Children of parents with mental illness at increased risk of injuries

Parents with mental illness appear to increase the risk of injuries in their offspring from birth through adolescence, particularly during the first year of their child’s life, according to a study.

“[T]here could be potential benefits to child injury prevention of increasing access to parental support for parents who are mentally ill and recognizing and treating perinatal mental illness among parents in secondary care,” the researchers said.

This retrospective cohort study identified a total of 1,542,000 children born in 1996–2011 linked to 893,334 mothers and 873,935 fathers using Swedish population-based registers. Maternal or paternal mental illness (eg, nonaffective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress-related disorders, seating disorders, personality disorders) were determined through linkage to inpatient or outpatient healthcare registers.

The researchers calculated the risk of injuries (eg, 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 patients with and without mental illness, as the rate difference and rate ratio (RR) adjusted for confounders.

Children with parental mental illness contributed to 201,670.5 person-years of follow-up, while those without contributed to 2,434,161.5 person-years. Children of parents with vs without mental illness had higher injury rates, experiencing an additional 2,088 injuries per 100,000 person-years at age 0–1. The rate differences at age 0–1 ranged from 18 additional transport injuries to 1,716 additional fall injuries per 100,000 person-years among children with vs without parental mental illness. [BMJ 2020;369:m853]

There was a higher adjusted RR for injuries reported from birth through adolescence, with the highest risk observed during the first year of the child’s life (adjusted RR at age 0–1 for the overall association between parental mental illness and injuries, 1.30, 95 percent confidence interval [CI], 1.26–1.33). At age 0–1, the adjusted RRs ranged from 1.28 (95 percent CI, 1.24–1.32) for fall injuries to 3.54 (95 percent CI, 2.28–5.48) for violence-related injuries.

Common and serious parental mental illness correlated with an increased risk of injuries in children, with slightly higher estimates for common mental disorders.

Although the mechanism driving the association between parental mental illness and increased risk of injuries among children appears to be complicated, several studies suggest that parents with a mental illness are less responsive to the child and its environment. [Infant Behav Dev 2008;31:532-538; J Pediatr Psychol 2014;39:349-357]

“Alongside such notions is the understanding that some parents with mental illness could find it harder to be vigilant and to maintain parental supervision,” the researchers said. “This might be especially important during the first years of life when the child is beginning to crawl and walk and needs a great deal of attention.”

It is also likely that parents with mental illness are not able to implement simple safety practices, with an earlier study suggesting that maternal depression is associated with a lack of understanding of parental prevention practices. [Infant Behav Dev 2010;33:1-6]

“[E]arly screening and treatment of perinatal mental illness in mothers and fathers might reduce the child’s risk of injury, including the risk of exposure to violence,” the researchers said, noting, however, that most people with mental illness do not have violent behaviour. [Int J Clin Pract 2017;71:1-7]