Mental health, health related quality of life and recurrent musculoskeletal pain in children with cerebral palsy 8–18 years old

Abstract

Purpose: To extend knowledge on mental health with children’s self-report and explore mental health and health related quality of life (HRQL) in a context of recurrent musculoskeletal pain in cerebral palsy (CP). Method: Eighty-three participants, mean age 14.2 ± 2.8 years, were assessed with clinical examination, interview and questionnaires. Gross motor function was GMFCS level I 42%, level II 42%, level III 12% and level IV–V 5%. Children self-reported mental health on SDQ (Strengths and Difficulty Questionnaire), HRQL on PedsQL (Pediatric Quality of Life), and pain on CHQ (Child Health Questionnaire). Mothers proxy-reported on the same questionnaires and reported own mental health on GHQ (General Health Questionnaire). Results: Both self-reported mental health and HRQL was better than proxy-reported. Recurrent musculoskeletal pain was associated with more mental health problems and reduced HRQL in self-reports, but not in proxy-reports. Conclusions: In CP, the importance of child-report on mental health and HRQL when possible, in addition to parent proxy-report, cannot be overstated. Close co-operation between (re)habilitation and child psychiatry is urgent. Further research on self-reported mental health and impact of mental health problems is warranted together with a focus on the impact of recurrent musculoskeletal pain on participation.

Implications for Rehabilitation

• Children with cerebral palsy experience musculoskeletal pain that is associated with more self-reported mental health problems and lower HRQL.

• Because mothers tend to not recognise these associations, self-report (when possible) is essential.

• A bio-psycho-social perspective in both individual and family approach is important because of the associations mentioned and because parents report that their children have a high prevalence of mental health problems.

• Assessment of HRQL has the potential to capture both pain and mental health problems, and should be an integrated part of the systematic clinical follow-up.

Keywords::

• Child
• cerebral palsy
• HRQL
• mental health
• pain

Acknowledgements

Thanks to the participating children and parents for generously sharing their time and experiences and to the Norwegian Cerebral Palsy Association for inspiration and advertising.

Declaration of Interest: The authors report no declarations of interest. The organisation “Exrastiftelsen” has partly founded the corresponding author. Neither the Cerebral Palsy Association nor Extrastiftelsen have been involved in study design, data collection, data analyses, and manuscript preparation or publication decisions.