This study provides nationally representative prevalence estimates of internalizing mental health symptoms among children with special health care needs (CSHCN) and identifies significant covariates of these symptoms by using multivariate regression. Internalizing symptoms include feeling anxious and depressed.


Data were obtained from the 2005–2006 National Survey of Children with Special Health Care Needs, a nationally representative, parent-reported, cross-sectional survey of 40 465 CSHCN. The presence of internalizing mental health symptoms was assessed by using 2 binary items capturing whether a child had or experienced difficulty with depression, anxiety, disordered eating, or other emotional problems. The odds of experiencing internalizing symptoms were assessed by using multivariate regression, controlling for sociodemographic, health-related, and burden-related covariates.


A total of 31.9% of CSHCN 3 to 17 years of age experienced internalizing mental health symptoms. Multivariate logistic regression showed internalizing symptoms to be strongly associated with female gender, older age, and frequent activity limitations, as well as externalizing mental health symptoms and conditions with behavioral components. Children with behavior problems had 6 times the odds of internalizing symptoms (adjusted odds ratio [aOR]: 5.95 [95% confidence interval [CI]: 5.30–6.69]), whereas children with autism spectrum disorder had 3 times the odds (aOR: 3.00 [95% CI: 2.39–3.77]). Increased odds of symptoms also were associated with frequent headaches (aOR: 1.76 [95% CI: 1.45–2.13]) and chronic pain (aOR: 1.46 [95% CI: 1.22–1.75]). Odds of symptoms were greater for children living in households that experienced employment changes or financial burdens resulting from the children's needs.


Internalizing mental health symptoms are common among CSHCN. Findings may help caregivers focus screening and prevention efforts for high-risk groups in this heterogeneous population.

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