Sarah Carsley1,2,3, Karen Tu1,4,5, Patricia C Parkin1,2,6, Eleanor Pullenayegum2, Catherine S Birken7,8,9. 1. Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 2. Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, the Hospital for Sick Children, Toronto, Canada. 3. Institute for Clinical Evaluative Sciences, Toronto, Canada. 4. Department of Family and Community Medicine, University of Toronto, Toronto, Canada. 5. Toronto Western Hospital Family Health Team, University Health Network, Toronto, Canada. 6. Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Canada. 7. Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. catherine.birken@sickkids.ca. 8. Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, the Hospital for Sick Children, Toronto, Canada. catherine.birken@sickkids.ca. 9. Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Canada. catherine.birken@sickkids.ca.
Abstract
OBJECTIVE: To determine if overweight or obesity in preschool-age children is associated with mental health service utilization in later childhood. SUBJECTS: Overall, 10,522 children 2 to <5 years, with no previous history of mental health service utilization, were identified from primary care electronic medical records (EMRs) across Ontario, Canada. METHODS: This was a retrospective longitudinal cohort study. Height and weight data were extracted and body mass index z-scores (zBMI) were calculated using the World Health Organization Growth Standards. Mental health service utilization, between ages 5 and <19, was defined using administrative billing codes for mental health outpatient visits, emergency department visits, and hospitalizations. A multivariable Cox proportional hazards model was performed. RESULTS: In total, 74.9% of children were healthy weight (zBMI between -2 and ≤1), 18.8% of children were at risk of overweight (zBMI between 1 and ≤2), 4.9% were overweight (zBMI > 2 and ≤3), and 1.5% had obesity (zBMI > 3). The median follow-up time was 2.2 years (IQR 1.0-4.2). The overall incidence rate of mental health service use was 44.5 events per 1000 person-years. The hazard ratio for girls with obesity was 2.73 (95% CI 1.62-4.60; p < 0.001) compared to girls with healthy weight. Compared to boys with healthy weight, boys 'at risk of overweight' and overweight were 1.22 (95% CI 1.03-1.44; p = 0.02) and 1.43 (95% CI 1.09-1.87; p = 0.01) times at higher risk of an incident mental health visit. CONCLUSION: Our study shows an association between weight status in preschool school aged children and higher incidence of mental health service use in later childhood. This relationship was strongest in girls. Future research is needed to understand this relationship by mental health diagnosis, sex, and age.
OBJECTIVE: To determine if overweight or obesity in preschool-age children is associated with mental health service utilization in later childhood. SUBJECTS: Overall, 10,522 children 2 to <5 years, with no previous history of mental health service utilization, were identified from primary care electronic medical records (EMRs) across Ontario, Canada. METHODS: This was a retrospective longitudinal cohort study. Height and weight data were extracted and body mass index z-scores (zBMI) were calculated using the World Health Organization Growth Standards. Mental health service utilization, between ages 5 and <19, was defined using administrative billing codes for mental health outpatient visits, emergency department visits, and hospitalizations. A multivariable Cox proportional hazards model was performed. RESULTS: In total, 74.9% of children were healthy weight (zBMI between -2 and ≤1), 18.8% of children were at risk of overweight (zBMI between 1 and ≤2), 4.9% were overweight (zBMI > 2 and ≤3), and 1.5% had obesity (zBMI > 3). The median follow-up time was 2.2 years (IQR 1.0-4.2). The overall incidence rate of mental health service use was 44.5 events per 1000 person-years. The hazard ratio for girls with obesity was 2.73 (95% CI 1.62-4.60; p < 0.001) compared to girls with healthy weight. Compared to boys with healthy weight, boys 'at risk of overweight' and overweight were 1.22 (95% CI 1.03-1.44; p = 0.02) and 1.43 (95% CI 1.09-1.87; p = 0.01) times at higher risk of an incident mental health visit. CONCLUSION: Our study shows an association between weight status in preschool school aged children and higher incidence of mental health service use in later childhood. This relationship was strongest in girls. Future research is needed to understand this relationship by mental health diagnosis, sex, and age.
Authors: Catherine S Birken; Jessica A Omand; Kim M Nurse; Cornelia M Borkhoff; Christine Koroshegyi; Gerald Lebovic; Jonathon L Maguire; Muhammad Mamdani; Patricia C Parkin; Janis Randall Simpson; Mark S Tremblay; Eric Duku; Caroline Reid-Westoby; Magdalena Janus Journal: BMJ Open Date: 2019-11-19 Impact factor: 2.692
Authors: Bradley C Johnston; Roah Merdad; Diana Sherifali; Maryam Kebbe; Catherine S Birken; Annick Buchholz; Long Ge; Nicole D Gehring; Stasia Hadjiyannakis; Jill Hamilton; Dawn Hatanaka; Mélanie Henderson; Tracy Lebel; Sarah A Moore; Katherine M Morrison; Ximena Ramos Salas; Meghan Sebastianski; Ian S Zenlea; Geoff D C Ball Journal: CMAJ Open Date: 2022-03-01
Authors: Laura M Kinlin; Stephan M Oreskovich; Raluca Dubrowski; Geoff D C Ball; Melanie Barwick; Elizabeth Dettmer; Jess Haines; Jill Hamilton; Theresa H M Kim; Marie Klaassen; Paola Luca; Jonathon L Maguire; Myla E Moretti; Elaine Stasiulis; Alene Toulany; Catherine S Birken Journal: Child Obes Date: 2022-01-26 Impact factor: 2.867
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