Adults With Cerebral Palsy Face Depression, Anxiety Risks

Adults with cerebral palsy had increased risks of depression and anxiety, a retrospective longitudinal U.K. study found.

The association was driven largely by people who had cerebral palsy without intellectual disability, reported Kimberley Smith, PhD, of the University of Surrey in Guildford, England, and co-authors in JAMA Neurology.

Over approximately 6 years of follow-up, 18.3% of people with cerebral palsy had a new event of depression and 15.3% had a new event of anxiety. Compared with the matched reference group, cerebral palsy patients showed an increased adjusted hazard of depression (HR 1.28, 95% CI 1.09-1.51) and anxiety (HR 1.40, 95%CI 1.21-1.63), after controlling for other chronic conditions and number of general practitioner visits.

When they stratified the data, only cerebral palsy patients with no comorbid intellectual disability had a higher risk of incident depression (HR 1.44, 95% CI 1.20-1.72) and anxiety (HR 1.55, 95% CI 1.28-1.87) than matched controls.

Adults with cerebral palsy increasingly are living into later adulthood, observed Robert Fortuna, MD, MPH, of the University of Rochester in Rochester, New York, who has studied the health of people with cerebral palsy in the U.S.

“Health conditions in adults with cerebral palsy and other developmental disabilities frequently go undetected,” Fortuna told MedPage Today. “Depression and anxiety are potentially treatable and treatment may lead to improved quality of life, health, and physical functioning in adults with cerebral palsy.”

It’s important to recognize that cerebral palsy represents a broad spectrum of conditions, he added: “Depending on the underlying cause and level of cognitive function, mood disorders may present differently.”

In this study, Smith and her group analyzed data from the Clinical Practice Research Datalink primary care database, a collection of consultation data from general practices throughout the U.K. from 1987 to 2015. Using diagnostic codes, the researchers identified 1,705 patients with cerebral palsy and matched each one to three controls without cerebral palsy (n=5,115) by age, sex, and practice visited as an indicator of area-level socioeconomic status.

The mean age of the sample was about 33, and 46.8% were women. Overall, people with cerebral palsy saw their physician more often and had higher frequencies of epilepsy and pain conditions than controls.

In the cerebral palsy cohort, the researchers identified 363 patients with comorbid intellectual disability and 1,342 patients with no comorbid intellectual disability.

Other research has found that these adults have a relatively high prevalence of depression and anxiety. “We add to this by showing that the risk of depression and anxiety is higher only in people with cerebral palsy who do not have comorbid intellectual disability when compared with age-, sex- and practice-matched controls,” Smith said. “Adults with cerebral palsy and comorbid intellectual disability did not actually have a greater risk of depression or anxiety when compared with matched controls.”

“This is the first study that has ever been done looking at the risk of depression and anxiety over time in adults with cerebral palsy,” Smith told MedPage Today. “There is a lack of knowledge about how aging with cerebral palsy affects people, as traditionally it is considered a pediatric condition.”

Cerebral palsy is a lifelong condition with most children living into adulthood, depending on the severity of cerebral palsy and its associated physical comorbidities, she noted.

More work is needed to understand how depression and anxiety are entwined with cerebral palsy, Smith said. “People with cerebral palsy face unique challenges as they age which could be linked with this increased risk of developing anxiety and depression,” she pointed out. “This study has allowed us to define the issue; the next step will be to better understand why it happens so we can develop targeted mental health interventions for this population.”

The researchers reported several limitations to their study. It relied on diagnostic codes to define outcomes, and associations may be underestimated if depression and anxiety were underdiagnosed. In addition, the term cerebral palsy incorporated heterogeneous etiologies; the researchers could not take into account the severity of gross motor function, communication, fatigue, and other potential differences among patients.