Children of parents suffering from mental health problems (most notably depression and substance abuse) are at higher risk of injuries in comparison to other children, as reported in a new study from Karolinska Institute in Sweden published in the British Medical Journal (BMJ).
The association between mental illness in parents and the risk of injuries in offspring is already well-established. However, the rising burden of the problem is worrisome; in the United States, roughly 18 percent of all parents present with some kind of mental illness, whereas in the United Kingdom, approximately one-quarter of all children are exposed to maternal mental illness.
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A comprehensive, nationwide study approach
Most studies so far have focused only on common mental disorders, specific maternal exposure, and younger children, and did not separate risks by type of injuries. Conversely, this new BMJ study, authored by Alicia Nevriana and her colleagues, addressed the aforementioned critical information gaps by detailing associations between all types of mental illness (from mothers and fathers alike) and risk of different injury types among their children from birth to adolescence.
By using national Swedish longitudinal health and administrative registers in a retrospective cohort study design, study authors ended up with a sizable dataset to answer their questions – i.e. more than 1,5 million children born between 1996 and 2011, of whom more than 330 thousand had at least one parent with a mental illness diagnosis.
The highest risk was found for children up to one year of age, where a striking 30 percent increased risk of injuries was found in instances when there was a parent with mental illness. Although the risk declined with age, it remained somewhat higher for children even in the 13-17 age groups (i.e., a 6 percent increase).
Furthermore, the risk of injuries was shown to be slightly higher for common mental disorders (such as anxiety, depression, and stress-related illnesses), compared to serious conditions such as schizophrenia and psychosis. Additionally, the risk was somewhat higher for maternal mental illness in comparison to paternal one, as well as for more uncommon injury types (such as interpersonal violence).
Translating data into practice
In a nutshell, the study findings suggest that there may be certain benefits to child injury prevention if access to parental support for those mentally ill is increased. Furthermore, risk can also be mitigated by recognizing and treating mental illness that arises immediately before and after birth, among parents in secondary care.
This confirmed by Alicia Nevriana, the study's corresponding author and Ph.D. student at the Department of Global Public Health of Karolinska Institute in Sweden. "Our results show there is a need for increased support to parents with mental illness, especially during the first year of life", she explains.
But the pertinent question is, how can we accurately translate data and evidence that are both uncomfortable and often misunderstood to inform policy measures and practice that will protect children as the most vulnerable group?
"It is a difficult balance to strike," says Dr. Antonis A Kousoulis, director of public mental health research, programs and policy functions at the Mental Health Foundation across England and Wales. "If we are to implement measures and care that are more likely to be successful in these families, we need greater understanding and action at many levels."
And naturally, a 'one size fits all' approach is not applicable in public health; thus, desired effects cannot be expected just by enabling better access to universal programs. Instead, targeted solutions should be designed in co-production with patients, explains Dr. Kousoulis.
The significance of socioeconomic conditions
And one of the targets should be socioeconomic factors since it is known that the prevalence distribution of mental illness and violence follows the social gradient. "Mental illness is often associated with worse socioeconomic conditions, which might lead to the family living in a less safe in- and outdoor environment or cannot afford some security measures," Nevriana says.
"We cannot entirely exclude that the higher risks in our study might be partly explained by the family's socioeconomic conditions, even though we tried to control for socioeconomic factors as best as we could," she adds.
This study adds timely weight to what we already know about the need for person-centered and early interventions in mental health," Dr. Kousoulis concludes in his analysis. "To achieve sustainable change, we need to place the lived experience of citizens at the core of research, decisions, and interventions in mental health across sectors, disciplines, and countries."
In the meantime, while the journey to reduce the burden of mental health stigma in societies around the world is ongoing, future studies on this topic need to pinpoint specific needs and appraise the implementation of targeted home safety interventions in families with parental mental illness.
- Nevriana Alicia, Pierce Matthias, Dalman Christina, Wicks Susanne, Hasselberg Marie, Hope Holly et al. Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden BMJ 2020; 369 :m853, https://www.bmj.com/content/369/bmj.m853
- Kousoulis, A.A. (2020) Injuries in the children of parents living with mental illness. British Medical Journal (BMJ). 10.1136/bmj.m1317, https://www.bmj.com/content/369/bmj.m1317