Chronic medical conditions can put young people at increased risk for anxiety disorders.

Young people who report one of seven chronic medical conditions (CMC), including asthma, congenital heart disease, diabetes, epilepsy, inflammatory bowel disease, juvenile idiopathic arthritis, and sickle cell disease, are often diagnosed with an anxiety disorder. A new systematic review in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, examines the prevalence of anxiety disorders and the impact of anxiety on disease-related outcomes in children and adolescents with CMC.

The research team based in Australia and the Netherlands found that the prevalence of anxiety disorders in young people with CMC was higher than in the general population. Anxiety may also be associated with adverse disease-related outcomes in children and adolescents with these conditions.

“The issue of ‘mental-physical comorbidity’ (that is, meeting the diagnostic criteria for at least one mental illness and one physical illness) is a critical one, with the combination of anxiety disorders and physical illness appearing to be particularly prevalent among youth, said lead author Vanessa Cobham, Ph.D. and clinical psychologist at the University of Queensland and Children’s Health Queensland’s Child and Youth Mental Health Service, Brisbane, Australia.

“Associated with significant implications, the combination of anxiety disorders and physical illness presents the potential for worse outcomes of physical illness. Health professionals working with children and adolescents with chronic medical conditions should routinely screen for the presence of anxiety disorders to provide the best possible care for these young people. “

The review based on 53 studies included examining the prevalence of anxiety disorders and disease-related outcomes in seven different CMCs in children and adolescents with an average age of 18 years or younger.

Twenty-nine studies investigated the occurrence of anxiety disorders and found that more than half of the identified studies relied on a single informant (either youth or parent) to determine whether or not the youth met the criteria for an anxiety disorder. anxiety. This was seen as the most significant limitation regarding the omnipresence of an anxiety disorder.

While these studies are likely to underestimate the occurrence of anxiety disorders, the authors did find that, across all CMCs, anxiety prevalence rates were high: they affected approximately 20 to 50 percent of youth. In studies that included a healthy control group, the rates of an anxiety disorder were substantially higher among patients with all CMCs. In all CMCs, the anxiety disorder rate was higher than the overall prevalence rate of 6.5 percent, as previously reported by Polanczyk and colleagues1.

The remaining 24 studies examined the impact of anxiety on disease-related outcomes. No studies were identified for disease-related outcomes for epilepsy or congenital heart disease, however, the authors reported that anxiety was associated with:

The most significant and common limitations regarding the question of the impact of anxiety on disease-related outcomes were the cross-sectional design of most studies and the fact that almost all studies relied on a single informant to assess both anxiety and illness. results.

Evidence for youth with diabetes was inconsistent, with some studies reporting a negative impact of anxiety on metabolic control and treatment adherence, and other studies reporting a positive association between elevated anxiety and treatment adherence.

While the evidence that anxiety is associated with adverse disease-related outcomes in these young people, more longitudinal research is needed to delineate the impact of anxiety on childhood outcomes, Dr. Cobham and her team concluded. It is recommended that health services routinely evaluate anxiety disorders among young people with CMC. Psychometrically validated anxiety questionnaires (parent and youth versions) are likely to be a feasible means of detecting anxiety disorders.