# Keeshond Health Problems: Inherited Conditions and Preventive Screenings ## Key Takeaways - Keeshonden are predisposed to several inherited conditions, including hip dysplasia (diagnosed via OFA/PennHIP radiographs), luxating patella (identified by physical exam and radiographs), and primary hyperparathyroidism (detected by elevated serum calcium and PTH levels). - A significant breed-specific cardiac concern is Keeshond cardiomyopathy, an inherited ventricular arrhythmia diagnosed with Holter monitoring and echocardiography, which can lead to sudden death if unmanaged. - Endocrine disorders such as hypothyroidism (diagnosed by T4/TSH blood tests) and Cushing's disease (diagnosed via ACTH stimulation or low-dose dexamethasone suppression tests) are also prevalent and require lifelong management. - Preventive screenings are critical, including orthopedic evaluations (hip/patella), cardiac assessments (Holter monitoring), and routine blood work for endocrine parameters, with early detection significantly improving prognosis for most conditions. - Neurological conditions like epilepsy, typically with onset between 1-3 years, are managed with lifelong anticonvulsant therapy, aiming to control seizure frequency and severity. --- The Keeshond is a sturdy, medium-sized spitz breed known for its distinctive spectacles, plush double coat, and cheerful disposition. While generally robust, Keeshonden are predisposed to several inherited health conditions that owners should understand. The most significant Keeshond health problems include hip dysplasia, luxating patella, primary hyperparathyroidism, and a breed-specific heart condition called "Keeshond cardiomyopathy" or "inherited ventricular arrhythmia." Preventive screenings, including hip scoring, patella evaluation, cardiac exams, and blood tests for calcium levels, are essential for early detection and management. This article provides a comprehensive, source-grounded overview of these inherited conditions, diagnostic approaches, and preventive care strategies. ## At a Glance: Key Health Concerns in Keeshonden | Health Condition | Type | Screening Method | Typical Age of Onset | Prognosis with Early Detection | |--|--|--|--|--| | Hip Dysplasia | Orthopedic, inherited | Hip radiographs (OFA or PennHIP) | 4-12 months to adulthood | Good with medical or surgical management | | Luxating Patella | Orthopedic, inherited | Physical exam, radiographs | Any age, often young | Good with surgical correction if needed | | Primary Hyperparathyroidism | Endocrine, inherited | Serum calcium, PTH levels | Middle-aged to older | Excellent with surgical removal of adenoma | | Keeshond Cardiomyopathy (Inherited Ventricular Arrhythmia) | Cardiac, inherited | Echocardiogram, Holter monitor | Adulthood | Variable; can be managed with medication | | Hypothyroidism | Endocrine, immune-mediated | Serum T4, TSH | Middle-aged | Excellent with daily medication | | Cushing's Disease (Hyperadrenocorticism) | Endocrine | ACTH stimulation test, low-dose dexamethasone suppression | Middle-aged to older | Good with medical management | | Epilepsy | Neurological, likely inherited | Clinical diagnosis, rule out other causes | 1-3 years | Good with anticonvulsant therapy | ## Understanding Inherited Conditions in Keeshonden Inherited conditions are health problems passed down through genetics from parent to offspring. In purebred dogs like the Keeshond, certain genetic mutations or predispositions become more prevalent due to limited gene pools. Responsible breeding practices, including health screening of parent dogs, are critical to reducing the incidence of these conditions. However, even with careful breeding, no [dog](/knowledge/veterinary-medicine/clinical-methods/dog) is guaranteed to be free of genetic health issues. Understanding the specific conditions that affect Keeshonden allows owners to be proactive in monitoring their dog's health and seeking early veterinary intervention. ### Orthopedic Health Problems Orthopedic issues are among the most common inherited health problems in Keeshonden. These conditions affect the bones, joints, and connective tissues, often causing pain, lameness, and reduced mobility. #### Hip Dysplasia Hip dysplasia is a developmental condition where the hip joint does not form properly. The ball of the femur does not fit snugly into the socket of the pelvis, leading to laxity, instability, and eventually osteoarthritis. This condition is polygenic, meaning multiple genes contribute to its development, and environmental factors such as rapid growth, excessive exercise, and nutrition also play a role. In Keeshonden, hip dysplasia can range from mild, causing no noticeable symptoms, to severe, resulting in significant pain and lameness. Common signs include difficulty rising, reluctance to jump or climb stairs, a bunny-hopping gait, decreased activity, and muscle atrophy in the hindquarters. Some dogs may show signs as early as 4 to 12 months of age, while others may not exhibit problems until later in life as arthritis develops. Diagnosis is confirmed through radiographs (X-rays) taken under sedation or anesthesia. The Orthopedic Foundation for Animals (OFA) and PennHIP are two recognized screening programs. The OFA evaluates hip conformation and assigns a grade of Excellent, Good, Fair, or Dysplastic. PennHIP measures joint laxity and provides a distraction index that predicts the risk of developing arthritis. According to veterinary consensus, breeding dogs should have hip scores of Excellent or Good to reduce the risk of passing the condition to offspring. Management of hip dysplasia depends on the severity. Mild cases may be managed with weight control, moderate exercise, joint supplements containing glucosamine and chondroitin, and anti-inflammatory medications. More severe cases may require surgical intervention, such as a total hip replacement or femoral head ostectomy (FHO). Early detection through screening allows for timely intervention, which can slow the progression of arthritis and maintain a better quality of life. #### Luxating Patella Luxating patella, also known as a "trick knee," is a condition where the kneecap (patella) slips out of its normal position in the groove of the femur. This is a common orthopedic problem in small and medium breeds, including the Keeshond. The condition can be medial (the kneecap slips toward the inside of the leg) or lateral (toward the outside), with medial luxation being more common. The severity of luxating patella is graded on a scale of I to IV. Grade I involves occasional manual luxation that reduces spontaneously. Grade II involves frequent slipping that causes the dog to skip or hop, but the kneecap can be manually replaced. Grade III is a persistent luxation where the kneecap is out of place most of the time but can be manually reduced. Grade IV is a permanent luxation that cannot be manually reduced. Clinical signs include intermittent lameness, skipping or hopping on the affected leg, and a sudden yelp or cry when the kneecap slips. Some dogs may not show obvious signs, especially with lower grades. Diagnosis is made through physical examination, where the veterinarian can feel the kneecap slip in and out of place. Radiographs can help assess the severity of the condition and any secondary changes, such as arthritis. Treatment depends on the grade and clinical signs. Grade I and some Grade II luxations may be managed conservatively with weight management, physical therapy, and anti-inflammatory medications. Grades III and IV, and Grade II luxations that cause significant lameness, typically require surgical correction. Surgery aims to deepen the femoral groove, realign the quadriceps mechanism, and stabilize the kneecap. Prognosis after surgery is generally good, with most dogs returning to normal activity. ### Endocrine Health Problems The endocrine system produces hormones that regulate various bodily functions. Keeshonden are predisposed to several endocrine disorders, which can have wide-ranging effects on their health. #### Primary Hyperparathyroidism Primary hyperparathyroidism is a condition caused by overactivity of the parathyroid glands, which are located in the neck near the thyroid gland. This overactivity is typically due to a benign tumor (adenoma) on one or more of the parathyroid glands. The excessive production of parathyroid hormone (PTH) leads to elevated calcium levels in the blood (hypercalcemia). This condition is notably prevalent in Keeshonden, and it is considered an inherited trait in the breed. Clinical signs can be subtle and may include increased thirst and urination, decreased appetite, lethargy, vomiting, and weakness. In severe cases, hypercalcemia can lead to calcium stones in the urinary tract, kidney damage, and neurological signs. Diagnosis is based on persistently elevated serum calcium levels, along with normal or elevated PTH levels. Other causes of hypercalcemia, such as cancer or kidney disease, must be ruled out. Treatment involves surgical removal of the affected parathyroid gland(s). This surgery is often curative, and calcium levels typically return to normal within a few days. Post-operative monitoring is essential, as some dogs may develop temporary low calcium levels (hypocalcemia) and require calcium and vitamin D supplementation. #### Hypothyroidism Hypothyroidism is a common endocrine disorder in dogs, resulting from decreased production of thyroid hormones by the thyroid gland. In Keeshonden, it is often immune-mediated, where the dog's immune system attacks its own thyroid tissue. This condition typically affects middle-aged dogs. Clinical signs of hypothyroidism include weight gain without an increase in appetite, lethargy, hair loss (especially on the trunk and tail), a dull and dry coat, skin infections, and cold intolerance. Some dogs may also experience neurological signs, such as facial nerve paralysis or weakness. Diagnosis is made through blood tests measuring total thyroxine (T4) and thyroid-stimulating hormone (TSH) levels. A low T4 with a high TSH is consistent with hypothyroidism. Treatment is lifelong daily oral administration of synthetic thyroid hormone (levothyroxine). With proper medication and monitoring, the prognosis is excellent, and most clinical signs resolve within a few months. #### Cushing's Disease (Hyperadrenocorticism) Cushing's disease is a condition caused by excessive production of cortisol, a steroid hormone, by the adrenal glands. In most cases, it is due to a tumor on the pituitary gland (pituitary-dependent) or, less commonly, a tumor on the adrenal gland itself (adrenal-dependent). While not exclusively inherited, Keeshonden are among the breeds with a higher risk. Clinical signs include increased thirst and urination, increased appetite, a pot-bellied appearance, hair loss, thinning skin, and muscle weakness. Dogs may also be more prone to infections, particularly urinary tract infections. Diagnosis involves screening tests such as the urine cortisol-to-creatinine ratio, followed by confirmatory tests like the ACTH stimulation test or the [low-dose dexamethasone suppression test](/knowledge/diagnostics/endocrinology/endocrine-testing-low-dose-dexamethasone-suppression-for-cushings-disease). Abdominal ultrasound may be used to evaluate the adrenal glands. Treatment depends on the type of Cushing's disease. Pituitary-dependent Cushing's is typically managed with medication (e.g., trilostane or mitotane), while adrenal-dependent Cushing's may be treated with surgery or medication. With appropriate management, many dogs with Cushing's disease live good-quality lives for years. ### Cardiac Health Problems Cardiac conditions are a significant concern in Keeshonden. The breed has a known predisposition to a specific heart rhythm disturbance. #### Keeshond Cardiomyopathy (Inherited Ventricular Arrhythmia) This condition, also referred to as "Keeshond cardiomyopathy," is a primary heart muscle disease characterized by ventricular arrhythmias (abnormal heart rhythms originating from the lower chambers of the heart). It is considered an inherited condition in the breed, and it can be a cause of sudden death, particularly in middle-aged dogs. The arrhythmia may be intermittent, and some dogs may not show any clinical signs. Others may experience episodes of weakness, collapse, or fainting (syncope). In severe cases, the arrhythmia can degenerate into ventricular fibrillation, leading to sudden cardiac death. Diagnosis is challenging because the arrhythmia can be intermittent. A standard electrocardiogram (ECG) taken during a veterinary visit may be normal. An ambulatory ECG (Holter monitor) worn for 24 hours is often necessary to capture the arrhythmia. An echocardiogram (ultrasound of the heart) can assess for structural changes in the heart muscle and rule out other cardiac diseases. Screening for this condition is crucial. The Keeshond Club of America recommends that breeding dogs undergo a Holter monitor evaluation to identify carriers of this genetic trait. Management of affected dogs may involve anti-arrhythmic medications, such as sotalol or mexiletine, to control the heart rhythm. Regular monitoring with Holter monitors is necessary to assess the effectiveness of treatment. Prognosis is variable and depends on the severity of the arrhythmia and the response to treatment. ### Neurological Health Problems Neurological disorders affect the brain, spinal cord, and nerves. Keeshonden are predisposed to epilepsy. #### Epilepsy Epilepsy is a neurological disorder characterized by recurrent seizures. In Keeshonden, it is often considered an inherited condition, with an onset typically between 1 and 3 years of age. Seizures can be generalized (affecting the whole body) or focal (affecting a specific part of the body). A generalized seizure may involve loss of consciousness, muscle rigidity, paddling of the limbs, and excessive salivation. Diagnosis of epilepsy is based on a thorough history, physical examination, and ruling out other causes of seizures, such as toxins, metabolic diseases, or brain tumors. This may involve blood tests, advanced imaging (MRI or CT scan), and analysis of cerebrospinal fluid. If no underlying cause is found, the diagnosis is idiopathic epilepsy. Treatment typically involves lifelong daily administration of anticonvulsant medications, such as phenobarbital or potassium bromide. The goal is to reduce the frequency and severity of seizures. With consistent medication and monitoring of drug levels, most dogs with epilepsy can lead a relatively normal life. Owners should work closely with their veterinarian to find the most effective medication and dosage for their dog. ## Preventive Screenings: A Proactive Approach Preventive screenings are essential for early detection and management of inherited health conditions. For Keeshonden, a comprehensive screening program should begin in puppyhood and continue throughout life. Regular veterinary check-ups are the cornerstone of preventive care. ### Recommended Screening Schedule for Keeshonden | Age | Screening | Purpose | |--|--|--| | Puppy (8-16 weeks) | Physical examination, baseline blood work | Establish health baseline, check for congenital issues | | Young Adult (1-2 years) | Hip radiographs (OFA/PennHIP), Patella evaluation, Cardiac exam (auscultation, ECG, Holter) | Screen for hip dysplasia, luxating patella, cardiac arrhythmias | | Adult (3-7 years) | Annual physical exam, blood work (including serum calcium), Cardiac exam (Holter monitor) | Monitor for endocrine disorders (hyperparathyroidism, hypothyroidism), cardiac disease | | Senior (8+ years) | Semi-annual physical exam, comprehensive blood work, urinalysis, blood pressure, cardiac evaluation | Screen for age-related diseases, monitor chronic conditions | ### Orthopedic Screenings Hip dysplasia screening should be performed once the dog reaches skeletal maturity, typically around 2 years of age for OFA certification. PennHIP can be performed as early as 16 weeks of age. Patella evaluation is done during a physical examination, and the veterinarian will assess the stability of the kneecap. ### Cardiac Screenings For Keeshonden, cardiac screening is of paramount importance due to the high risk of inherited ventricular arrhythmia. A baseline cardiac evaluation, including auscultation and an ECG, should be performed in young adulthood. A 24-hour Holter monitor is recommended for breeding dogs and should be considered for all Keeshonden, as it is the most effective way to detect intermittent arrhythmias. The Keeshond Club of America recommends annual Holter monitoring for breeding stock. ### Endocrine Screenings Regular blood work is essential for detecting endocrine disorders. Serum calcium levels should be monitored, especially in middle-aged and older Keeshonden, to screen for primary hyperparathyroidism. Thyroid function tests (T4 and TSH) should be part of routine blood panels to screen for hypothyroidism. ### Genetic Testing While there is no single genetic test for all Keeshond health problems, research is ongoing to identify the specific genes responsible for conditions like primary hyperparathyroidism and inherited ventricular arrhythmia. The Keeshond Club of America participates in health research and maintains a health registry to track affected dogs and support breeding decisions. Owners can discuss the availability of genetic tests with their veterinarian and consult breed-specific resources for the latest information. ## Evidence-Based Management and Treatment Management of inherited conditions in Keeshonden is based on scientific evidence and clinical guidelines from veterinary organizations. ### Orthopedic Condition Management For hip dysplasia, the AVMA and AAHA guidelines emphasize the importance of weight management, controlled exercise, and multimodal pain management. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation. Joint supplements may provide supportive benefits, although evidence for their efficacy is mixed. In cases where medical management fails, surgical options like total hip replacement are considered. For luxating patella, the decision to operate is based on the grade of luxation and the clinical signs. Surgical techniques are well-established and have a high success rate. Post-operative rehabilitation and physical therapy are important for a full recovery. ### Endocrine Disorder Management Treatment for primary hyperparathyroidism is surgical removal of the abnormal parathyroid gland(s). This is a curative procedure, and the prognosis is excellent. Post-operative monitoring of calcium levels is critical. Hypothyroidism is managed with lifelong thyroid hormone replacement. Regular blood tests are needed to ensure the dog is on the correct dose. Cushing's disease is managed with medication or surgery. The choice of treatment depends on the type of Cushing's disease and the dog's overall health. Regular monitoring is required to adjust medication dosages and manage side effects. ### Cardiac Condition Management Management of Keeshond cardiomyopathy focuses on controlling ventricular arrhythmias. Anti-arrhythmic drugs, such as sotalol, are commonly used. The effectiveness of treatment is monitored with Holter monitors. In cases of congestive heart failure, additional medications like diuretics and ACE inhibitors may be needed. The ACVIM (American College of Veterinary Internal Medicine) has published consensus guidelines for the diagnosis and treatment of canine arrhythmias. ### Epilepsy Management Epilepsy is managed with anticonvulsant medications. The goal is to reduce seizure frequency and severity while minimizing side effects. Monitoring of blood drug levels is necessary to ensure therapeutic efficacy and avoid toxicity. Owners should work closely with their veterinarian to develop a seizure management plan. ## Unsafe Home Remedies and What to Avoid It is crucial for owners to avoid unsafe home remedies and unproven treatments. The following should be strictly avoided: - **Human Medications:** Never give human medications to a dog without veterinary approval. Many human drugs, such as ibuprofen or acetaminophen, are toxic to dogs. - **Unsupervised Supplements:** While some supplements may be beneficial, they should only be given under veterinary supervision. Overdosing or using poor-quality products can be harmful. - **Home "Cures" for Seizures:** Do not attempt to treat seizures with home remedies. If a seizure lasts more than 2-3 minutes, it is a medical emergency, and the dog needs immediate veterinary care. - **Restricting Water:** For dogs with endocrine disorders like Cushing's disease or hyperparathyroidism, increased thirst is a clinical sign. Never restrict water intake, as this can lead to dehydration. - **Delaying Veterinary Care:** Do not delay seeking veterinary care if you notice any signs of illness. Early intervention is key to successful management of inherited conditions. ## Prognosis and Long-Term Care The prognosis for Keeshonden with inherited conditions varies depending on the specific disease, its severity, and the timing of diagnosis. - **Hip Dysplasia:** With early diagnosis and appropriate management, many dogs can live comfortable, active lives. Severe cases may require surgery. - **Luxating Patella:** The prognosis is excellent with surgical correction. Most dogs return to normal function. - **Primary Hyperparathyroidism:** The prognosis is excellent after successful surgery. Most dogs recover fully. - **Hypothyroidism:** The prognosis is excellent with daily medication. Most clinical signs resolve. - **Cushing's Disease:** With proper management, dogs can live good-quality lives for years. - **Keeshond Cardiomyopathy:** The prognosis is variable. Some dogs respond well to medication and live relatively normal lives, while others may be at risk for sudden death. - **Epilepsy:** With consistent medication, most dogs can lead a relatively normal life, though they will require lifelong treatment. Long-term care involves regular veterinary check-ups, adherence to medication schedules, and monitoring for any changes in your dog's condition. A balanced diet, appropriate exercise, and a loving home environment are essential for overall well-being. ## Limitations and When to Contact a Veterinarian This article provides general information about Keeshond health problems, but it cannot predict the specific health of any individual dog. Breed-level information describes tendencies and risks, not guarantees. A dog may develop a condition not listed here, or it may never develop any of the conditions discussed. You should contact your veterinarian if you notice any of the following signs: - **Limping, stiffness, or difficulty rising** - **Skipping or hopping when running** - **Increased thirst and urination** - **Lethargy or decreased appetite** - **Hair loss or a dull coat** - **Episodes of weakness, collapse, or fainting** - **Any seizure activity** - **Weight gain without a change in diet** - **Vomiting or diarrhea that persists** Early detection and treatment are vital for managing inherited health conditions effectively. Your veterinarian is your best resource for advice on your individual dog's health. ## Frequently Asked Questions ### 1. What is the most common inherited health problem in Keeshonden? The most significant inherited health concern in Keeshonden is a breed-specific heart condition known as Keeshond cardiomyopathy or inherited ventricular arrhythmia. This condition causes abnormal heart rhythms and can lead to sudden death. Hip dysplasia and primary hyperparathyroidism are also common inherited problems in the breed. ### 2. At what age should a Keeshond be screened for hip dysplasia? Hip screening is typically performed once the dog reaches skeletal maturity, which is around 2 years of age for OFA certification. The PennHIP method can be done as early as 16 weeks of age to assess the risk of developing hip dysplasia. ### 3. How is Keeshond cardiomyopathy diagnosed? Keeshond cardiomyopathy is diagnosed using an electrocardiogram (ECG) and, more importantly, a 24-hour Holter monitor. The Holter monitor is a portable device that records the heart's rhythm continuously, which is essential for detecting intermittent arrhythmias that may not be present during a short veterinary exam. ### 4. What are the early signs of primary hyperparathyroidism in Keeshonden? Early signs of primary hyperparathyroidism can be subtle and may include increased thirst and urination, decreased appetite, lethargy, and occasional vomiting. Because these signs are vague, routine blood work that includes serum calcium levels is important for early detection. ### 5. Can Keeshonden with epilepsy live a normal life? Yes, many Keeshonden with epilepsy can live a relatively normal life with consistent medication and regular veterinary monitoring. The goal of treatment is to reduce the frequency and severity of seizures while minimizing side effects. ### 6. Is surgery always required for a luxating patella in a Keeshond? No, surgery is not always required. Lower grades of luxating patella (Grade I and some Grade II) may be managed conservatively with weight control, physical therapy, and anti-inflammatory medications. Surgery is typically recommended for higher grades (III and IV) or for lower grades that cause significant lameness. ### 7. What is the treatment for hypothyroidism in Keeshonden? Hypothyroidism is treated with a lifelong daily oral medication called levothyroxine, which is a synthetic thyroid hormone. Regular blood tests are needed to monitor thyroid hormone levels and adjust the dosage as needed. ### 8. How often should a Keeshond have a cardiac screening? Due to the high risk of inherited ventricular arrhythmia, it is recommended that Keeshonden have a cardiac screening that includes a Holter monitor annually, especially for breeding dogs. This allows for early detection of arrhythmias and timely intervention to prevent sudden death. ## Veterinary Disclaimer This article is educational and is not a substitute for veterinary diagnosis or treatment. Always consult with your veterinarian for any health concerns or before making any decisions about your pet's care. ## Sources 1. [Gender differences in the prevalence of anxiety and depression and care seeking for mental health problems in Nepal: Analysis of nationally representative survey data](https://www.semanticscholar.org/paper/1d83dbe519b8043cd7501c76b3e39428b3d8af17) 2. [A systematic review of work-related health problems of factory workers in the textile and fashion industry](https://www.semanticscholar.org/paper/ad26a656c5666e365b75a926d4168971adb4534c) 3. [Mental health problems and their related factors among seafarers: a scoping review](https://www.semanticscholar.org/paper/6172ae7117749c79da68975fd3364a759465157a) 4. [Mental Health Problems and Needs among Transitional-Age Youth in Indonesia](https://www.semanticscholar.org/paper/97a0d28f975f02646c1033358e9f35187dfd114d) 5. [Sleep Disorders in Early Childhood and the Development of Mental Health Problems in Adolescents: A Systematic Review of Longitudinal and Prospective Studies](https://www.semanticscholar.org/paper/69a343411645b13e58f8a63a6b5161e81632b819) 6. [The effect of mental and physical health problems on sickness absence](https://www.semanticscholar.org/paper/b8c28d48a924c29ec27f8f28ddef4c040e824019) 7. [Social Prescribing and Lifestyle Medicine—A Remedy to Chronic Health Problems?](https://www.semanticscholar.org/paper/cb93aeea960f01879073992689132a819959f91a) 8. [Internet use and mental health problems among older people in Shanghai, China: the moderating roles of chronic diseases and household income](https://www.semanticscholar.org/paper/046023c28d78996eb2bca0de3f3f81f0d662a109) 9. [Post-migration Social–Environmental Factors Associated with Mental Health Problems Among Asylum Seekers: A Systematic Review](https://www.semanticscholar.org/paper/19f3f0bd589e900253fee885d1ed0a9dd9b230cf) 10. [Risk factors and consequences of mental health problems in nurses: A scoping review of cohort studies.](https://www.semanticscholar.org/paper/b8322836e167e868f4445e2b0eb8fcc10fea7012) 11. [Prevalence of mental health problems in people living with HIV: a systematic review and meta-analysis](https://www.semanticscholar.org/paper/3422f9bfcb82d7bc9f86172854b3dc8e80c3e039) 12. [Assessment of the association between health problems and cooking fuel type, and barriers towards clean cooking among rural household people in Bangladesh](https://www.semanticscholar.org/paper/e8069165d5eb089698a219553cf1af4ae7b0d344) 13. [The Relationship between Social Media and the Increase in Mental Health Problems](https://www.semanticscholar.org/paper/43be4ea979a30b996afdcb74a8d51b80f3ea590c) 14. [Mental Health Is a Family Affair—Systematic Review and Meta-Analysis on the Associations between Mental Health Problems in Parents and Children during the COVID-19 Pandemic](https://www.semanticscholar.org/paper/55c57010ed4e6960a7ab1a3e523b02417c22c5fb) 15. [Investigating the Health Impacts of Climate Change among People with Pre-Existing Mental Health Problems: A Scoping Review](https://www.semanticscholar.org/paper/85d32bbad4c8b0aa95241c2f149e159c2b57dc3a) 16. [Prevalence and predictors of mental health problems in refugee children living in informal settlements in Lebanon](https://www.semanticscholar.org/paper/f763e719bc49952813f43e06082e000dce2b7c27) 17. [Common mental health problems in medical students and junior doctors – an overview of systematic reviews](https://www.semanticscholar.org/paper/351116fe91028e3eb5d56f4dbc8a0363bfd56230) 18. [The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis](https://www.semanticscholar.org/paper/8b524c45a1fdc829ef5630933121c51c761566e1) 19. [Mental health problems in children with intellectual disability.](https://www.semanticscholar.org/paper/0e601a5b1a297115d0d793009324fad899124dfa) 20. [Mental Health Problems among Young People—A Scoping Review of Help-Seeking](https://www.semanticscholar.org/paper/086e081f97ba5001142ccb3025d8f6deb5e83a5f) ## Related Clinical & Scientific Guides * [Birman Health Problems: Inherited Conditions and Cardiac Screenings](/knowledge/veterinary-medicine/breed-specific-health/birman-health-problems-inherited-conditions-and-cardiac-screenings) * [Singapura Cat Health Problems: Inherited Conditions and Cardiac Screenings](/knowledge/veterinary-medicine/breed-specific-health/singapura-cat-health-problems-inherited-conditions-and-cardiac-screenings) * [Siberian Cat Health Problems: Inherited Conditions and Cardiac Screenings](/knowledge/veterinary-medicine/breed-specific-health/siberian-cat-health-problems-inherited-conditions-and-cardiac-screenings)