Abstract
We examined the associations of middle childhood infectious morbidity and inflammatory biomarkers with adolescent internalizing and externalizing behavior problems. We recruited 1018 Colombian schoolchildren aged 5-12 years into a cohort. We quantified white blood cell (WBC) counts and C-reactive protein at enrollment and prospectively recorded incidence of gastrointestinal, respiratory, and fever-associated morbidity during the first follow-up year. After a median 6 years, we assessed adolescent internalizing and externalizing behavior problems using child behavior checklist (CBCL) and youth self-report (YSR) questionnaires. Behavior problem scores were compared over biomarker and morbidity categories using mean differences and 95% confidence intervals (CI) from multivariable linear regression. Compared with children without symptoms, CBCL internalizing problem scores were an adjusted 2.5 (95% CI: 0.1, 4.9; p = .04) and 3.1 (95% CI: 1.1, 5.2; p = .003) units higher among children with moderate diarrhea with vomiting and high cough with fever rates, respectively. High cough with fever and high fever rates were associated with increased CBCL somatic complaints and anxious/depressed scores, respectively. WBC >10,000/mm3 was associated with both internalizing problem and YSR withdrawn/depressed scores. There were no associations with externalizing behavior problems. Whether or not decreasing the burden of common infections results in improved neurobehavioral outcomes warrants further investigation.
Highlights
Mental health disorders affect approximately 13.4% of children and adolescents, and are associated with increased risk of adverse health outcomes in the short and long term (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015; Prince et al, 2007)
Behavior problems are among the most common mental health complaints in youngsters; they are associated with premature death and adult-life illness including depressive, anxiety, bipolar, obsessive-compulsive, and panic disorders (Roza, Hofstra, van der Ende, & Verhulst, 2003)
The objective of this study was to ascertain whether high incidence of common middle childhood infections was related to the development of internalizing and externalizing behavior problems in adolescence
Summary
Mental health disorders affect approximately 13.4% of children and adolescents, and are associated with increased risk of adverse health outcomes in the short and long term (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015; Prince et al, 2007). Behavior problems are among the most common mental health complaints in youngsters; they are associated with premature death (von Stumm et al, 2011) and adult-life illness including depressive, anxiety, bipolar, obsessive-compulsive, and panic disorders (Roza, Hofstra, van der Ende, & Verhulst, 2003). The role in behavioral development of recurrent infections at life stages when they are common, including middle childhood, has not been elucidated. Evidence is scant on the associations between biomarkers of subclinical inflammation, often resulting from recurrent infections, and neurobehavioral outcomes. The objective of this study was to ascertain whether high incidence of common middle childhood infections was related to the development of internalizing and externalizing behavior problems in adolescence. A secondary aim was to examine the associations between biomarkers of inflammation of any grade, which may result from acute or recurrent infections, and behavior problems
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