A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Cerebral palsy (CP) is the most common physical disability in children. CP is caused by brain damage early in life that affects muscle coordination. People with CP may have lifelong challenges with movement, communication, and health. Up to half of people with CP also have other disabilities such as intellectual disability (ID), autism, or epilepsy. In addition, adults with CP may also experience other physical and mental health conditions at higher rates than adults without CP. In a recent NIDILRR-funded study, researchers looked at data showing the rates of mental health diagnoses among a large sample of adults with and without CP. They wanted to find out if higher percentages of adults with CP were diagnosed with mental health disorders than adults without CP. They also wanted to find out if these mental health disorders were more commonly diagnosed in adults with CP who also had other disabilities compared to adults with CP alone.

Researchers at the Rehabilitation Research and Training Center (RRTC) on Promoting Healthy Aging for People with Long-Term Physical Disabilities looked at data from the Optum Clinformatics Data Mart, a large insurance claims database. The researchers looked at diagnosis data from 8.7 million adults who received insurance coverage for a doctor’s appointment, hospital visit, or emergency room visit in 2016. Based on diagnosis codes, the researchers determined which of the adults had CP, and whether they had CP alone or CP along with ID, autism, or epilepsy. The researchers then compared the percentages of both men and women with CP alone, CP plus another disability, and no CP who had been diagnosed with six types of mental health disorders: schizophrenia/psychosis; mood disorders such as depression or bipolar disorder; anxiety disorders; disorders with a physical component such as eating, sleep, and sexual disorders; personality disorders; and substance use disorders.

The researchers found that about a third of the adults with CP also had ID, autism, and/or epilepsy. When they looked at the rates of mental health disorders, they found that the adults with CP had higher overall rates of each type of mental health disorder, except disorders with a physical component, compared to the adults without CP. When the researchers looked at men and women separately, they found the following results:

• Men with CP had four times the rates of schizophrenia/psychosis and personality disorders compared to men without CP, and about twice the rate of mood and anxiety disorders compared to men without CP.
• Women with CP also had five times the rates of schizophrenia/psychosis and personality disorders, and three times the rate of mood and anxiety disorders, compared to women without CP.
• Rates for disorders with a physical component (sleep, eating, or sexual) were about the same between all groups.

When the researchers compared adults with CP alone and adults with CP plus another disability, they found that some of the rates varied:

• Both men and women with CP plus another disability had higher rates of schizophrenia/psychosis and personality disorders than men and women with CP alone.
• Men and women with CP plus another disability had lower rates of substance use disorders than men and women with CP alone.

The authors noted that the data for this study came from adults who all had private insurance coverage. Adults with CP who have private insurance may be healthier overall than the full population of adults with CP, many of whom receive public insurance such as Medicaid, due to unemployment or multiple medical conditions. Adults with CP who receive public health insurance may have even higher rates of additional disabilities and mental health disorders than what was found in this study. Future research may be useful to examine any associations between the severity of CP and the prevalence of mental health disorders.

The authors noted that prompt diagnosis and treatment of mental health disorders may improve the quality of life for many adults with CP. Physicians may wish to develop mental health screening and referral programs to coordinate effective services for their patients with CP.

To Learn More

Adults aging with physical disabilities such as CP are at higher risk for some mood disorders than older adults without disabilities. Learn more about depression and aging with physical disabilities, and ways to cope, in this factsheet from the Rehabilitation Research and Training Center on Aging with Long-Term Physical Disabilities.

The NIDILRR-funded Center for Health and Self-Directed Recovery offers a Solutions Suite, featuring evidence-based resources to support people with mental health conditions in managing their self-directed recovery and maintain their overall health and wellness.

To Learn More About this Study

Whitney, D.G., et al (2019) Prevalence of mental health disorders among adults with cerebral palsy: A cross-sectional analysis. Annals of Internal Medicine, 2019. This article is available from the NARIC collection under Accession Number J81798.