Health Functioning Moderates the Association Between Chronic Conditions and Mental Illness in Childhood.

The survey was done at a single point in time, so it cannot show whether chronic conditions lead to mental illness, whether mental illness worsens health, or both. Mental illness was a parent-completed symptom checklist over the previous six months rather than a diagnostic assessment, and the children themselves were not the reporters. Data were collected before the COVID-19 pandemic, so the current burden of combined physical and mental health problems may be underestimated. Autism spectrum disorder and learning disabilities were not on the condition checklist, so this study says nothing about them. Children living on Indigenous reserves and in collective dwellings such as welfare or justice settings were excluded. The authors describe these as potentially high-risk groups and say the findings cannot be generalised to them. Only about half of the households approached took part, and children with higher health functioning were somewhat more likely to have missing mental illness data, which could affect the health functioning results. The authors state that their explanation for why the chronic condition link showed up only in children with better health functioning is speculative and would need longitudinal studies. The mediation analysis of family functioning was labelled exploratory and not part of the main question.

The first author received an Ontario Graduate Scholarship and a University of Waterloo President's Scholarship to support the manuscript. The senior author holds the Canada Research Chair in Youth Mental Health and is an Associate Editor for this journal. The authors declare no conflicts of interest.

Do not read the moderation result as children with poorer health functioning being protected from mental illness. The authors suggest their mental health needs may be overshadowed by pressing physical health concerns, or that assessment is harder in this group and problems go under-reported. The survey was cross-sectional, so it cannot tell you which problem came first.