Association between care experience and mental health hospitalisation among children in Scotland, with a focus on chronic conditions (CHiCS): a population-wide longitudinal study using administrative data.

BACKGROUND: Chronic conditions in children are associated with an increased risk of mental health problems. However, not much is known about the nature of this association among care experienced children. We explore the association between three chronic conditions (epilepsy, asthma, and diabetes) and mental health hospitalisation in children with or without care experience. METHODS: The Children's Health in Care in Scotland (CHiCS) is a population-wide longitudinal study that links health and social care data for 13 830 care-experienced children (6274 [45%] female, 7556 [55%] male) and 649 771 general population children (319 438 [49%] female, 330 333 [51%] male). Hospitalisations were followed up from birth between 1990 and 2004, up to July 31, 2016 (when children were aged 12-27 years). We used Cox proportional hazards models with age as timescale to estimate hazard ratios (HR) and 95% CIs for first mental health hospitalisation separately among care-experienced children and general population children. FINDINGS: Among general population children, 3152 (0·49%) children had epilepsy, 94 700 (14·57%) had asthma, and 5501 (0·85%) had diabetes. In comparison, among care-experienced children, 160 (1·16%) children had epilepsy, 2242 (16·21%) had asthma, and 142 (1·03%) had diabetes. Care-experienced children were more likely to have mental health hospitalisations than general population children, with 701 cases (5·1%) versus 5225 cases (0·8%), respectively. Among general population children, out of all three chronic conditions, epilepsy showed the highest risk (HR 2·61, 95% CI 2·20-3·09) for first mental health hospitalisation, followed by diabetes (1·93, 1·62-2·31), and asthma (1·25, 1·16-1·34). Among care-experienced children, asthma showed an HR of 1·43 (1·17-1·74) for first mental health hospitalisation, whereas epilepsy (1·33, 0·70-2·52) and diabetes (1·71, 0·96-3·05) had no association with first mental health hospitalisation in this subgroup. INTERPRETATION: The study highlights the associations between chronic conditions and risk of mental health hospitalisation among children with or without care experience. One limitation of the study is the small number of care experienced children with a chronic condition and mental health hospitalisation, which might have contributed to the lack of association found among care-experienced children between epilepsy and mental health, and diabetes and mental health. Nevertheless, one of its strengths is contributing to the limited knowledge regarding this association. FUNDING: Economic and Social Research Council, Medical Research Council, Scottish Government Chief Scientist Office.