Associations Between Participation and Mental Health for Vulnerable Youth with Special Healthcare Needs

Objectives To understand the role of adverse child experiences and breadth of participation in the mental health outcomes of youth with special healthcare needs (YSHCN). Breadth of participation refers to the number of different activity contexts within which YSHCN participate. Methods The present, cross-sectional, study utilized the 2016 National Survey of Children's Health, a nationally representative survey of the physical and emotional health of children in the United States. In total, 5862 YSHCN, aged 12-17 years were included in the sample. Results Increased exposure to adverse childhood experiences was associated with an increased risk of both depression and anxiety for YSHCN. Low (versus high) breadth of participation was associated with an increased risk of both depression and anxiety. Breadth of participation altered the association between exposure to adverse childhood experiences and anxiety, such that YSHCN with high breadth of participation had lower rates of anxiety at all levels of exposure to adverse childhood experiences. Conclusions for Practice YSHCN with greater exposure to adverse childhood experiences and with low breadth of participation may be most vulnerable to depression and anxiety.