PEDIATRICS Vol. 91 No. 6 June 1993, pp. 1131-1136
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Long-term Psychosocial Sequelae of Chronic Physical Disorders in Childhood

Ivan B. Pless CM, MD, FRCP(C)1, Christine Power PhD2, and Catherine S. Peckham MD, FRCP2

1 From the Departments of Pediatrics and Epidemiology, McGill University, Montreal, Quebec, Canada
2 From the Division of Public Health, Epidemiology, and Biostatistics, Institute of Child Health, London, England

Objective. This study was designed to examine the long-term psychosocial sequelae of chronic physical disorders that begin during childhood.

Design. We analyzed data from a national birth cohort. 12 537 children were followed until age 23 years—76% of all born in Britain during one week in 1958. Of these, 1667 had a chronic disorder before age 16 and 1279 were included in the 23-year follow-up.

Measures. Outcome measures included self-reported psychological disturbances between ages 16 and 23, scores on the Malaise Inventory, social class, educational qualifications, unemployment, and social activities.

Results. The total cumulative incidence rate before 16 years was 109.5 per 1000. Demographic comparisons showed that the group with chronic physical disorders was similar to those free of chronic disorders in all respects except the sex ratio. Men with chronic physical disorders had significantly higher relative risks for abnormal scores on the Malaise Inventory (1.52, confidence interval [C]]1.13, 2.05); specialist psychological care (1.43, CI 1.00, 2.03); poor educational qualifications (1.26, CI 1.08, 1.47); periods of unemployment (1.20, CI 1.03, 1.41); and less social drinking (1.36, CI 1.15, 1.60). In contrast, women only had a significantly elevated risk for having seen a mental health specialist (1.32, CI 1.02, 1.71). Among the men some of the risks were further elevated for those in specific diagnostic groups. These findings are examined in the light of postulates about the impact of chronic physical disorders as a whole and in an attempt to explain the striking sex differences. For clinicians they provide further reason to justify concern about the psychosocial aspects of care for children with chronic disorders.

Key Words: chronic physical disorders • psychosocial sequelae • longitudinal analyses

Submitted on June 12, 1992
Accepted on January 7, 1993




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