Mental, Behavioral, and Developmental Disorders (MBDDs) Among U.S. Children with and Without Heart Conditions, 2016-2021 Restricted; Files Only

Abstract

Background: Children with heart conditions, particularly congenital heart defects, are at greater risk than their peers for adverse neurodevelopmental and psychosocial outcomes. This research aimed to compare prevalence of mental, behavioral, and developmental disorders (MBDDs) among children with and without heart conditions and to examine sociodemographic factors associated with MBDDs in U.S. children with heart conditions.

Methods: Parent-reported National Survey of Children’s Health data (2016-2021) on children aged 6-17 years without Down syndrome were analyzed. Heart condition was defined as a healthcare provider ever telling the parent that the child has a heart condition. MBDDs were defined as current diagnosis of depression, anxiety problems, attention-deficit/ hyperactivity disorder (ADHD), behavioral or conduct problems, Tourette syndrome, autism spectrum disorder, developmental delay, intellectual disability, or speech or language disorder. Logistic regression models using the predicted marginal approach were used to compare prevalence of MBDDs by heart condition status and, among children with heart conditions, assessed whether child’s sex, race/ethnicity, age, adverse childhood experiences (ACEs), health insurance, family income, primary caregiver’s marital status, and highest parental education were associated with MBDDs. Estimates were weighted to yield national estimates.

Results: Of children with heart conditions, 42.0% had an MBDD, compared to 22.0% of children without heart conditions (adjusted prevalence ratio [aPR]= 1.9; 95% confidence interval [CI]: 1.7, 2.0). Each MBDD was more prevalent among children with heart conditions, compared to children without, with aPRs ranging from 1.9 for depression and ADHD to 5.1 for intellectual disability. Among children with heart conditions, MBDDs were associated with an increased number of ACEs (aPR range: 2-3 ACEs: 1.7-4.0; ≥4 ACEs: 1.0-6.7). Independent associations between other factors and MBDDs varied by MBDD, and included male sex, Non-Hispanic Black race/ethnicity, older age (12-17 years), public insurance coverage, lower family income, and divorced, separated, or widowed parental marital status.

Conclusion: In a nationally representative sample of U.S. children, 2 in 5 children with heart conditions had ≥1 MBDD, almost twice that of children without heart conditions. Among children with heart conditions, varying factors associated with MBDDs suggest a need for holistic support for families of children with heart conditions to reduce MBDDs.  

Table of Contents

CHAPTER 1: LITERATURE REVIEW 1

Congenital Heart Defects (CHD) 1

Etiology of Mental, Behavioral and Developmental Disabilities in Children with Congenital Heart Defects 1

Mental Health Conditions Among Children with CHD 4

Behavioral Disorders Among Children with CHD 6

Developmental Disorders Among Children with CHD 7

Autism Spectrum Disorder (AuSD) 7

Intellectual Disability 8

Developmental Delay 9

Speech and Other Language Disorders 10

Study Rationale 10

CHAPTER II: MANUSCRIPT 12

Background 12

Methods 13

National Survey of Children’s Health 13

Outcome Measures 14

Demographic and Contextual Characteristics 14

Statistical Analysis 15

Results 16

MBDD Prevalence 17

Resource Use Among Children with MBDDs 18

Demographic and Contextual Characteristics Associated with MBDDs among Children with Heart Conditions 18

Discussion 20

Conclusion 22

CHAPTER III: PUBLIC HEALTH IMPLICATIONS 24

References 27

Figures 35

Tables 39

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palabra Clave	heart conditions mental and behavioral disorders congenital heart defects developmental disorders
Committee Chair / Thesis Advisor	Vijaya Kancherla, Emory University
Committee Members	Karrie Finn Downing, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities Sherry L. Farr, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
Partnering Agencies	CDC

Última modificación

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	File download under embargo until 18 May 2025	2023-04-18 18:30:07 -0400	File download under embargo until 18 May 2025

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions