Socioemotional and behavioural difficulties in children with chronic physical conditions: analysis of the Longitudinal Study of Australian Children

Impact of play restriction during the COVID-19 pandemic on mental well-being in children with a chronic condition

This study is to investigate the effects of social restrictions, induced by the COVID-19 pandemic, on play behavior, and the associations with mental well-being in children with a chronic physical condition. Additionally, we explored potential moderating effects of environmental factors. Data from the PROactive cohort study including children with a chronic physical condition was used. Play behavior was measured with a self-developed questionnaire distributed during the pandemic with questions concerning behavior before and during the pandemic (with whom they most often played, where, and how many days/week (face-to-face and online)). Mental well-being, including life satisfaction, quality of life, and internalizing symptoms were assessed during the pandemic. Analyses were performed separately for the ages 8-12 years and 13-18 years. Differences in play behavior were analyzed with McNemar's and Wilcoxon signed-rank tests. Linear regression analyses were used to analyse associations between play behavior and mental well-being. P-values were adjusted for false discovery rate. Interaction terms were added with several environmental factors, to explore potential moderating effects. In total, 756 participants (8-12 years: n = 261; 13-18 years: n = 495) were included in this study. Differences in play behavior between pre-pandemic and during the pandemic were observed. With whom they mostly played (friends/family members), compared to playing alone, was related to mental well-being in both age groups. Moreover, for children between 13 and 18 years playing outside was positively associated with life satisfaction and negatively related to internalizing symptoms. Experiencing a negative influence of the pandemic on leisure time, social support, and distress of the child are potential moderators.

CONCLUSIONS

The COVID-19 pandemic induced changes in play behavior. During the pandemic, mainly not playing alone, but with friends or family members, and for older children playing outside, was related to better mental well-being in children with a chronic physical condition.

WHAT IS KNOWN

• Children with a chronic physical condition are at risk for developing social and emotional problems, that include depressive symptoms, anxiety, aggression, physical impairment and problems in academic and social functioning. These problems may be related to limitations in play activities these children are thought to experience. However, there is limited empirical data to relate limitations in play and mental well-being in these children.

WHAT IS NEW

• The COVID-19 pandemic presented an opportunity to investigate alterations in play behavior in relation with mental well-being among children with a chronic physical condition. Based on data from the PROactive cohort, including data for children with a chronic condition, we determined the impact of the pandemic on play in these children and related it to their mental well-being. Our data emphasize the importance of play, and particular playing with others, for mental-well-being and may facilitate prevention strategies for children growing up with a chronic condition.

Changing contexts of child health: an assessment of unmet physical, psychological and social needs of children with common chronic childhood illness

BACKGROUND

We assessed the biopsychosocial needs and key health drivers among children living with a common chronic illness, as baseline for a cluster randomised controlled trial of a child health system strengthening intervention.

METHODS

Cross-sectional data were analysed from a large population sample of children from South London with asthma, eczema or constipation, as exemplar tracer conditions of a new integrated care service. Descriptive and regression analyses, accounting for sociodemographic factors, investigated social needs, psychosocial outcomes and quality of life associated with poor symptom control.

RESULTS

Among 7779 children, 4371 children (56%) had at least one uncontrolled physical health condition. Across the three domains of physical health, mental health and social needs, 77.5% of children (n=4304 of 5554) aged 4-15 years had at least one unmet need, while 16.3% of children had three unmet needs. Children from the most socioeconomically disadvantaged quintile had a 20% increased risk of at least one poorly controlled physical condition (risk ratio (RR)=1.20, 95% CI: 1.11 to 1.31, p<0.001) compared with those from the least disadvantaged quintile. There was an 85% increased risk of clinically important mental health needs among children with uncontrolled asthma (RR=1.85, 95% CI: 1.65 to 2.07, p<0.001), 57% for active constipation (RR=1.57, 95% CI: 1.12 to 2.20, p<0.01) and 39% for uncontrolled eczema (RR=1.39, 95% CI: 1.24 to 1.56, p<0.001). Health-related quality of life was associated with poor symptom control.

CONCLUSIONS

There is a large burden of unmet biopsychosocial needs among children with chronic illness, signalling an urgent need for prevention, early intervention and integrated biopsychosocial care.