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Browsing by Author "Dol, Megan"

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    Trajectories of Psychopathology and Mental Health Service Use Among Youth with A Physical Illness
    (University of Waterloo, 2025-03-04) Dol, Megan
    Youth with chronic physical illness (CPI) are at an increased risk of developing co-occurring mental disorders (i.e., multimorbidity). About 40% of youth with CPI receive a mental disorder diagnosis. The relatively high multimorbidity prevalence suggests this is a pressing public health issue—youth with multimorbidity experience greater symptom severity and functional impairment. In addition, multimorbidity negatively impacts psychosocial outcomes, including health-related quality of life, self-esteem, and academic functioning. Although these children experience poorer outcomes and use a greater amount of mental health services, there is limited understanding of how specific trajectories of mental disorder symptoms (i.e., psychopathology) influence service use over time. By examining the course of psychopathology and its association with mental health service use (MHSU), we can identify critical intervention points aiming to improve the effectiveness of care and allocation of resources. In Canada, the financial burden of mental illness is approximately $51 billion annually, including costs arising from healthcare services, lost productivity, and poor quality of life. Compounding on these burdens, there is an acute shortage of youth-specific mental health services in Canada, where up to 70% of youth with mental health concerns do not receive the specialized services they need. Understanding MHSU in youth with CPI may help efficiently use resources, identify unmet needs, improve the timing of interventions, support families in predicting care needs, and inform policies for targeted and integrated services. This dissertation addresses critical gaps in research on youth psychopathology among you with CPI. While previous studies have explored youth MHSU, few have examined the unique trajectories of psychopathology in this population or how these trajectories affect mental health service use over time. Additionally, limited research has investigated the interplay between parent psychological distress, youth psychopathology, and healthcare use, particularly using longitudinal models. Focusing on these areas, this dissertation provides insights into the complex needs of youth with CPI. It highlights opportunities for improving integrated mental health and healthcare support for this at-risk group. To address these gaps, this dissertation examined youth psychopathology trajectories and transitions and whether psychopathology trajectories impact the association between family factors and MHSU. Specifically, the objectives were to: 1) identify distinct trajectories of psychopathology among youth with a CPI; 2) validate these trajectories by comparing with categorical classifications produced by a diagnostic interview tool; 3) examine predictors of the trajectory groups; 4) identify distinct subgroups of youth psychopathology; 5) examine transitions across these subgroups of psychopathology; 6) identify predictors of such transitions; 7) explore if youth psychopathology trajectories mediate the association between family factors and MHSU. The first study developed a trajectory model using latent class growth analysis (LCGA) to examine the optimal number of trajectories of youth psychopathology and predictors of the different trajectories. Results indicated a three-trajectory model characterized as low-stable, moderate-decreasing, and high-decreasing trajectories. Older age, higher disability, greater parent psychological distress, and higher household income were associated with less favourable trajectories. Results demonstrate that youth with CPI exhibit different courses of psychopathology, and that different individual and family characteristics are associated with trajectory group membership. The second study used latent profile analysis to identify four profiles of youth psychopathology: low psychopathology, primarily internalizing, primarily externalizing, and high psychopathology. Additionally, latent transition analysis was used to track transitions between these profiles over time. Many youths in the primarily internalizing subgroup transitioned to the low psychopathology subgroup over time. Further, youth classified in the high psychopathology subgroup from six to 24 months were more likely to have persistent psychopathology. These findings suggest that youth with CPI exhibit distinct profiles of psychopathology, with unique symptom combinations and patterns of change over time, emphasizing the potential for different mental health needs and trajectories within this population. Youth with CPI do not all experience psychopathology in the same way, and they may shift between profiles, suggesting dynamic changes in symptom patterns. The third study conducted a path analysis to determine if youth psychopathology trajectories mediate the association between family factors (parent psychological distress and family functioning) and MHSU (i.e., contact with a healthcare professional). Results demonstrated that youth psychopathology trajectories (subclinical vs. low) mediate the association between parent psychological distress and contact with a healthcare professional. These findings support using a family-centred care approach to youth healthcare to minimize the burden on families and promote well-being and positive health outcomes. This dissertation fills a critical gap in terms of knowledge of psychopathology and MHSU among youth with CPI. Taken together, these findings can be distilled into four themes: (1) call for integrated physical and mental healthcare; (2) early identification of psychopathology among youth with CPI; (3) adaptive treatment approaches to care; and (4) the need for family-centred care in youth mental health settings. Future longitudinal research should investigate transitions across psychopathology profiles over longer periods and investigate other potential mediators that facilitate or impede the use of mental health services for youth with CPI.