Rachel Sewell1, Cindy L Buchanan2, Shanlee Davis3, Dimitri A Christakis4, Amanda Dempsey5, Anna Furniss6, Anne E Kazak7, Anna J Kerlek8, Brianna Magnusen9, Nathan M Pajor10, Laura Pyle3, Louise C Pyle11, Hanieh Razzaghi12, Beth I Schwartz13, Maria G Vogiatzi14, Natalie J Nokoff15. 1. Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO. 2. Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO. 3. Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO. 4. Seattle Children's Research Institute, Center for Child Health, Behavior & Development, Seattle, WA. 5. Merck and Co., Kenilworth, NJ. 6. University of Colorado Anschutz Medical Campus, Adult & Child Consortium for Health Outcomes Research & Delivery, Aurora, CO. 7. Nemours Children's Health, Department of Pediatrics, Center for Healthcare Delivery Science and Thomas Jefferson University, Wilmington, DE. 8. Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, Columbus, OH. 9. Nationwide Children's Hospital, Institute for Informatics, Columbus, OH. 10. Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine and University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH. 11. Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 12. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 13. Nemours Children's Health, Department of Pediatrics and Thomas Jefferson University, Department of Obstetrics and Gynecology, Wilmington, DE. 14. Division of Endocrinology and Diabetes, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 15. Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address: Natalie.Nokoff@childrenscolorado.org.
Abstract
OBJECTIVE: To evaluate the odds of a behavioral health diagnosis among youth with differences of sex development (DSD) or congenital adrenal hyperplasia (CAH) compared with matched controls in the PEDSnet database. STUDY DESIGN: All youth with a diagnosis of DSD (n = 1216) or CAH (n = 1647) and at least 1 outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables (1:4) with controls (n = 4864 and 6588, respectively) using multivariable logistic regression. The likelihood of having behavioral health diagnoses was examined using generalized estimating equations. RESULTS: Youth with DSD had higher odds of a behavioral health diagnosis (OR, 1.7; 95% CI, 1.4-2.1; P < .0001) and neurodevelopmental diagnosis (OR, 1.7; 95% CI, 1.4, 2.0; P < .0001) compared with matched controls. Youth with CAH did not have an increased odds of a behavioral health diagnosis (OR, 1.0; 95% CI, 0.9, 1.1; P = .9) compared with matched controls but did have higher odds of developmental delay (OR, 1.8; 95% CI, 1.4, 2.4; P < .0001). CONCLUSIONS: Youth with DSD diagnosis have higher odds of a behavioral health or neurodevelopmental diagnosis compared with matched controls. Youth with CAH have higher odds of developmental delay, highlighting the need for screening in both groups.
OBJECTIVE: To evaluate the odds of a behavioral health diagnosis among youth with differences of sex development (DSD) or congenital adrenal hyperplasia (CAH) compared with matched controls in the PEDSnet database. STUDY DESIGN: All youth with a diagnosis of DSD (n = 1216) or CAH (n = 1647) and at least 1 outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables (1:4) with controls (n = 4864 and 6588, respectively) using multivariable logistic regression. The likelihood of having behavioral health diagnoses was examined using generalized estimating equations. RESULTS: Youth with DSD had higher odds of a behavioral health diagnosis (OR, 1.7; 95% CI, 1.4-2.1; P < .0001) and neurodevelopmental diagnosis (OR, 1.7; 95% CI, 1.4, 2.0; P < .0001) compared with matched controls. Youth with CAH did not have an increased odds of a behavioral health diagnosis (OR, 1.0; 95% CI, 0.9, 1.1; P = .9) compared with matched controls but did have higher odds of developmental delay (OR, 1.8; 95% CI, 1.4, 2.4; P < .0001). CONCLUSIONS: Youth with DSD diagnosis have higher odds of a behavioral health or neurodevelopmental diagnosis compared with matched controls. Youth with CAH have higher odds of developmental delay, highlighting the need for screening in both groups.
Keywords:
anxiety; congenital adrenal hyperplasia; depression; developmental delay; difference of sex development; disorder of sex development; intellectual disability; neurodevelopmental; psychiatric