Grant: Project Grant

Nearly 15% of youth less than 18 years of age are affected by both a physical and mental health problem, a situation known as 'multimorbidity'. This combination of problems can lead to compromised life quality, hardship for families, and considerable burden on the healthcare system. However, given the normal challenges of childhood and adolescence and stress of having a chronic physical condition managing multimorbidity in youth is difficult, but critical. We will determine how and why some youth develop multimorbidity, while others do not, because this knowledge is essential for establishing interventions to improve outcomes. Building on our successful feasibility study, we will document the course of mental health symptoms over time, as well as identify individual, family, and community predictors of mental disorder among 504 youth with chronic physical conditions. We will also examine whether the effects of these predictors are amplified or act through other psychosocial and biological variables such as poverty or physical activity. Furthermore, we will assess the extent to which multimorbidity increases the amount or alters patterns of psychiatric services usage among youth. We will enroll youth aged 2-17 years with a variety of chronic physical conditions (e.g., asthma, diabetes, epilepsy) receiving outpatient care at McMaster Children's Hospital and follow them for 24 months. We will also enroll a subset of age-matched healthy sibling controls. We will use provincial health care data to confirm psychiatric diagnoses and service use. Advanced statistical modeling will be used to estimate trajectories of health outcomes. With rare exceptions, previous studies were cross-sectional and none examined the extent to which youth multimorbidity impacts the amount of psychiatric services youth access. Preventing youth multimorbidity is essential to improve youth trajectories, strengthen families, and in turn, improve care and reduce costs.