Also associated with higher rates of injury-related hospitalization and mortality

Young children whose parents have severe mental illness had higher rates of injury events, injury hospitalization, and death related to injury compared to children of parents without severe mental illness, a population-based, retrospective cohort study from Taiwan reported.

The study, by Shiow-Wen Yang, MD, PhD, Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan, and colleagues was published in JAMA Pediatrics.

Research on the impact of parental mental illness on childhood health has mainly focused on areas such as maternal depression and its effects on child cognitive and language development. There have also been studies that have found an association between parental severe mental illness (SMI) and adverse neonatal outcomes such as low birth weight and premature birth. However, the effect of parental SMI on other aspects of childhood health are uncertain.

In this study, Yang and colleagues, noting that injury is a leading cause of childhood morbidity and mortality, wanted to determine whether young children of patients with severe mental illness are at a greater risk of injury than children of parents without severe mental illness.

The authors carried out a retrospective cohort study using data from the Taiwan National Health Insurance Research Database, the Maternal and Child Health Database, and birth and death certificate databases over an 11-year period. The study included 1,999,322 children who were followed from birth to their fifth birthday from Jan. 1, 2004 to Dec. 31, 2014, or date of death.

Parental SMI was defined as physician-diagnosed mental illnesses, including schizophrenia, bipolar disorder, and major depressive disorder. The study’s main outcomes included rates of medically attended injury events, injury hospitalization, and injury death.

Of the children in the study cohort, 1,082,064 (54.1%) suffered injuries. More children with parental SMI (61.0%) than without (53.8%) suffered injuries. Injury rates among children who were exposed to parental SMI (294.8 injury events per 1,000 person-years) were higher than among children who were unexposed (256.1 injury events per 1,000 person-years).

After adjustment for sociodemographic factors, children with parental SMI had 14% greater rates of injury events (IRR, 1.14; 95% CI, 1.13-1.15), 49% higher rates of injury hospitalization (IRR, 1.49; 95% CI, 1.42-1.57), and 82% higher rates of death due to injury (IRR, 1.82; 95% CI, 1.38-2.39) compared with children without parental SMI.

The authors also looked at appendicitis as a negative control outcome and found that it was not associated with parental SMI. In addition, children with and without parental SMI had similar patterns of preventive care, with prenatal and well-child visits slightly lower among children with parental SMI (mean number of 8.09 prenatal visits and 5.70 well-child visits) compared with children without parental SMI (8.17 prenatal visits and 5.80 well-child visits).

Considering the results of the study, Yang and colleagues suggested that effectively managing parental SMI could reduce child injury. “Evidence suggests that home visiting programs are associated with improved maternal depression symptoms and reduced child injury,” they pointed out. “Reducing stigma toward mental health treatment, enhancing parenting skills, and enacting home safety interventions for parents with SMI may contribute to a reduction in injury risk for their children.”

In an editorial accompanying the study, John V. Campo, MD, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, and colleagues wrote that it “generates important questions and a foundation for future research.”

For example, they pointed out that SMI is associated with factors such as poverty and substance abuse, making it difficult to break down the specific association between parental SMI and child health. And factors such as increased risks of premature birth, low birth weight, and mental and neurodevelopmental disorders in children of parents with SMI could be associated with increased risk for injury in this population, they noted.

Still, whatever the mechanisms associating parental SMI and childhood injury and mortality, “children born to parents with SMI represent a population at special risk,” wrote Campo and his colleagues, adding that the issue of mental health across generations must be taken seriously. “To address the multifaceted and intergenerational effects of SMI, our efforts to intervene must focus not only on parent mental health or child mental health but also on family mental health.”

  1. Children whose parents have severe mental illness (SMI) had higher rates of injuries, injury-related hosptializations, and injury-related mortality the children of patients without SMI.

  2. Be aware that parental SMI was defined as physician-diagnosed mental illnesses, including schizophrenia, bipolar disorder, and major depressive disorder.

Michael Bassett, Contributing Writer, BreakingMED™

Yang and Campo reported no disclosures.

Cat ID: 146

Topic ID: 87,146,933,138,192,146,925