Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden

Abstract

Objective To determine the association between parental mental illness and the risk of injuries among offspring. Design Retrospective cohort study. Setting Swedish population based registers. Participants 1 542 000 children born in 1996-2011 linked to 893 334 mothers and 873 935 fathers. Exposures Maternal or paternal mental illness (non-affective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress related disorders, eating disorders, personality disorders) identified through linkage to inpatient or outpatient healthcare registers. Main outcome measures Risk of injuries (transport injury, fall, burn, drowning and suffocation, poisoning, violence) at ages 0-1, 2-5, 6-9, 10-12, and 13-17 years, comparing children of parents with mental illness and children of parents without mental illness, calculated as the rate difference and rate ratio adjusted for confounders. Results Children with parental mental illness contributed to 201 670.5 person years of follow-up, while children without parental mental illness contributed to 2 434 161.5 person years. Children of parents with mental illness had higher rates of injuries than children of parents without mental illness (for any injury at age 0-1, these children had an additional 2088 injuries per 100 000 person years; number of injuries for children with and without parental mental illness was 10 235 and 72 723, respectively). At age 0-1, the rate differences ranged from 18 additional transport injuries to 1716 additional fall injuries per 100 000 person years among children with parental mental illness compared with children without parental mental illness. A higher adjusted rate ratio for injuries was observed from birth through adolescence and the risk was highest during the first year of life (adjusted rate ratio at age 0-1 for the overall association between any parental mental illness that has been recorded in the registers and injuries 1.30, 95% confidence interval 1.26 to 1.33). Adjusted rate ratios at age 0-1 ranged from 1.28 (1.24 to 1.32) for fall injuries to 3.54 (2.28 to 5.48) for violence related injuries. Common and serious maternal and paternal mental illness was associated with increased risk of injuries in children, and estimates were slightly higher for common mental disorders. Conclusions Parental mental illness is associated with increased risk of injuries among offspring, particularly during the first years of the child’s life. Efforts to increase access to parental support for parents with mental illness, and to recognise and treat perinatal mental morbidity in parents in secondary care might prevent child injury.

Associations between pre-pregnancy psychosocial risk factors and infant outcomes: a population-based cohort study in England

“…2 , 8 For example, the crude risk differences in birthweight observed in this study were similar to those seen when comparing smoking and non-smoking mothers (150–200 g) and relative risks were comparable to those identified for parental mental health and infant injuries (1·3). 11 , 12 By considering and adjusting for a range of psychosocial risk factors within a national cohort, our study fills a gap in evidence on which factors are associated with the greatest population attributable risk.…”

“…Previous evidence has identified associations between poor birth and infant outcomes and risk factors that are routinely recorded in hospital records such as young maternal age, parity, risky behaviours (including smoking, drug or alcohol misuse, or poor diet), exposure to intimate partner violence, maternal mental health, and poor engagement with antenatal care services. 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Routine hospital records can be used to identify psychosocial risk factors and their influence on child outcomes. 11 , 17 , 18 , 19 However, most previous studies focused on single risk factors, and there is a gap in the evidence on which of these risk factors—when considered together—are associated with the highest risk.…”

“… 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Routine hospital records can be used to identify psychosocial risk factors and their influence on child outcomes. 11 , 17 , 18 , 19 However, most previous studies focused on single risk factors, and there is a gap in the evidence on which of these risk factors—when considered together—are associated with the highest risk. There is an absence of studies using routine records to explore multiple psychosocial risk factors across maternal age groups, before and during early pregnancy.…”

Death in childhood and adolescence: Accident!

“…These follow-ups may be in the form of both knowledge determination and psychological evaluation together with the training of families during and after pregnancy. [ 30 ] It is important for every family physician to have a basic level of knowledge in the differentiation of accident and child abuse in order to handle these cases correctly. In some countries, children are followed up by family physicians for their development after birth.…”

Injuries in the children of parents living with mental illness

“…In a linked study, Nevriana and colleagues (doi:10.1136/bmj.m853) report a large analysis of preventable injuries in children whose parents were living with mental illness 2. This retrospective cohort study used national Swedish longitudinal health and administrative registers to examine associations between all types of maternal and paternal mental illness and risk of injuries from birth to adolescence.…”