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Medical and Psychiatric Comorbidity and Health Care Use Among Children 6 to 17 Years Old
Donald W. Spady, MD;
Donald P. Schopflocher, PhD;
Lawrence W. Svenson;
Angus H. Thompson, PhD
Arch Pediatr Adolesc Med. 2005;159:231-237.
Background The association of psychiatric disorders (PDs) with other PDs and medical disorders (MDs) has been insufficiently explored in children and adolescents.
Objectives To estimate medical and psychiatric comorbidity present in children with PDs and to determine the medical service usage of children with PDs.
Design We use administrative health care data to describe the health care provided for study children. Psychiatric disorders were classified into the following 3 categories: psychosis, emotion, and behavior. We used logistic regression to assess medical comorbidity for each category. Psychiatric comorbidity was determined using  2 test analysis. Health care use was determined by comparing the frequency of visits for MDs and PDs between children with PDs and children without PDs.
Setting We studied 406 640 children (50.6% male) between 6 and 17 years old, living in Alberta, Canada, during the fiscal year April 1, 1995, through March 31, 1996.
Results A PD was diagnosed in 32 214 (60.3% male) children. Psychiatric comorbidity was present in 13.6% of the children; comorbidity existed in all 3 psychiatric groups and peaked in postpubertal children. More girls than boys had significant medical comorbidity. Significant odds ratios (ORs) for girls varied from 1.2 (behavior and sinusitis, bronchitis, and chronic disorders; psychosis, and menstrual problems) to 15.3 (behavior and developmental delay). Among boys, the highest OR was seen with the combination of behavior and developmental delay (OR, 8.3) and psychosis and poisoning (OR, 8.2). With ORs ranging from 4.6 to 15.3, developmental delay consistently had high ORs for both sexes and all 3 types of PDs. Poisoning also had high ORs (3.3-14.1) with all 3 PDs and both sexes. Among girls, disorders associated with pregnancy and the genitourinary system had modest associations (OR, 1.9-2.2, for behavior) to moderate (OR, 2.5-4.0, for emotion). Children with PDs had significantly greater medical service usage than did children without PDs. Girls had greater medical health care usage than boys. Psychiatric service usage was similar for both sexes.
Conclusions Medical and psychiatric comorbidity exist in children with PDs. Girls are more commonly affected. Health care usage is higher in children with PDs.
Author Affiliations: Departments of Pediatrics (Dr Spady) and Psychiatry (Dr Thompson) and Public Health Sciences (Drs Spady and Thompson), University of Alberta; and the Health Surveillance Branch, Alberta Health and Wellness, Government of Alberta (Dr Schopflocher and Mr Svenson), Edmonton.
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