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Network analysis of functional disabilities and their association with mental well-being in children and adolescents: multi-country study across low- and middle-income countries

Shanquan Chen,E. Fernández-Egea,Sara Rotenberg,R. Cardinal,D. B. Machado,T. Smythe,T. Ford,Hannah Kuper

Published 2025 in British Journal of Psychiatry

ABSTRACT

Background To develop effective mental health interventions for children and adolescents, it is essential to understand the intricate link between functional disability and mental well-being in this group. Aims To explore the network connections between various aspects of functional disability and mental well-being in young people with disabilities. Method We analysed data from the Multiple Indicator Cluster Surveys in 47 low- and middle-income countries, tracking progress towards health-related sustainable development goals. Our focus was on children and adolescents aged 5–17 with functional disabilities. Mental well-being was gauged using carer-reported signs of depression, anxiety and disability on the Child Functioning Module. Network-analysis techniques were used to examine links between mental well-being and functional disability domains. Results The study included 32 669 eligible children aged 5–17 with functional disabilities (14 826 females and 17 843 males). The core domains of disability with the strongest connections to poor mental well-being were difficulties in accepting change, making friends, behavioural control (controlling own behaviour) and remembering/concentrating. These associations remained largely consistent across different genders and developmental stages. However, there were notable gender differences and age-related shifts in the relationships between specific disabilities and mental well-being. In particular, signs of anxiety in males and depression in females were most associated with functional disability overall, while signs of depression had the closest links to disability in adolescents. Conclusions The network perspective may enable the design of tailored interventions and support services that consider age and gender differences. Further research should continue to explore these complex relationships, incorporating novel methodologies like network-analysis to enhance the understanding of these associations.

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