Investigating Physiological Symptoms Associated with Mental Health Symptoms in Youth with Cerebral Palsy: An Observational Study
Open accessAbstract
Over 50 % of children and youth with cerebral palsy (CP) experience mental health challenges, with anxiety and depression most common. Youth with CP also experience several physiological symptoms such as fatigue, pain, sedentary lifestyle, and sleep disturbances that impact their daily living; however, little is known about the impact of these symptoms on mental health outcomes in these youth. This study addressed this gap and examined the individual and cumulative impacts of physiological symptoms on anxiety and depression symptoms in youth with CP. Forty youth with CP aged 8 to 18 years, and their caregiver, participated in this cross-sectional observational study. Pain, fatigue, anxiety, and depressive symptoms were measured using caregiver- and self-reported questionnaires and participants wore accelerometers for seven consecutive days, providing non-invasive physical activity and sleep pattern data. Youth with CP experienced substantial physiological symptoms and elevated anxiety and depression symptoms. Linear regression models determined that all physiological factors were predictive of caregiver-reported youth anxiety (R2 = 0.23) and youth depressive symptoms (R2 = 0.48). Fatigue, pain severity, sleep efficiency, and physical activity outcomes individually and cumulatively contributed to caregiver-reported youth anxiety and depression symptoms. These findings highlight the important role of physiological symptoms as potential risk factors and potential targets for intervention for mental health issues for in youth with CP.
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Between 15 and 30% of youth with CP experienced elevated or very elevated anxiety and depression symptoms.
“In an observational study, between 15 and 30% of youth (youth- and caregiver-reported) experienced anxiety and depression symptoms that were elevated or very elevated [32].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
There may be under-diagnosis of mental health concerns, especially anxiety, in the CP youth population.
“Researchers have suggested that there may be under-diagnosis of mental health concerns, especially anxiety, in the CP youth population [30,32].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
The co-occurrence of physiological and mental health symptoms suggests a bi-directional relationship between physical and mental well-being in youth with CP.
“which suggests a bi-directional relationship between physical and mental well-being [32].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
Sleep issues combined with lower quality of life are associated with higher risk of developing mental health concerns in the short and long term and impact general engagement in day-to-day activity.
“These sleep issues combined with lower quality of life are also further associated with higher risk of developing mental health concerns, both in the short and long term, and impact general engagement in day-to-day activity [32].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
Fatigue is a predictor related to youth-reported depression and anxiety scores in youth with CP.
“the experience of fatigue was a predictor related to youth-reported depression and anxiety scores [32].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
85% of youth with anxiety disorders experience at least one sleep issue.
“Testani and colleagues’ research [32] indicated that 85% of youth with anxiety disorders experience at least 1 sleep issue”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
Increased participation in physical activities can mitigate the risk of depression in children with CP.
“Evidence suggests that increased participation in physical activities can mitigate the risk of depression in these children [32].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
Fatigue is a strong predictor of both depression and anxiety symptoms in youth with CP.
“with fatigue identified as a strong predictor of both depression and anxiety symptoms [32].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
There is increased risk of developing depression symptoms in youth with CP when they also experience pain.
“researchers have found that there is increased risk of developing depression symptoms in youth with CP when they also experience pain”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
Physiological symptoms such as fatigue, muscle pain, and sleep disturbances often co-occur with mental health symptoms in youth with CP.
“Results from this study indicated that physiological symptoms such as fatigue, muscle pain, and sleep disturbances often co-occur with mental health symptoms in youth with CP”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
Approximately 55% of youth with anxiety disorders experience three or more sleep-related issues.
“and that approximately 55% experience three or more sleep-related issues”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
Associated characteristics such as pain, sleep, and fatigue may contribute to higher reported rates of anxiety and depression diagnoses in children with CP.
“However, associated characteristics such as pain, sleep, and fatigue may contribute to higher reported rates of these diagnoses [32].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [32]
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Self-citation
- Authors
- Testani, D., McMorris, C. A., Clark, C. A., Sanguino, H., Condliffe, E. G., Noel, M. E., Kopala Sibley, D. C., & Brunton, L. K.
- Affiliations
- University of Toronto (CA)
- University of Calgary (CA)
- Western University (CA)
- Corresponding author
- Brunton, L.K.
- Venue
- Research in Developmental Disabilities
- Publisher
- Elsevier BV
- Published
- 2024-08
- Volume
- 151
- Pages
- 104783
- ISSN
- 0891-4222 (ISSN-L)
- OpenAlex
- W4399992400
- Cited by
- 7
- References
- 38
- Citations by year
- 2026: 4 · 2025: 3
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Research in Developmental Disabilities (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- University of Calgary Hotchkiss Brain Institute
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- cerebral palsy, youth mental health, anxiety, depressive symptoms, fatigue, pain, sleep efficiency, physical activity, sedentary behavior, physiological symptoms, risk factors, accelerometry, caregiver-reported outcomes
- MeSH terms
- Adolescent, Anxiety, Cerebral Palsy, Child, Cross-Sectional Studies, Depression, Fatigue, Female, Humans, Male, Mental Health, Pain, Surveys and Questionnaires, Sleep Wake Disorders, Exercise, Caregivers, Sedentary Behavior, Self Report, Accelerometry
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