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Pet Dogs and Children’s Health: Opportunities for Chronic Disease Prevention?

Authors:
  • Bassett Medical Center,Cooperstown,NY

Abstract and Figures

Introduction: Positive associations between having a pet dog and adult health outcomes have been documented; however, little evidence exists regarding the benefits of pet dogs for young children. This study investigates the hypothesis that pet dogs are positively associated with healthy weight and mental health among children. Methods: This cross-sectional study accrued a consecutive sample of children over 18 months in a pediatric primary care setting. The study enrolled 643 children (mean age, 6.7 years); 96% were white, 45% were female, 56% were privately insured, and 58% had pet dogs in the home. Before an annual visit, parents of children aged 4 to 10 years completed the DartScreen, a comprehensive Web-based health risk screener administered using an electronic tablet. The screener domains were child body mass index (BMI), physical activity, screen time, mental health, and pet-related questions. Results: Children with and children without pet dogs did not differ in BMI (P = .80), screen time of 2 hours or less (P = 0.99), or physical activity (P = .07). A lower percentage of children with dogs (12%) met the clinical cut-off value of Screen for Child Anxiety and Related Disorders (SCARED-5) of 3 or more, compared with children without dogs (21%, P = .002). The mean SCARED-5 score was lower among children with dogs (1.13) compared with children without dogs (1.40; P = .01). This relationship was retained in multivariate analysis after controlling for several covariates. Conclusions: Having a pet dog in the home was associated with a decreased probability of childhood anxiety. Future studies need to establish whether this relationship is causal and, if so, how pet dogs alleviate childhood anxiety.
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PREVENTING CHRONIC DISEASE
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY
Volume 12, E205 NOVEMBER 2015
ORIGINAL RESEARCH
Pet Dogs and Children’s Health:
Opportunities for Chronic Disease
Prevention?
AnneM.Gadomski,MD,MPH; MelissaB.Scribani,MPH; NicoleKrupa;
PaulJenkins,PhD; ZsoltNagykaldi,PhD; ArdisL.Olson,MD
Suggested citation for this article:
Gadomski AM, Scribani MB,
Krupa N, Jenkins P, Nagykaldi Z, Olson AL. Pet Dogs and
Children’s Health: Opportunities for Chronic Disease Prevention?
Prev Chronic Dis 2015;12:150204. DOI: http://dx.doi.org/
10.5888/pcd12.150204.
PEER REVIEWED
Abstract
Introduction
Positive associations between having a pet dog and adult health
outcomes have been documented; however, little evidence exists
regarding the benefits of pet dogs for young children. This study
investigates the hypothesis that pet dogs are positively associated
with healthy weight and mental health among children.
Methods
This cross-sectional study accrued a consecutive sample of chil-
dren over 18 months in a pediatric primary care setting. The study
enrolled 643 children (mean age, 6.7 years); 96% were white, 45%
were female, 56% were privately insured, and 58% had pet dogs in
the home. Before an annual visit, parents of children aged 4 to 10
years completed the DartScreen, a comprehensive Web-based
health risk screener administered using an electronic tablet. The
screener domains were child body mass index (BMI), physical
activity, screen time, mental health, and pet-related questions.
Results
Children with and children without pet dogs did not differ in BMI
(
P
= .80), screen time of 2 hours or less (
P
= 0.99), or physical
activity (
P
= .07). A lower percentage of children with dogs (12%)
met the clinical cut-off value of Screen for Child Anxiety and Re-
lated Disorders (SCARED-5) of 3 or more, compared with chil-
dren without dogs (21%,
P
= .002). The mean SCARED-5 score
was lower among children with dogs (1.13) compared with chil-
dren without dogs (1.40;
P
= .01). This relationship was retained
in multivariate analysis after controlling for several covariates.
Conclusions
Having a pet dog in the home was associated with a decreased
probability of childhood anxiety. Future studies need to establish
whether this relationship is causal and, if so, how pet dogs allevi-
ate childhood anxiety.
Introduction
Childhood mental illness and obesity are significant public health
problems in the United States (1,2). Because both conditions start
in childhood, preventive and early intervention approaches are
needed. Pet dogs have been linked with varied physical and men-
tal health benefits for adults (3,4), benefits that are promoted by
the US Public Health Service (USPHS) (Figure 1). Although dog
ownership may improve adult physical activity, body weight, and
mental health (5,6), less is known about the relationship between
pet dogs and children’s health. In Australia and the United King-
dom, dog ownership was associated with increased accelerometer-
measured physical activity among children aged 5 to 12 years
(7–9) and a lower likelihood of overweight or obesity among chil-
dren aged 5 to 6 years (10). In those countries, promoting walking
and active play with a dog is an effective strategy to increase chil-
dren’s physical activity. Such studies have not been done in the
United States, so more evidence is needed to support this as a US
strategy.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health
and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 1
Figure 1. US Public Health Service flyer, “Pets Promote Health,” describing
benefits of pet ownership.
Children may interact with dogs in other ways that may benefit
them. From a mental health standpoint, children aged 7 to 8 often
ranked pets higher than humans as providers of comfort and self-
esteem and as confidants (11,12). Animal-assisted therapy (AAT)
with dogs affects children’s mental health and developmental dis-
orders by reducing anxiety and arousal or enhancing attachment
(13). Because dogs follow human communicative cues, they may
be particularly effective agents for children’s emotional develop-
ment (14). Despite the evidence for the therapeutic effects of AAT
for certain childhood conditions, little evidence is available for
primary care providers to use when counseling parents regarding
the benefits of pet dogs for young children.
Promoting children’s behavioral and emotional competence is an
effective strategy to prevent mental, emotional, and behavioral dis-
orders during adulthood (15). If exposure to pet dogs during child-
hood is inversely related to mental health problems, positive
child-–-dog interactions could prevent the evolution of these prob-
lems into full-fledged disorders during adolescence or later life.
Studies support this possibility (Figure 2). Our study investigated
the hypothesis that pet dogs are positively associated with healthy
weight and mental health among children.
Figure 2. Model for how pet dogs may influence the physical and mental
health of children aged 4 to 10 years. The model summarizes study findings
regarding how pet dogs promote children’s behavioral and emotional
development, mental health (3,4, 11–13,30), and physical activity (6–10,26).
Methods
This cross-sectional study was conducted at a general pediatric
clinic in an academic medical center at the hub of a not-for-profit
rural health network in Upstate New York. From July 2012
through December 2013, we consecutively recruited parents of
children, aged 4 to 10 years who came to clinic for their annual
check-ups. Over the 18 months, we consecutively enrolled 643
children who were 96% white, 45% female, and 56% privately in-
sured. One child per family was eligible; ill or developmentally
disabled children were excluded. Before the doctor’s check-up the
parent completed the DartScreen, a comprehensive Web-based
child health screener using an electronic tablet (16,17) . A re-
search assistant entered the age, sex, height, and weight measured
by the nurse.
The DartScreen includes questions about somatic and mental
health concerns, nutrition, physical activity, screen time, general
health, anxiety, parental depression, and whether or not the child
has emotional difficulties or difficulties with attention, behavior,
or getting along with others (17). A pet module added to the end
of the DartScreen was automatically triggered by a question about
having pets in the home: “Do you live with a pet in your home?”
If the parent selected “yes,” the screener branched to the kind of
pet. If dog was selected, the screener branched to more detailed
PREVENTING CHRONIC DISEASE VOLUME 12, E205
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
questions about the dog, including duration of exposure to the pet
dog in the child’s lifetime and time spent being physically active
with the dog. If the family had more than one dog, the parent was
prompted to think of the dog that the child spent the most time
with. The Flesch-Kincaid Reading Ease score for the pet module
was 91 and the grade level was 3.
Mental health measures were 4 widely used and validated assess-
ment tools used for screening but not for formal diagnosis.
DartScreen automatically coded responses and calculated scores
for the validated scales it contains. All parents completed the
SCARED-5, a 5-item scale adapted from the Screen for Child
Anxiety and Related Disorders, a screening tool for childhood
anxiety disorders validated in both psychiatric (18) and primary
care settings (19,20). The abbreviated SCARED-5 has shown psy-
chometrics similar to the full 41-item SCARED screening tool,
which measures general anxiety, separation anxiety, social phobia,
school phobia, and physical symptoms of anxiety. In addition to
analyzing the mean SCARED-5 score, the proportion of children
meeting the SCARED-5 clinical score threshold of 3 or more was
also analyzed.
For children with reported emotional, attention, or behavioral dif-
ficulties, the screener branched to the Strengths and Difficulties
Questionnaire (SDQ) Impact Supplement (21) and, if responses
were positive, to the Pediatric Symptom Checklist (22).The SDQ
inquires whether the child has difficulties in 4 areas (emotion, con-
centration, behavior, and getting along with others) and whether
such difficulties interfere with home life, friendships, classroom
learning, and leisure activities. SDQ questions are scored at 3
levels (0, not at all or a little; 1, a medium amount; 2, a great deal)
to yield an impairment score of 0 to 10 for unlikely, possible, or
probable mental disorder the higher the score, the more prob-
able a mental disorder (21). The PSC-17, adapted from the Pediat-
ric Symptom Checklist (PSC), assesses psychosocial problems
among children and youths aged 6 to 16 years (23). PSC-17 has
been validated against structured psychiatric interviews, and in-
cludes subscales for internalizing, externalizing, and attention con-
ditions; however, it is less accurate for anxiety disorders (23).
Because a parent’s mental health can affect reporting about the
child (24), the DartScreen included the 2-item Patient Health
Questionnaire (PHQ-2), which has a sensitivity of 79% and spe-
cificity of 86% for any depressive disorder (25). We used the
PHQ-2, a commonly used screening test for depression, as a brief
measure of parental depressive symptoms. To be at risk for de-
pression, the parent had to have a score of 3 or higher out of a pos-
sible 6, a cut point that has been validated.
Potential confounders
Research on human–animal interactions requires controlling for
potential covariates such as age, sex, socioeconomic status (SES),
and race/ethnicity, which may account for the differences between
pet owners and nonowners (9,12,26). Families who own pets may
differ from families who do not have pets by several factors that
can also influence a child’s health (26). Among a set of 17 SES in-
dicators, a community's poverty rate was ranked as the leading
measure of socioeconomic environment that is a social determin-
ant of health (27). Family income is also significantly related to
adolescent mental health, accounting for 28% of the prevalence of
DSM IV disorders among adolescents (2). Therefore, we investig-
ated 2 SES proxies: 1) the type of health insurance the child had,
and 2) the percentage of the population living below the 2013
poverty level in the child’s residence zip code (28). In our catch-
ment area, this latter indicator ranges from 4% to 61%. Type of
health insurance (none, Medicaid, Child Health Plus [New York
State Children's Health Insurance Program], or commercial insur-
ance) was not related to the dependent variables. However,
poverty level (percentage of population under the poverty
threshold by zip code) was related to SDQ impact and PSC-17, so
it was used to adjust multivariate analyses.
Sample size
Using the proportion of overweight or obese children in Australia
aged 5 to 6 years who owned a dog (19.8%) and did not own a dog
(25.2%) (10), we estimated that the proportion of overweight US
children among those with dogs versus those without would be
20% and 25% respectively. Assuming a 1-tailed
α
of .05, a sample
of 311 subjects in both of these groups (622 subjects total)
provided a power of .80 for the test of the null hypothesis of no
difference in proportions. Our target sample size was 650, and our
effective sample size was 643 after excluding cases with incom-
plete data or duplicates.
Statistical methods
At the conclusion of data collection, data were de-identified be-
fore analysis. Univariate comparisons of BMI classes, screen time
(dichotomized as ≤2 hours/d vs >2 hours/d), physical activity,
SDQ impairment, PSC-17, SCARED-5, and the child’s history of
mental disorder were made between the pet dog group and the no
pet dog group. Because the distribution of SCARED-5 skewed to
the right, this variable was transformed to square-root values be-
fore analyses. Mean values and 95% confidence intervals were
then back-transformed to display in tables.
Using SAS 9.3 (SAS Institute), continuous variables, such as age,
BMI z-score, total SCARED-5 score and total PSC-17 score, were
PREVENTING CHRONIC DISEASE VOLUME 12, E205
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 3
compared between groups by using the
t
test. Categorical vari-
ables, such as BMI classification, parent PHQ-2 positivity,
SCARED-5 score of 3 or greater, 3-level SDQ impairment, and
the child’s history of mental disorder were compared between the
pet dog group and the no pet dog group by using the χ
2
test.
Multivariate analyses were carried out using multiple linear re-
gression for composite outcomes (SCARED-5 and total PSC-17),
and using logistic regression for dichotomous outcomes for
SCARED-5 (≥ 3 vs < 3) and SDQ impairment (SDQ ≥2 vs <2). In
these multivariate models, we controlled for the child’s sex, the
child’s age, the parent PHQ positivity, and percentage of popula-
tion under the poverty threshold in the child’s zip code.
To further delineate the relationship between specific anxiety ele-
ments and dog ownership, we analyzed the 5 screener items of the
SCARED-5. The scores for each item were compared between the
pet dog group and no pet dog group by using the
t
test.
We also conducted subanalyses to assess the relationship between
anxiety and other mental health measures. Specifically, the distri-
bution of 3-level SDQ impairment of function was compared
between children with SCARED-5 of 3 or greater and children
with SCARED-5 of less than 3 by using χ
2
. The 4-item internaliz-
ing subscale of the PSC-17 was also dichotomized at the cut point
and compared with SCARED-5 ≥ 3 by using χ
2
.
The Bassett Hospital Institutional Review Committee approved
this study on March 19, 2012, and reviews it annually for the life
of the study.
Results
Among the 643 enrolled children, 470 (73%) had a pet, 133 (21%)
had no pets, and 40 (6%) were missing all pet data and were as-
signed to the no-pet-dog group. Among the 470 with pets, 4 were
missing data about the type of pet; 3 of these were assigned to the
group with pet dogs because they had answered screener ques-
tions specific to a pet dog. The remaining subject was assigned as
having no pet dog. In the final analysis, 370 (57.5%) children with
a pet dog were compared with 273 (42.5%) with no pet dog.
Mothers most often completed the screener (80% mother, 16%
father, 4% other). A total of 20 parents scored positively on the
PHQ-2 (3.2%), and 14 (2.2%) parents reported family issues they
wished to discuss with the provider during the visit. We observed
no significant difference in parental PHQ-2 between those with
and those without a pet dog (Table 1).
We found no difference between children with and children
without a pet dog in BMI (
P
= .80) or screen time of 2 hours or
more (
P
= .99) (Table 1). We also found no difference for physic-
al activity (
P
= .07). Among families with pet dogs, BMI
z
-score
was not associated with the parent’s reported time that the child
was physically active with the dog (
P
= .15).
Twenty-six children (7.6%) who had pet dogs had a history of a
mental disorder, and 15 (7.0%) children with a mental disorder
history did not have a pet dog (
P
= .76). The mean PSC-17 score
for children with a pet dog was 11.6 versus 12.0 for children
without a pet dog (
P
= .65) (Table 1).
Ninety-nine children (15.7%) had a SCARED-5 score of 3 or
higher. The mean age for children with a positive SCARED-5
score (6.71 years) was virtually identical to those with a negative
SCARED-5 score (6.70 years) (
P
= .95). Girls had higher mean
SCARED-5 scores than did boys; however, there was no differ-
ence in percentage scoring SCARED-5 ≥ 3. In univariate analyses,
the mean SCARED-5 score was significantly lower among chil-
dren with a pet dog (1.13 untransformed, 0.65 transformed) com-
pared with children without a dog (1.40 untransformed, 0.89 trans-
formed,
P
= .02) (Table 1). Duration of pet dog exposure (years) in
the child’s lifetime was not correlated with the SCARED-5 score
(
r
= - 0.087,
P
= .10). Table 2 displays the results for each com-
ponent of SCARED-5 stratified by pet dog or no pet dog. Signific-
ant differences between groups were found for the separation anxi-
ety component (“My child is afraid to be alone in the house”) and
social anxiety component (“My child is shy”) favoring pet owner-
ship.
Among children with a SCARED-5 score of 3 or higher, 18.6%
had an SDQ Impairment score of 2 or higher compared with only
5.5% with an SDQ score of 2 or higher among those with a
SCARED-5 score lower than 3 (
P
< .001). This finding suggests
that the child’s anxiety score was associated with functional
impairment. For children with a SCARED-5 score of 3 or higher,
12.5% scored positively on the internalizing subscale of the PSC-
17. In contrast, only 1.6% of children who scored lower than 3 on
SCARED-5 scored positively on this subscale.
The significant association between pet dog versus no pet dog
groups and SCARED-5 score was maintained in a linear regres-
sion model controlling for poverty level, parent PHQ positivity,
age, and sex (Table 3). This finding was also true in the logistic re-
gression model for children meeting the SCARED-5 score point of
3 or higher. The predicted probability of a SCARED-5 score of 3
or higher was 0.20 for children without pet dogs compared with
0.11 for children with pet dogs. A pet dog in the home was associ-
ated with a 9% decreased probability of a SCARED-5 score of ≥ 3
or higher.
PREVENTING CHRONIC DISEASE VOLUME 12, E205
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
4 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
Discussion
Our study results suggest that children who have a pet dog in the
home have a lower anxiety screening score than children who do
not. A greater percentage (21%) of children without pet dogs than
children with pet dogs (12%) had a SCARED-5 score of 3 or
higher, a point at which further assessment is indicated to dia-
gnose anxiety. The anxiety scores in our study were higher for
girls than boys as were the social and separation anxiety subfactor
distribution. These findings are consistent with those documented
in a predominantly white primary care sample of slightly older
children (8–12 y) (19). Whereas that study showed no variation
with demographic factors, our study found and controlled for an
association between SCARED score and poverty level. Despite
controlling for age, sex, poverty level, and parent PHQ positivity
in our multivariate models, the association between having a pet
dog in the home and a lower child anxiety score remained signific-
ant. However we observed no difference in body weight, screen
time, or physical activity between children with and children
without pet dogs in the home.
Because anxiety disorders often start in childhood, often persist in-
to adulthood, and have the longest delays for treatment (eg, age
20–23 y for social and separation anxiety disorders) , addressing
subthreshold conditions in primary care settings during childhood
is a reasonable target for preventive interventions (2,11,20,21).
Our study findings are more relevant to a discussion of sub-
threshold conditions than of disorders, because this study was of a
primary care population as opposed to a population of children
with diagnosed mental disorders or a clinically referred popula-
tion. Only 18% of children who met the SCARED-5 cutoff also
met SDQ criteria for probable mental disorder, whereas 82% of
children who met the SCARED-5 cutoff did not meet SDQ criter-
ia. This finding is consistent with the relatively high rates of the
different types of anxiety among children, including subthreshold
anxiety symptoms (2).
Pet dogs could reduce childhood anxiety, particularly social and
separation anxiety, by various mechanisms (Figure 2). A pet dog
can stimulate conversation, an ice-breaking effect that can allevi-
ate social anxiety via a social catalyst effect (12). Companionship
with a pet can alleviate separation anxiety and strengthen attach-
ment (13). Social interaction of humans and dogs may also lead to
increased oxytocin levels in both the human and the dog (29). In-
teracting with a friendly dog also reduces cortisol levels most
likely through oxytocin release, which attenuates physiologic re-
sponses to stress (29). These hormonal effects may underlie the
observed emotional and behavioral benefits of AAT and pet dogs.
The advantage of this study is that it used a real-world setting for
data collection, adapted a tablet for in-clinic data collection, and
enabled a more comprehensive analysis of the relationship
between pet dogs and children’s mental health symptoms while
adjusting for several covariates. The study was of children being
seen for preventive care, a far larger and more inclusive group of
children than those in prior human–animal interaction studies,
which focused on children with mental and developmental dis-
orders.
Because this was a cross-sectional study of associations, a correla-
tional study, no cause or effect can be inferred. It may be that less
anxious children have pet dogs or pet dogs make children less
anxious. To make such inferences, a quasi-experimental design is
required in which families who acquire a pet dog are followed lon-
gitudinally with a comparison group. Although AAT lends itself to
randomized controlled trial design, routine pet exposure does not;
however, children spend more time with pets at home than they
would with AAT animals. This study does not answer whether pet
dogs have direct effects on children’s mental health or whether
other factors associated with acquisition of a pet dog benefit their
mental health.
This study was limited by parental report. However, parental con-
cerns about emotional and behavioral problems, if carefully eli-
cited, can detect mental health problems among children age 4
years or older (30). Furthermore, in primary care settings, moder-
ate to high concordance between parents’ and children’s reported
anxiety scores have been documented (19,20). Given the homo-
geneity of this study population (96% white), this study requires
replication in settings that have more racially and ethnically di-
verse populations (20).
The USPHS currently promotes pet dogs for improving adult
physical and mental health (Figure 1). However, more evidence is
needed before promoting interactions between pet dogs and chil-
dren. Yet, pet dog ownership was associated with a 9% reduction
in the probability of a SCARED-5 score of 3 or higher. If this
were an effect size, it could provide significant prevention on a
population level, assuming a broad reach but only if the relation-
ship is found to be causal. However, a prospective study is re-
quired to establish the magnitude of the potential effect as well as
causality. Future research should establish the direction of causal-
ity, the specificity and magnitude of the effect, and its potential
long-term impact on anxiety.
Acknowledgments
This study was funded by Grant No. 1 RO3 NR013873-01 (PI
Anne M. Gadomski) from the National Institute of Nursing Re-
PREVENTING CHRONIC DISEASE VOLUME 12, E205
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 5
search, Eunice Kennedy Shriver National Institute of Child Health
and Human Development and the Mars-WALTHAM Centre for
Pet Nutrition, a division of Mars, Incorporated.
Author Information
Corresponding Author: Anne M. Gadomski MD, MPH, Research
Institute, Bassett Medical Center, One Atwell Road, Cooperstown,
NY 13326. | Telephone: 607-547 3066. Email:
anne.gadomski@bassett.org.
Author Affiliations: Melissa B. Scribani, Nicole Krupa, Paul
Jenkins, Research Institute, Bassett Medical Center, Cooperstown,
New York; Zsolt Nagykaldi, University of Oklahoma Health
Sciences Center, Oklahoma City, Oklahoma; Ardis L. Olson MD,
Dartmouth Medical School, Lebanon, New Hampshire.
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6 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
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Tables
Table 1. Summary Statistics for Children’s (N = 643) Health Indicators and Results of Bivariate Tests for Effects of a Pet Dog in the
Home
Indicator n
a
Sample
Pet Dog in Home
(n = 370)
No Pet Dog in home
(n = 273)
P
Value
b
Female, % 643 45.1 45.1 45.1 .98
Age, mean (95% CI) 643 6.72 (6.55– 6.88) 6.72 (6.50– 6.94) 6.71 (6.46, 6.96) .94
Poverty level, mean (95% CI)
c
643 0.15 (0.14–0.15) 0.15 (0.14– 0.16) 0.15 (0.14– 0.15) .23
Positive on Parent PHQ, % 617 3.2 3.3 3.1 .87
Child history of mental health diagnosis, % 594 7.2 7.5 6.9 .76
PSC-17 score, mean (95% CI)
d
177 11.75 (10.80–
12.70)
11.55 (10.14– 12.96) 11.99 (10.73– 13.25) .65
Screen time ≤2 h/d, % 630 54.9 54.9 54.9 .99
BMI
z
-score, mean (95% CI) 640 0.54 (0.46– 0.63) 0.53 (0.42– 0.65) 0.56 (0.43– 0.68) .80
BMI
e
, %
Normal 423 66.1 65.8 66.5
.80Overweight 108 16.9 17.7 15.8
Obese 109 17.0 16.6 17.7
SCARED-5 score, mean (95% CI)
Mean SCARED-5 (untransformed [raw data]) 630 1.24 (1.14– 1.35) 1.13 (1.00– 1.26) 1.40 (1.23– 1.58) .01
Mean SCARED-5 (transformed) 630 0.74 (0.65– 0.84) 0.65 (0.54– 0.77) 0.89 (0.73– 1.06) .02
SCARED-5 score ≥3, % 630 15.7 12.0 21.0 .002
SDQ impact scores, %
Normal (SDQ = 0) 551 87.7 89.0 85.9
.33Borderline (SDQ = 1) 29 4.6 4.7 4.6
Abnormal (SDQ ≥2) 48 7.6 6.3 9.5
Abbreviations: BMI, body mass index; CI, confidence interval; PHQ, PSC, Pediatric Symptom Checklist; SCARED, Screen for Child Anxiety and Related Disorders;
SDQ, Strengths and Difficulties Questionnaire Impact Supplement.
a
The number for covariates. These numbers do not equal 643 in cases where data were missing for the given covariate.
b
P
value is for having a dog versus not having a dog.
c
Percentage of population below the poverty level in NY by zip code.
d
The screener branched to the Pediatric Symptom Checklist if the SDQ Impact Supplement was positive. Therefore not all children were screened with the PSC.
e
We used the CDC definitions for the 3 child BMI classes (normal, overweight, obese): overweight = BMI ≥85th percentile and <95th percentile for children of the
same age and sex; obesity = BMI ≥95th percentile for children of the same age and sex).
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8 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
Table 2. Screen for Child Anxiety and Related Disorders (SCARED-5) Component Questions Comparing Children With a Pet Dog with
Children Without A Pet Dog
Question Pet Dog in Home, Mean No Pet Dog in Home, Mean
P
Value
My child gets really frightened for no reason at all. 0.14 0.20 .07
My child is afraid to be alone in the house. 0.31 0.42 .02
People tell me that my child worries too much. 0.13 0.14 .99
My child is scared to go to school. 0.07 0.06 .64
My child is shy. 0.49 0.60 .01
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the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 9
Table 3. Multivariate Regression Showing Relationship Between Having a Pet Dog in the Home and Child Body Mass Index
Z
-Score
and Child Mental Health Indicators, Adjusted for Poverty Level, Parent PHQ Positivity, Age, And Sex
Variable
β
Coefficient
a
SE 95% CI
P
Value
Child BMI
z
score 0.01 0.09 −0.16 to 0.19 .87
SCARED-5 −0.27 0.11 −0.49 to 0.06 .01
PSC-17 score −0.70 0.89 −2.46 to 1.06 .43
Variable Odds Ratio
b
SE 95% CI
P
Value
SCARED-5 score ≥3 0.49 0.23 0.31 to 0.77 .002
SDQ score ≥2 0.63 0.30 0.35 to 1.15 .13
Abbreviations: BMI, body mass index; CI, confidence interval; PSC-17, Pediatric Symptom Checklist-17; SCARED-5, Screen for Child Anxiety and Related Disorders-
5; SDQ, Strengths and Difficulties Questionnaire.
a
Linear regression results are shown for BMI z score, SCARED-5 score, and PSC-17 score.
b
Logistic regression result is shown for the binary outcomes of SCARED-5 score. <3 vs ≥3. and SDQ score, <2 vs ≥2 .
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10 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
... In addition to only-child status, factors such as parental age, educational attainment, household income, and pet ownership collectively shape children's upbringing environments. Among these, pet ownership has become increasingly common and may influence children's neurodevelopment (13)(14)(15)(16). The emotional benefits of pet attachment, such as providing emotional comfort, reducing stress, and fostering compassion and social skills, may contribute to neurodevelopmental advantages (14)(15)(16)(17)(18)(19)(20), particularly for only children lacking companionship. ...
... Among these, pet ownership has become increasingly common and may influence children's neurodevelopment (13)(14)(15)(16). The emotional benefits of pet attachment, such as providing emotional comfort, reducing stress, and fostering compassion and social skills, may contribute to neurodevelopmental advantages (14)(15)(16)(17)(18)(19)(20), particularly for only children lacking companionship. However, pets can also introduce environmental toxins (e.g., pesticides) into the home (21), which might increase the risk of ADHD (22). ...
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Background The associations of only-child status and household pet ownership with the risk of attention-deficit/hyperactivity disorder (ADHD) are inconclusive, and the joint effects of only-child status and household pet ownership on ADHD have not been thoroughly investigated. Methods A population-based study was conducted in 2021 involving preschool children aged 3–6 years attending kindergartens in Longhua District, Shenzhen, China. Parents were invited to complete questionnaires providing information on socio-demographic and family-environmental factors. ADHD symptoms were assessed using the 26-item Swanson, Nolan, and Pelham Rating Scale as reported by parents. Results This study included 63,282 children (mean age: 4.86 ± 0.85 years, 53.6% boys), representing 72.6% of all preschool children in this district in 2021. Among them, 34.4% were only-child and 9.6% were identified as having ADHD. Only-child status was associated with an increased risk of ADHD [adjusted odds ratio: 1.30 (95%CI: 1.23–1.38). Compared to children without a pet (cats or dogs) at ages 0–3 years, pet ownership at ages only 0–1 year, only 1–3 years, and both ages were associated with increased odds of ADHD: 1.59 (1.30–1.95), 1.58 (1.28–1.93), and 1.66 (1.42–1.92), respectively, after controlling for potential confounders. A significant interaction between pet ownership at only 1–3 years and only-child status was observed (adjusted P for interaction = 0.028). Similar findings were observed when the analyses were performed separately for boys and girls. Conclusion Both only-child status and household pet ownership are associated with an increased risk of ADHD; however, the detrimental effect of pet ownership appears to be mitigated among only children when pet exposure occurs at ages 1–3 years, providing new insight into reducing family-related risk factors of ADHD.
... It is becoming widely recognized that one aspect of mental health support is involvement with companion animals. While there have been reported the positive effects of companion animals on children's and adolescents' mental health (Black, 2012;Gadomski et al., 2015;Lem et al., 2016), some studies have indicated negative effects or no significant association (Miles et al., 2017;Żebrowska et al., 2023;Gilbey et al., 2007;Koivusilta and Ojanlatva, 2006;Gillum and Obisesan, 2010), or mixed effects dependent on pet species (Endo et al., 2020). For an example of positive effect, adolescents who owned pets felt less loneliness than those who did not (Black, 2012). ...
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The mental health of adolescents is an important issue, since it has a significant impact on their future lives. In this regard, one of the methods for supporting adolescents’ mental health is the interaction with companion animals, which is becoming widely recognized. In our previous research, we showed that owning companion animals has positive effects on adolescents’ wellbeing and cultural estrangement. However, the effect was notably small. The findings of studies examining companion animals and mental health are inconsistent. These results suggest the need to not only focus on pet ownership, but also how their relationship with companion animals such as attitudes toward animals and attachment. In addition, the impact of cultural estrangement on wellbeing is not always negative, and their relationship may not be a simple correlation. Therefore, this study focused on individuals with high cultural estrangement and aimed to clarify how attitudes toward animals and attachment to their pets differ depending on whether their wellbeing is high or low. Based on the results, the group with high cultural estrangement and high wellbeing exhibited an anthropocentric attitude and a strong interest in nature and ecology. In addition, the group with high cultural estrangement and high wellbeing exhibited close attachment to their pets, which functioned as confidants. This finding highlights the specific role of such animals in supporting adolescents’ mental health during this critical developmental stage.
... Research suggests that positive family and social support systems are associated with resilient outcomes in children experiencing social adversity (Gartland et al., 2019). Additionally, pets have been shown to increase children's resilience and self-worth (Purewal et al., 2017), including the reduction and prevention of depressive symptoms (Gadomski et al., 2015). These findings are corroborated by a recent meta-analysis which found that social support-based interventions yielded the largest positive effects for action-based resilience outcomes (i.e., functional and/or performance-related activities in relation to the intervention) (Liu et al., 2020). ...
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Background Understanding resilience factors in children is essential for developing early mental health interventions. Middle childhood is an understudied developmental stage, with many quantitative measures lacking validation for this age group and not capturing diverse experiences. This study aimed to use body mapping, an arts-based method, as a novel approach to understand 7-10-year-old children’s concepts of resilience (including definitions and factors that contribute to resilience) in East London. An advisory group of six children commented on the findings. Methods Body mapping was included in the Development of Emotional Resilience (DEER) Study. Participants drew a resilience symbol, wrote recent worries and colored on an A4-sized body map to signal where they embody stress. Demographic data were collected via self- and parent-report surveys and school records. Manifest content analysis identified four thematic categories related to worries, somatic stress and resilience. Results 196 children (48.47% boys, 46.43% girls; 35.20% White, 30.10% Asian, 11.22% Black) across school years 3–5 completed body mapping. Concepts of resilience included perseverance and metaphorical representations of personal strength. We also identified socioecological factors that contributed to resilience, mainly at the individual and interpersonal levels. Boys more often depicted Sports whilst more girls depicted Engagement in the arts and Social networks. 11 worry categories emerged, including education, relationships and physical health. Of the body categories colored (n = 51), the most common were the head, hands and abdomen/stomach. Conclusion Children expressed dominant and abstract symbols of resilience and identified factors that contributed to resilience. Hobbies and strong relationships may be particularly important in middle childhood, corroborated by the advisory group’s experiences. Body mapping revealed diverse worries (e.g., education, change and uncertainty and global and societal concerns) and somatic experiences of stress (e.g., the head, chest and torso). Through prioritising children’s perspectives, body mapping holds promise in clinical and educational settings.
... Feelings of loneliness and isolation from others are reduced [8][9][10] in children and adolescents with a canine companion, particularly for homeless youth [9,10]. Similarly, reductions in anxiety [30] or reductions in the probability of developing childhood anxiety [31] are reported with dog ownership. Stress is a major health concern in children, particularly today, as children are faced with social challenges brought on by the pandemic, such as missed opportunities for face-to-face social interaction during a period of development when social and emotional behaviors and skills are still developing. ...
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Simple Summary There is evidence to suggest that the strength of the social attachment that forms between a human and their pet dog is important for maximizing the therapeutic outcomes of pet dog ownership, more so than the presence of a dog alone. Here, we review the literature to determine whether this evidence is supported specifically in children with pet dogs. We discuss the benefits to child health and well-being that are associated with pet dog ownership, the neural and endocrinological mechanisms that may support these intra-species attachments, and the importance of taking a dyadic approach to the study of this topic in the future. Abstract An increasing body of evidence indicates that owning a pet dog is associated with improvements in child health and well-being. Importantly, the degree of the social bond between child and dog may mediate the beneficial outcomes of dog ownership. The formation of social bonds is an intrinsically dyadic, interactive process where each interactor’s behavior influences the other’s behavior. For this reason, it is critical to evaluate the biological mechanisms of attachment in both children and their pet dogs as a socially bonded pair. Here, we review the physical, mental, and emotional outcomes that are associated with pet dog ownership or interaction in children. We then discuss the evidence that suggests that the strength of a social bond between a child and their pet dog matters for maximizing the beneficial outcomes associated with pet dog ownership, such as possible stress-buffering effects. We review the existing literature on the neural and endocrinological mechanisms of social attachment for inter-species social bonds that form between human children and dogs, situating this emerging knowledge within the context of the mechanisms of intra-species bonds in mammals. Finally, we highlight the remaining open questions and point toward directions for future research.
... Scientific studies indicate positive health effects of having pets around both children and adults. Owning a cat or dog positively influences physical activity, lowers blood pressure, reduces the risk of obesity, reduces anxiety, and shapes pro-social behavior, reducing the risk of social isolation among the elderly [1][2][3][4]. However, pet ownership is not advisable in every case. ...
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Background: Some epidemiological studies suggest that early exposure to animal allergens during infancy reduces the risk of bronchial asthma in school-age children. However, the observed associations in some cases may be an effect of the study used (epidemiological observational studies, especially a cross-sectional study) and indicate reverse causality. Aim: This study aimed to determine the association between exposure to animal allergens and the prevalence of respiratory diseases, including bronchial asthma, considering the potential impact of reverse causality on the observed relationships. Material and methods: An analysis of data from a cross-sectional epidemiological study conducted in 2020 involving 3237 primary school students aged 7–15 years in the Silesian Province (Southern Poland) was carried out. The parents of students completed a questionnaire based on The International Study on Asthma and Allergies in Childhood (ISAAC). The relationship between the occurrence of chronic cough, wheezing, and dyspnea in the last 12 months, night waking due to dyspnea, and asthma in the presence of pets was assessed. Exposure to animal allergens was determined by answering the question, “Are there any furry or feathered animals in the home?” with three response options: “yes; they have been in the past; no” (Scenario 1). For the analyses and to reveal a potential reverse causality effect, the last two response categories regarding pet ownership were combined to form a “no” category in Scenario 2, and the first two answers were combined into a “yes” category in Scenario 3. A chi-square test was used to assess the relationship between variables, and a statistical significance level of p < 0.05 was adopted. Results: Chronic cough affected 9.5% of children, wheezing in the last 12 months—9.2%, night waking due to dyspnea—5.8%, dyspnea in the last 12 months—4.8%, bronchial asthma—9.2%. Analysis considering the category of having or not having pets (yes vs. no) showed that bronchial asthma was statistically significantly more common in children who did not have pets at home (10.9% vs. 7.9%, p = 0.002). A similar situation was observed for wheezing in the past 12 months (10.7% vs. 8.1%; p = 0.01) and nocturnal awakening due to dyspnea (6.8% vs. 5.1%, p = 0.03). No statistically significant differences were observed for the other symptoms. Analysis by time of pet ownership (a. present; b. present but in the past; c. not present) highlighted similar relationships. Asthma (a. 7.7% vs. b. 13.4% vs. c. 7.7%; p = 0.004), wheezing in the past 12 months (a. 8.1% vs. b. 8.9% vs. c. 10.9%, p = 0.03) and night waking (a. 5.0% vs. b. 4.5% vs. c. 7.1%; p = 0.04) were more common in children without pets and those who had owned pets in the past. The highest proportion of children with asthma was in homes where pets were present in the past. Conclusions: Analyses indicating a relationship between a higher prevalence of asthma and some respiratory symptoms, and the absence of pets cannot be considered as a casual association. The analysis conducted did not reveal a reverse causality effect. The results of observational epidemiological studies, especially a cross-sectional study, should always be interpreted with caution, considering possible distortions and conclusions drawn.
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Introduction: Dog ownership is common in families with children and could play a role in children's social-emotional development. This study used longitudinal data on dog ownership and changing dog ownership to investigate their effects on young children's social-emotional development. Methods: Parents reported family dog ownership when their child was aged 2-5 years and at 5-7 years. Children (n = 591) were assigned to a dog ownership group by combining their current and prior dog ownership status. The parent-report Strengths and Difficulties Questionnaire (SDQ) measured children's social-emotional development at 5-7 years. Analyses included linear, Poisson, and logistic regression and adjusted for socio-demographic factors. Results: Girls who acquired a dog had significantly higher peer problems scores than non-dog owner girls (exp(β) = 1.8; 95% CI 1.3, 2.6). Boys who acquired a dog had significantly lower peer problems scores than continuing non-dog owner boys (exp(β) = 0.5; 95% CI 0.3, 0.8). There were no other significant effects observed between dog ownership group and SDQ scores or the odds of having abnormal scores. Conclusions: Overall, changing or continuing dog ownership status had minimal impact on young children's social-emotional development. Future longitudinal research should examine the effects of dog ownership on child development by family characteristics and attachment to the dog. Impact: Dog acquisition was associated with higher peer problems for girls and lower peer problems for boys, but not the odds of having abnormal peer problems scores. Dog acquisition, dog loss, and continuing dog ownership status were not associated with other measure of social-emotional development. This study used longitudinal data to examine effects of dog ownership on child development. Overall, changing or continuing dog ownership status had minimal impact on young children's social-emotional development. Since dog ownership is selected into, longitudinal research is needed to confirm if changes in children's social-emotional development occur following changes in dog ownership.
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Bu araştırma evcil hayvan sahibi olmanın çocukların psikolojik iyi oluşları üzerindeki etkisini incelemek amacıyla yapılmıştır. Alanyazın tarandığında yurtiçinde evcil hayvan sahibi olmanın çocukların psikolojik iyi oluşları üzerindeki etkisini inceleyen bir araştırmaya rastlanmadığından bu çalışma ile literatüre katkı sağlamak amaçlanmıştır. Araştırmanın örneklemini 9-12 yaş grubu çocuklar oluşturmuştur. Araştırmada veri toplama aracı olarak kişisel bilgi formu ve çocukların psikolojik iyi oluşlarını ölçmek için “Stirling Çocuklar için Duygusal ve Psikolojik İyi Oluş Ölçeği” kullanılmıştır. Araştırmanın bulgularında, evcil hayvana sahip olan çocukların psikolojik iyi oluş puanları ve evcil hayvana sahip olmayan çocukların psikolojik iyi oluş puanları arasındaki fark anlamlı bulunmuştur. Evcil hayvana sahip olan çocukların psikolojik iyi oluş puanları anlamlı düzeyde daha yüksektir. Evcil hayvana sahip olan çocukların, evcil hayvana sahip olma süresine göre psikolojik iyi oluş puanlarında anlamlı düzeyde farklılık bulunamamıştır. Çocukların psikolojik iyi oluş puanlarının, cinsiyete, kardeş durumuna, doğum sırasına, anne-baba öğrenim durumuna, algılanan gelir durumuna ve anne çalışma durumuna göre anlamlı bir farklılık göstermediği saptanmıştır. Bu sonuç doğrultusunda, özellikle pandemi sonrası çocuklarımızın hayatında daha da önemli bir yere sahip olan evcil hayvanların, çocukların psikolojik iyi oluştaki bu olumlu etkisinin, çocuklardaki duygu ve davranış sorunlarını önlemede de önemli olacağı düşünülmektedir.
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During the last decade it has become more widely accepted that pet ownership and animal assistance in therapy and education may have a multitude of positive effects on humans. Here, we review the evidence from 69 original studies on human-animal interactions (HAI) which met our inclusion criteria with regard to sample size, peer-review, and standard scientific research design. Among the well-documented effects of HAI in humans of different ages, with and without special medical, or mental health conditions are benefits for: social attention, social behavior, interpersonal interactions, and mood; stress-related parameters such as cortisol, heart rate, and blood pressure; self-reported fear and anxiety; and mental and physical health, especially cardiovascular diseases. Limited evidence exists for positive effects of HAI on: reduction of stress-related parameters such as epinephrine and norepinephrine; improvement of immune system functioning and pain management; increased trustworthiness of and trust toward other persons; reduced aggression; enhanced empathy and improved learning. We propose that the activation of the oxytocin system plays a key role in the majority of these reported psychological and psychophysiological effects of HAI. Oxytocin and HAI effects largely overlap, as documented by research in both, humans and animals, and first studies found that HAI affects the oxytocin system. As a common underlying mechanism, the activation of the oxytocin system does not only provide an explanation, but also allows an integrative view of the different effects of HAI.
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Although the increased prevalence of childhood obesity in the United States has been documented, little is known about its incidence. We report here on the national incidence of obesity among elementary-school children. We evaluated data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999, a representative prospective cohort of 7738 participants who were in kindergarten in 1998 in the United States. Weight and height were measured seven times between 1998 and 2007. Of the 7738 participants, 6807 were not obese at baseline; these participants were followed for 50,396 person-years. We used standard thresholds from the Centers for Disease Control and Prevention to define "overweight" and "obese" categories. We estimated the annual incidence of obesity, the cumulative incidence over 9 years, and the incidence density (cases per person-years) overall and according to sex, socioeconomic status, race or ethnic group, birth weight, and kindergarten weight. When the children entered kindergarten (mean age, 5.6 years), 12.4% were obese and another 14.9% were overweight; in eighth grade (mean age, 14.1 years), 20.8% were obese and 17.0% were overweight. The annual incidence of obesity decreased from 5.4% during kindergarten to 1.7% between fifth and eighth grade. Overweight 5-year-olds were four times as likely as normal-weight children to become obese (9-year cumulative incidence, 31.8% vs. 7.9%), with rates of 91.5 versus 17.2 per 1000 person-years. Among children who became obese between the ages of 5 and 14 years, nearly half had been overweight and 75% had been above the 70th percentile for body-mass index at baseline. Incident obesity between the ages of 5 and 14 years was more likely to have occurred at younger ages, primarily among children who had entered kindergarten overweight. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.).
Article
To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit. A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented for a well-child visit with a child 4 to 10 years of age. Parents completed an electronic previsit screen, which included somatic concerns, health risks, and 4 mental health tools (SCARED5, PHQ-2, SDQ Impact, and PSC-17). Parents completed an exit survey, and a subset were interviewed. All primary care providers (PCPs) were interviewed. A total of 120 parents and 16 PCPs participated. The exit surveys showed that nearly 90% of parents agreed or strongly agreed that the screener was easy to use and maintained confidentiality. During interviews, parents noted that the screener helped with recall, validated concerns, reframed issues they thought might not be appropriate for primary care, and raised new questions. PCPs thought that the screener enabled them to normalize sensitive issues, and it permitted them to simultaneously focus and be comprehensive during the visit. Parents and PCPs agreed that the screener helped guide discussion, promoted in-depth exchange, and increased efficiency. Findings were consistent across quantitative and qualitative methods and between parents and PCPs. A comprehensive electronic previsit screening tool is an acceptable and practical strategy to facilitate well-child visits. It may help with problem identification as well as with setting agendas, engaging the family, and balancing attention between somatic and psychosocial concerns.
Article
Background: Routine use of a brief psychosocial screening instrument has been proposed as a means of improving recognition, management, and referral of children's psychosocial morbidity in primary care.
Article
Objective: To replicate and extend work on the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a child and parent self-report instrument used to screen for children with anxiety disorders. Method: The 41-item version of the SCARED was administered to a new sample of 190 outpatient children and adolescents and 166 parents. The internal consistency, discriminant, and convergent validity were assessed. In addition, using discriminant function analysis, a briefer version of the SCARED was developed. Results: Using item analyses and factor analyses on the 41-item version, 5 factors were obtained: panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia. In general, the total score and each of the 5 factors for both the child and parent SCARED demonstrated good internal consistency and discriminant validity (both between anxiety and depressive and disruptive disorders and within anxiety disorders). A reduced version of the SCARED yielded 5 items and showed similar psychometrics to the full SCARED. Conclusions: In a new sample, the authors replicated their initial psychometric findings that the SCARED is a reliable and valid instrument to screen for childhood anxiety disorders in clinical settings. Furthermore, pending future research, the 5-item SCARED appears to be a promising brief screening inventory for anxiety disorders in epidemiological studies.
Article
Community epidemiological data on the prevalence and correlates of adolescent mental disorders are needed for policy planning purposes. Only limited data of this sort are available. To present estimates of 12-month and 30-day prevalence, persistence (12-month prevalence among lifetime cases and 30-day prevalence among 12-month cases), and sociodemographic correlates of commonly occurring DSM-IV disorders among adolescents in the National Comorbidity Survey Replication Adolescent Supplement. The National Comorbidity Survey Replication Adolescent Supplement is a US national survey of DSM-IV anxiety, mood, behavior, and substance disorders among US adolescents based on face-to-face interviews in the homes of respondents with supplemental parent questionnaires. Dual-frame household and school samples of US adolescents. A total of 10,148 adolescents aged 13 to 17 years (interviews) and 1 parent of each adolescent (questionnaires). The DSM-IV disorders assessed with the World Health Organization Composite International Diagnostic Interview and validated with blinded clinical interviews based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Good concordance (area under the receiver operating characteristic curve ≥0.80) was found between Composite International Diagnostic Interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children diagnoses. The prevalence estimates of any DSM-IV disorder are 40.3% at 12 months (79.5% of lifetime cases) and 23.4% at 30 days (57.9% of 12-month cases). Anxiety disorders are the most common class of disorders, followed by behavior, mood, and substance disorders. Although relative disorder prevalence is quite stable over time, 30-day to 12-month prevalence ratios are higher for anxiety and behavior disorders than mood or substance disorders, suggesting that the former are more chronic than the latter. The 30-day to 12-month prevalence ratios are generally lower than the 12-month to lifetime ratios, suggesting that disorder persistence is due more to episode recurrence than to chronicity. Sociodemographic correlates are largely consistent with previous studies. Among US adolescents, DSM-IV disorders are highly prevalent and persistent. Persistence is higher for adolescents than among adults and appears to be due more to recurrence than chronicity of child-adolescent onset disorders.
Article
The aim of this study was to examine the influence of maternal health status (MHS) on the relationship between child health conditions and child health status (CHS). The study sample included 38 207 children aged 5 to 17 years in the 2001 to 2008 National Health Interview Surveys whose mothers were the survey respondent for the child and herself. Information was collected about CHS, MHS, diagnosed child health conditions, and sociodemographic characteristics. Responses to a question on general health status were used to rate CHS and MHS as "better" (excellent/very good health) or "worse" (good/fair/poor health). The percentage of children with worse CHS, adjusted for sociodemographic characteristics, was estimated using logistic regression. Adjusting for child and family sociodemographic characteristics had a negligible effect on the association between CHS and a 4-level variable that classified children by both MHS and child health conditions. The adjusted percentage of children with worse CHS was higher among children whose mothers had worse MHS compared with children whose mothers had better MHS. Moreover, among children whose mothers had worse MHS, there was a weak relationship between child health conditions and worse CHS. Among children whose mothers had better MHS, there was a strong relationship between child health conditions and worse CHS. Because mother-reported CHS is used widely in epidemiological studies as a measure of a child's actual state of health, it is important to consider how maternal characteristics may influence a mother's report of a child's status. In particular, CHS reported by mothers with worse health status merits further investigation.