, showed higher rates of mental health disorders in a cross-sectional study.

In many cases, mental health disorders were more pronounced in cerebral palsy patients who had co-occurring disabilities, reported Mark Peterson, PhD, MS, of the University of Michigan, and coauthors in .

The study is the first to show the prevalence of mental health disorders in adults with cerebral palsy using a U.S. population-representative sample, Peterson told 乌鸦传媒.

"There is a general lack of clinical awareness and resources for mental health disorders for individuals with cerebral palsy," Peterson said. "Some recent work suggests that children and adults with cerebral palsy may have a higher risk for mental health disorders compared to individuals without cerebral palsy. However, these studies were performed outside of the U.S., had small samples sizes, and in most cases, used questionnaires not designed for individuals with disabilities."

"The adult cerebral palsy population is expanding due to increased survival rates and stable or marginally increased global prevalence," he added. "Children and adolescents with cerebral palsy experience an array of health-and function-related problems affecting neuromuscular, musculoskeletal, and other physiologic systems, and these problems may increase in severity as they transition into and throughout adulthood."

In this study, Peterson and colleagues looked at 2016 data from Optum Clinformatics Data Mart, a nationwide, de-identified insurance claims database of 79 million beneficiaries. They used physician diagnosis data from inpatient, outpatient, and emergency department claims to identify those to include in the analysis.

The sample included 8.7 million adults, of whom 5,052 had cerebral palsy alone and 2,296 had it with co-occurring neurodevelopmental disorders -- namely, intellectual disorders, autism spectrum disorders, or epilepsy.

Overall, the prevalence of cerebral palsy was 0.84 per 1,000. Prevalence of co-occurring neurodevelopmental conditions among the entire sample for adults with cerebral palsy, versus those without, was 13.5% versus 0.1% for intellectual disabilities, 2.3% versus 0.1% for autism, and 24.3% versus 1.1% for epilepsy.

Men with cerebral palsy alone had higher age-standardized prevalence than men without cerebral palsy in five mental health categories:

• Schizophrenic disorders (2.8% vs 0.7%)
• Mood affective disorders (19.5% vs 8.1%)
• Anxiety disorders (19.5% vs 11.1%)
• Disorders of adult personality and behavior (1.2% vs 0.3%)
• Alcohol-and opioid-related disorders (4.7% vs 3.0%)

Women followed similar patterns. In almost all cases, people who had cerebral palsy and co-occurring neurodevelopmental disorders had similar or higher prevalence of mental health disorders than people with cerebral palsy alone.

This research adds to an emerging literature of population-based studies about adults with developmental disabilities, observed Gloria Krahn, PhD, MPH, of Oregon State University in Corvallis, and Susan Havercamp, PhD, of Ohio State University in Columbus, in an .

"Our calculations of their findings indicate that, compared with adults without cerebral palsy, those with cerebral palsy have estimated rates more than 5 times higher for psychotic disorders, 2 to 3 times higher for mood affective disorders, 1.5 to 2 times higher for anxiety disorders, and more than 3 times higher for disorders of adult personality and behavior," they wrote.

"Diagnosis and treatment of mental health conditions in persons with developmental disabilities is challenging," they pointed out. "Limitations in their ability to self-report symptoms of mental distress may mean that health care needs are unrecognized and unmet."

There is a call to promote for all physicians "to increase quality of care as well as to outline disability competencies for health care education," Krahn and Havercamp added. "In 2017, the adopted Resolution 315 to promote curricula on the care of persons with developmental disabilities, and the Liaison Committee on Medical Education is now considering a request from the for required training on developmental disabilities."

The study had several limitations, the researchers noted. It used a single claims code to define cohorts and was not able to determine the severity of cerebral palsy. It assessed only privately-insured adults and people with other or no insurance may be different. Claims data may be prone to inaccurate diagnostic coding and the study did not include prescription data to ascertain the presence of a mental health disorder, they added.

Comment