Mental health and substance use disorders in young adults with spina bifida

Bao Y. SciscentDepartment of Neurosurgery, Penn State Health, Hershey, Pennsylvania

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David R. HallanDepartment of Neurosurgery, Penn State Health, Hershey, Pennsylvania

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Elias B. RizkDepartment of Neurosurgery, Penn State Health, Hershey, Pennsylvania

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OBJECTIVE

Although medical advances have allowed most patients with spina bifida (SB) to survive into adulthood, these patients may have physical impairments, urological complications, infections, and neurocognitive deficits. These factors can cause psychological distress and impact the transition from pediatric to adult care. There remains limited research on mental health disorders (MHDs) and substance use disorders (SUDs) in SB patients during this vulnerable transition period. This study aimed to investigate the 10-year incidence of MHDs and SUDs in 18- to 25-year-old patients with SB.

METHODS

TriNetX, a federated de-identified database, was retrospectively queried to identify 18- to 25-year-old patients with SB. The presence of MHDs and SUDs based on ICD-10 codes in SB patients (cohort 1) was analyzed and compared with those of patients without SB (cohort 2). Subgroup analysis was performed on SB patients with hydrocephalus and neurogenic bladder (NB). SB patients were further compared to patients with a spinal cord injury (SCI).

RESULTS

After propensity score matching, the authors identified 1494 patients in each cohort. SB patients were more likely to have depression (OR 1.949, 95% CI 1.64–2.317), anxiety (OR 1.603, 95% CI 1.359–1.891), somatoform disorders (OR 2.102, 95% CI 1.052–4.199), and suicidal ideations or attempts and self-harm (OR 1.424, 95% CI 1.014–1.999). The prevalence of attention-deficit/hyperactivity disorder (ADHD) and eating disorders were comparable between cohorts. SB patients also had increased rates of nicotine dependence (OR 1.546, 95% CI 1.22–1.959) but not of alcohol or opioid disorders. In SB patients, the presence of hydrocephalus and NB was not associated with significantly increased rates of any measured MHDs or SUDs. When compared with SCI patients, SB patients were more likely to have anxiety (OR 1.377, 95% CI 1.028–1.845) and ADHD (OR 1.875, 95% CI 1.084–3.242). However, SB patients had lower rates of nicotine dependence (OR 0.682, 95% CI 0.482–0.963) and opioid-related disorders (OR 0.434, 95% CI 0.223–0.845). SB and SCI patients shared similar rates of depression, suicidal ideations or attempts and self-harm, and alcohol-related disorders.

CONCLUSIONS

Young adults with SB have higher prevalence rates of MHDs and SUDs compared with the general population. Therefore, incorporation of mental health and substance use management is critical to facilitate transition to adulthood.

ABBREVIATIONS

ADHD = attention-deficit/hyperactivity disorder; HCO = healthcare organization; MHD = mental health disorder; NB = neurogenic bladder; SB = spina bifida; SCI = spinal cord injury; SUD = substance use disorder.
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  • 1

    Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA. Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 2001;34(3):114120.

  • 2

    Padua L, Rendeli C, Rabini A, Girardi E, Tonali P, Salvaggio E. Health-related quality of life and disability in young patients with spina bifida. Arch Phys Med Rehabil. 2002;83(10):13841388.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Oakeshott P, Reid F, Poulton A, Markus H, Whitaker RH, Hunt GM. Neurological level at birth predicts survival to the mid-40s and urological deaths in open spina bifida: a complete prospective cohort study. Dev Med Child Neurol. 2015;57(7):634638.

    • Search Google Scholar
    • Export Citation
  • 4

    Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. 2021;8(5):416427.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Taquet M, Husain M, Geddes JR, Luciano S, Harrison PJ. Cerebral venous thrombosis and portal vein thrombosis: a retrospective cohort study of 537,913 COVID-19 cases. EClinicalMedicine. 2021;39:101061.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Raiker R, DeYoung C, Pakhchanian H, et al. Outcomes of COVID-19 in patients with rheumatoid arthritis: a multicenter research network study in the United States. Semin Arthritis Rheum. 2021;51(5):10571066.

    • Search Google Scholar
    • Export Citation
  • 7

    Topaloglu U, Palchuk MB. Using a federated network of real-world data to optimize clinical trials operations. JCO Clin Cancer Inform. 2018;2:110.

  • 8

    Murray CB, Holmbeck GN, Ros AM, Flores DM, Mir SA, Varni JW. A longitudinal examination of health-related quality of life in children and adolescents with spina bifida. J Pediatr Psychol. 2015;40(4):419430.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Rofail D, Maguire L, Kissner M, Colligs A, Abetz-Webb L. Health-related quality of life is compromised in individuals with spina bifida: results from qualitative and quantitative studies. Eur J Obstet Gynecol Reprod Biol. 2014;181:214222.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Shepard CL, Doerge EJ, Eickmeyer AB, Kraft KH, Wan J, Stoffel JT. Ambulatory care use among patients with spina bifida: change in care from childhood to adulthood. J Urol. 2018;199(4):10501055.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Showen A, Copp HL, Allen IE, Baradaran N, Liaw A, Hampson LA. Characteristics associated with depression, anxiety, and social isolation in adults with spina bifida. Urology. 2021;149:255262.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Appleton PL, Ellis NC, Minchom PE, Lawson V, Böll V, Jones P. Depressive symptoms and self-concept in young people with spina bifida. J Pediatr Psychol. 1997;22(5):707722.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Bellin MH, Zabel TA, Dicianno BE, et al. Correlates of depressive and anxiety symptoms in young adults with spina bifida. J Pediatr Psychol. 2010;35(7):778789.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Goodwin RD, Weinberger AH, Kim JH, Wu M, Galea S. Trends in anxiety among adults in the United States, 2008–2018: rapid increases among young adults. J Psychiatr Res. 2020;130:441446.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Verhoef M, Lurvink M, Barf HA, et al. High prevalence of incontinence among young adults with spina bifida: description, prediction and problem perception. Spinal Cord. 2005;43(6):331340.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Elmer T, Stadtfeld C. Depressive symptoms are associated with social isolation in face-to-face interaction networks. Sci Rep. 2020;10(1):1444.

  • 17

    Braaf S, Lennox A, Nunn A, Gabbe B. Social activity and relationship changes experienced by people with bowel and bladder dysfunction following spinal cord injury. Spinal Cord. 2017;55(7):679686.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Lee NG, Andrews E, Rosoklija I, et al. The effect of spinal cord level on sexual function in the spina bifida population. J Pediatr Urol. 2015;11(3):142.e1142.e6.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Streur CS, Corona L, Smith JE, Lin M, Wiener JS, Wittmann DA. Sexual function of men and women with spina bifida: a scoping literature review. Sex Med Rev. 2021;9(2):244266.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Kritikos TK, Smith K, Holmbeck GN. Mental health guidelines for the care of people with spina bifida. J Pediatr Rehabil Med. 2020;13(4):525534.

  • 21

    Kelly NC, Ammerman RT, Rausch JR, et al. Executive functioning and psychological adjustment in children and youth with spina bifida. Child Neuropsychol. 2012;18(5):417431.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Wasserman RM, Stoner AM, Stern A, Holmbeck GN. ADHD and attention problems in children with and without spina bifida. Top Spinal Cord Inj Rehabil. 2016;22(4):253259.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Bramham J, Murphy DG, Xenitidis K, Asherson P, Hopkin G, Young S. Adults with attention deficit hyperactivity disorder: an investigation of age-related differences in behavioural symptoms, neuropsychological function and co-morbidity. Psychol Med. 2012;42(10):22252234.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Hampton LE, Fletcher JM, Cirino PT, et al. Hydrocephalus status in spina bifida: an evaluation of variations in neuropsychological outcomes. J Neurosurg Pediatr. 2011;8(3):289298.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Foss S, Flanders TM, Heuer GG, Schreiber JE. Neurobehavioral outcomes in patients with myelomeningocele. Neurosurg Focus. 2019;47(4):E6.

  • 26

    Sareen J, Cox BJ, Afifi TO, et al. Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Arch Gen Psychiatry. 2005;62(11):12491257.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Wang YJ, Li X, Ng CH, Xu DW, Hu S, Yuan TF. Risk factors for non-suicidal self-injury (NSSI) in adolescents: a meta-analysis. EClinicalMedicine. 2022;46:101350.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Singhal A, Ross J, Seminog O, Hawton K, Goldacre MJ. Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage. J R Soc Med. 2014;107(5):194204.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Janssens KA, Rosmalen JG, Ormel J, van Oort FV, Oldehinkel AJ. Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: the TRAILS study. J Child Psychol Psychiatry. 2010;51(3):304312.

    • Search Google Scholar
    • Export Citation
  • 30

    Dersh J, Gatchel RJ, Polatin P. Chronic spinal disorders and psychopathology. research findings and theoretical considerations. Spine J. 2001;1(2):8894.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Buffart LM, Roebroeck ME, Rol M, Stam HJ, van den Berg-Emons RJ. Triad of physical activity, aerobic fitness and obesity in adolescents and young adults with myelomeningocele. J Rehabil Med. 2008;40(1):7075.

    • Search Google Scholar
    • Export Citation
  • 32

    Dosa NP, Foley JT, Eckrich M, Woodall-Ruff D, Liptak GS. Obesity across the lifespan among persons with spina bifida. Disabil Rehabil. 2009;31(11):914920.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Stiles-Shields C, Holmbeck GN. Health behaviors and disordered eating in adolescents and young adults with spina bifida: results from a national survey. Disabil Rehabil. 2020;42(20):29102916.

    • Search Google Scholar
    • Export Citation
  • 34

    Chaudhary MA, Schoenfeld AJ, Harlow AF, et al. Incidence and predictors of opioid prescription at discharge after traumatic injury. JAMA Surg. 2017;152(10):930936.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    DiPiro ND, Murday D, Corley EH, DiPiro TV, Krause JS. Opioid use among individuals with spinal cord injury: prevalence estimates based on state prescription drug monitoring program data. Arch Phys Med Rehabil. 2021;102(5):828834.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Saunders LL, Krause JS, Carpenter MJ, Saladin M. Risk behaviors related to cigarette smoking among persons with spinal cord injury. Nicotine Tob Res. 2014;16(2):224230.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Fergusson DM, Lynskey MT, Horwood LJ. Comorbidity between depressive disorders and nicotine dependence in a cohort of 16-year-olds. Arch Gen Psychiatry. 1996;53(11):10431047.

    • Search Google Scholar
    • Export Citation
  • 38

    McKenzie M, Olsson CA, Jorm AF, Romaniuk H, Patton GC. Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood: findings from a 10-year longitudinal study. Addiction. 2010;105(9):16521659.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Murray CB, Lennon JM, Devine KA, Holmbeck GN, Klages K, Potthoff LM. The influence of social adjustment on normative and risky health behaviors in emerging adults with spina bifida. Health Psychol. 2014;33(10):11531163.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Soe MM, Swanson ME, Bolen JC, Thibadeau JK, Johnson N. Health risk behaviors among young adults with spina bifida. Dev Med Child Neurol. 2012;54(11):10571064.

    • PubMed
    • Search Google Scholar
    • Export Citation

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