Increased Prevalence of Mental Illness Seen in Cerebral Palsy

Girl with cerebral palsy sitting in wheelchair at sunset
Compared with adults without cerebral palsy, adults with cerebral palsy had higher age-standardized prevalence of mental health disorders, including anxiety and mood affective disorders.

An elevated prevalence of mental health disorders was observed in adults with cerebral palsy (CP), according to cross-sectional study data published in the Annals of Internal Medicine.

Investigators abstracted data from the Optum Clinformatics Data Mart, a nationwide insurance claims database of 79 million beneficiaries. All adults who were enrolled continuously for 12 months in 2016 were eligible for inclusion. CP, neurodevelopmental comorbidities, and 37 mental health disorders were identified on the basis of diagnostic codes. Direct age standardization was performed using US Census Bureau data on age and sex composition of the 2016 US adult population. Direct age-standardized prevalence of mental health disorders was estimated by sex for adults with CP only, adults with CP and neurodevelopmental comorbidities, and adults without CP.

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Data were extracted from 8.7 million adults, of whom 7348 had a diagnosis of CP. Compared with men without CP, men with CP alone had a higher prevalence of mood affective disorders (19.5% vs 8.1%), anxiety disorders (19.5% vs 11.1%), schizophrenic disorders (2.8% vs 0.7%), alcohol- and opioid-related disorders (4.7% vs 3.0%), and disorders of adult personality and behavior (1.2% vs 0.3%). However, behavioral syndromes related to physical factors, such as eating disorders, were observed at similar prevalence rates in men with and without CP. Trends were similar in women with and without CP. Compared with adults with CP alone, patients with CP and neurodevelopmental comorbidities had similar or higher age-standardized prevalence of mental health disorders. Only alcohol- and opioid-related disorders in men were less prevalent in patients with CP and neurodevelopmental disorders compared with the CP-only cohort. 

These data underscore the elevated prevalence of mental illness in patients with CP. This trend was particularly pronounced in patients with comorbid neurodevelopmental conditions. The use of a private insurance database limits data generalizability; patients using private insurance may be in better health than patients receiving federally subsidized care. Thus, investigators hypothesized that the figures produced in this cohort may underestimate the true prevalence of mental illness in patients with CP.

“[Increasing] clinical awareness of the mental health disorders and risks among adults with CP, improving clinical screening strategies, and developing efficient referral resources for mental health care services may help reduce the burden of mental health disorders in this population,” investigators concluded.


Whitney DG, Warschausky SA, Ng S, Hurvitz EA, Kamdar NS, Peterson MD. Prevalence of mental health disorders among adults with cerebral palsy: a cross-sectional analysis [published online August 6, 2019]. Ann Intern Med. doi:10.7326/M18-3420

This article originally appeared on Psychiatry Advisor