Mental health hospitalisations of care-experienced and general-population children with chronic conditions: evidence from the Children's Health in Care in Scotland (CHiCS) study, a population-wide longitudinal study using administrative data.

BACKGROUND: Care experience and chronic physical conditions in children are associated with an increased risk of mental health (MH) problems. These issues can compound, leading to poorer prognosis for both MH and chronic conditions. Examining the relationship between care experience and mental ill-health, and exploring how chronic conditions may influence this, is crucial for informing policy and mitigating the burdens on children, families and healthcare systems. METHODS: Routine health and social care data were linked for 13,830 care-experienced children (CEC) and 649,771 general-population children (GPC) in Scotland. Hospitalisations were followed from birth (between 1990 and 2004) to 2016. Cox proportional hazards models and negative binomial regression models were used to analyse the associations between care, asthma, diabetes, epilepsy and MH hospitalisations. RESULTS: Care experience was associated with a higher risk for MH hospitalisations compared with GPC. For first MH hospitalisations, hazard ratios were 3.22 (95% CI: 2.82-3.68) for CEC females and 2.64 (95% CI: 2.32-2.99) for CEC males. For repeated MH hospitalisations, incident rate ratios were 4.06 (95% CI: 3.58-4.62) for CEC females and 3.66 (95% CI: 3.25-4.12) for CEC males. In both cohorts, chronic conditions were associated with a higher risk for repeated MH hospitalisations. CONCLUSION: CEC are at a higher risk of MH hospitalisations compared with GPC. Irrespective of care status, chronic conditions are associated with a higher risk of repeated MH hospitalisations. Interventions aimed at improving MH would benefit from a focus on children with chronic conditions.