Chronic Physical Conditions in Youth Linked to Risk for Mental Illness

Boy, aged 8-9, excluded from his team in a school sports hall
The risk for mental illness was 51% greater in youth with physical illness compared with US youth without chronic physical health conditions.

Youth with chronic physical conditions (CPCs) are at an increased risk for mental illness, according to nationwide cohort data published in Pediatrics. In addition, activity limitations may contribute to the development of mental health conditions.

Investigators abstracted data from the Medical Expenditure Panel Survey (MEPS), an annually conducted, nationally representative survey of the US population. A total of 11 consecutive years of MEPS panels were included in analyses (2003-2014) for a pooled cohort of 48,572 youths age 6 to 25 years. The Chronic Condition Indicator was applied to MEPS data to identify youths with CPCs. The outcome of interest was the timing of incident mental health conditions, defined as time from baseline MEPS administration to time of first diagnosis. Patient demographics were also extracted and applied as covariates. Cox proportional hazard models were used to estimate the association between CPCs and incident mental health conditions.

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Youth with CPCs represented 14.7% of the total MEPS sample. The 2-year cumulative incidence of mental health conditions was 11.5% in youth with CPCs, compared with just 7.1% in youth without CPCs (P <.001). After adjusting for sociodemographic characteristics, the risk for incident mental health conditions was 51% greater (adjusted hazard ratio [aHR], 1.51; 95% CI, 1.30-1.74) in youth with CPCs compared with their counterparts without CPCs. Youth with CPCs had increased risk for all categories of mental illness, including anxiety (aHR, 1.51; 95% CI, 1.20–1.89), mood (aHR, 1.70; 95% CI, 1.32–2.18), and behavior (aHR, 1.54; 95% CI, 1.17–2.04) disorders. Among all sampled youth, 1.8% reported any activity limitations; after adding activity limitations to the Cox model, the association between CPCs and incident mental illness decreased from 51% to 42% greater risk (aHR, 1.42; 95% CI, 1.23-1.66). As such, activity limitations accounted for 13.5% of the relationship between incident mental health conditions and chronic physical conditions.

These data suggest that having a CPC may be a significant risk factor for subsequent development of mental illness in youth. The relationship between CPCs and mental health conditions may be mediated, in part, by limitations in physical activity.

“[Interventions]…should identify opportunities to both bolster individual strengths and to modify the physical or social environment to maximize youth ability to fully participate in activities important to their developmental progress,” investigators concluded.


Adams JS, Chien AT, Wisk LE. Mental illness among youth with chronic physical conditions [published online June 14, 2019]. Pediatrics. doi:10.1542/peds.2018-1819