Maternal Mental Health after Custody Loss and Death of a Child: A Retrospective Cohort Study Using Linkable Administrative Data

Wall‐Wieler, Elizabeth; Roos, Leslie L.; Bolton, James M.; Brownell, Marni; Nickel, Nathan; Château, Dan

doi:10.1177/0706743717738494

Cited by 32 publications

(17 citation statements)

References 28 publications

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“…In our study, the high rate of premature mortality among the mothers of infants with NAS was mirrored by high rates for the mothers of control infants discharged to social services and for mothers with a history of hospitalization for addiction. Other studies have demonstrated maternal well-being declining in association with the loss of a child to foster care [42,47], whereas retaining care of the child may help facilitate treatment [48]. An estimated 7%–20% of NAS-affected infants do not return home with their mother at the time of postnatal discharge from hospital [49–52], which is similar to the percentage in our study (10%–15%).…”

Section: Discussionsupporting

confidence: 84%

Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada

Guttmann

Blackburn²,

Amartey

et al. 2019

PLoS Med

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BackgroundOpioid addiction is a major public health threat to healthy life expectancy; however, little is known of long-term mortality for mothers with opioid use in pregnancy. Pregnancy and delivery care are opportunities to improve access to addiction and supportive services. Treating neonatal abstinence syndrome (NAS) as a marker of opioid use during pregnancy, this study reports long-term maternal mortality among mothers with a birth affected by NAS in relation to that of mothers without a NAS-affected birth in 2 high-prevalence jurisdictions, England and Ontario, Canada.Methods and findingsWe conducted a population-based study using linked administrative health data to develop parallel cohorts of mother–infant dyads in England and Ontario between 2002 and 2012. The study population comprised 13,577 and 4,966 mothers of infants with NAS and 4,205,675 and 929,985 control mothers in England and Ontario, respectively. Death records captured all-cause maternal mortality after delivery through March 31, 2016, and cause-specific maternal mortality to December 31, 2014. The primary exposure was a live birth of an infant with NAS, and the main outcome was all deaths among mothers following their date of delivery. We modelled the association between NAS and all-cause maternal mortality using Cox regression, and the cumulative incidence of cause-specific mortality within a competing risks framework. All-cause mortality rates, 10-year cumulative incidence risk of death, and crude and age-adjusted hazard ratios were calculated. Estimated crude 10-year mortality based on Kaplan–Meier curves in mothers of infants with NAS was 5.1% (95% CI 4.7%–5.6%) in England and 4.6% (95% CI 3.8%–5.5%) in Ontario versus 0.4% (95% CI 0.41%–0.42%) in England and 0.4% (95% CI 0.38%–0.41%) in Ontario for controls (p < 0.001 for all comparisons). Survival curves showed no clear inflection point or period of heightened risk. The crude hazard ratio for all-cause mortality was 12.1 (95% 11.1–13.2; p < 0.001) in England and 11.4 (9.7–13.4; p < 0.001) in Ontario; age adjustment did not reduce the hazard ratios. The cumulative incidence of death was higher among NAS mothers than controls for almost all causes of death. The majority of deaths were by avoidable causes, defined as those that are preventable, amenable to care, or both. Limitations included lack of direct measures of maternal opioid use, other substance misuse, and treatments or supports received.ConclusionsIn this study, we found that approximately 1 in 20 mothers of infants with NAS died within 10 years of delivery in both England and Canada—a mortality risk 11–12 times higher than for control mothers. Risk of death was not limited to the early postpartum period targeted by most public health programs. Policy responses to the current opioid epidemic require effective strategies for long-term support to improve the health and welfare of opioid-using mothers and their children.

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Section: Discussionsupporting

confidence: 84%

Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada

Guttmann

Blackburn²,

Amartey

et al. 2019

PLoS Med

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“…Child removal often results in increased substance use among mothers (e.g. Kenny et al, 2015, Wall-Wieler et al, 2017.…”

Section: Treatment Contactmentioning

confidence: 99%

Time to look beyond ageing as a factor? Alternative explanations for the continuing rise in drug related deaths in Scotland

McPhee

Sheridan

O’Rawe

2018

DAT

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Purpose-The purpose of this paper is to examine the reasons and risk factors that explain the threefold increase in drug-related deaths from 267 in 1996 to 934 in 2017 in Scotland. The authors explore the known links between deprivation and problem drug use (PDU) and discuss the impact of drug policy and service provision on PDU and drug-related deaths. Design/methodology/approach-Using quantitative data sets from the National Records of Scotland (NRS) for drug-related deaths registered in 2017 and data sets from the Scottish Index of Multiple Deprivation (SIMD), we produce statistical data on mortality rates relating to areas of deprivation, gender and age. Findings-The data highlight the disproportionate number of deaths in the most deprived areas in comparison to the least deprived areas and the national average. Findings indicate that one quarter of male and female DRD in 2017 were under 35. When examining the least deprived vingtile, drugrelated deaths account for 2.84 per 100,000 population. Based on this mortality rate calculation, the amount of drug-related deaths are 23 times higher in the most deprived area than the least deprived area. Research limitations/implications-The research design uses data obtained from the NRS and data from Scottish Multiple Index of Deprivation. Due to the limitations of available data, the research design focused on SIMD population vingtiles. Practical implications-This research contributes to making unarguable links between entrenched structural inequality and increased drug-related death. Social implications-This paper contributes to knowledge on the need for drug policy advisors to recognise the importance of deprivation that plays a major part in risks of problematic drug use and harms. Originality/value-While several national data sets have published information by SIMD vingtile, no published research has sought to investigate the disproportionate number of deaths by population in the most deprived areas.

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“…we matched on few variables and adjusted only for age), previous research into deaths among women whose children entered care in Manitoba, Canada and Sweden has shown that higher rates of death remain after adjusting for other mortality risk-factor and different control groups such as biological sisters or women whose children died. [14,47,48] Strengths and limitations This is one of the first UK studies to describe maternal mental health service use among women involved in care proceedings, focused on England. Though the SLaM population may vary in terms of population demographics and service availability from other parts of the UK -potentially affecting the generalisability of these findings -we found similarly high rates of mental health need among women in proceedings as were found in Wales.…”

Section: Findings In Contextmentioning

confidence: 99%

Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007-2019

Pearson¹,

Grant²,

Wijlaars³

et al. 2021

Preprint

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Background Research in England suggests a high burden of mental health problems and substance misuse among women whose children enter care. Family courts therefore need to consider timely support for parental mental health and likely time to recovery within public family law proceedings concerning placement of a child into care (‘care proceedings’). We report population-based evidence from linked, routinely collected, de-identified records on the type and severity of maternal mental health problems in relation to care proceedings. Methods We linked family court data and mental health service records for 2137 (66%) of women involved in care proceedings between 2007-2019 in the South London and Maudsley NHS Mental Health Trust (SLaM) catchment area. We compared their mental health service use and risk of dying with 17,096 female matched controls who accessed SLaM between 2007 and 2019, aged 16-55 years old. Results Most women (79%) were known to SLaM before care proceedings began. Compared to the matched controls, women had higher rates of schizophrenia spectrum disorders (19% vs 11% matched controls), personality disorders (21% vs 11%), and substance misuse (33% vs 12%). They were more likely to be admitted to a SLaM inpatient unit (27% vs 14%) or to be sectioned under the Mental Health Act (19% vs 8%). Finally, women had a 2.15 (95% CI: 1.68 to 2.74) times greater hazard of dying, compared with the matched controls, adjusted for age. Conclusions Given the high prevalence and severity of mental health problems among women involved in care proceedings, family law and social care policy is needed to ensure adequate and timely treatment for parent mental health problems. The increased risk of dying among those accessing mental health services highlights the critical need for post-proceeding services to ensure parents whose children enter care continue to receive support after care proceedings conclude.

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Maternal Mental Health after Custody Loss and Death of a Child: A Retrospective Cohort Study Using Linkable Administrative Data

Cited by 32 publications

References 28 publications

Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada

Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada

Time to look beyond ageing as a factor? Alternative explanations for the continuing rise in drug related deaths in Scotland

Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007-2019

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