Maternal depression and risk of injuries in children aged 0–4 years: a population-based cohort study

Abstract

BackgroundThe association between maternal depression and childhood injuries is underexplored, with existing studies relying on maternal reporting of injury occurrences. We aimed to assess the association between the incidence of three common childhood injuries and exposure to maternal antenatal depression, postnatal depression, or both. MethodsUsing a cohort of 209 418 mother–child pairs who had linked data from the Clinical Practice Research Datalink and Hospital Episode Statistics for 1997–2014, we estimated incidence of poisonings, fractures, and burns per 10 000 person-years from birth to the child's fifth birthday, stratified by whether the mother had antenatal depression, postnatal depression, or both. One child was randomly selected per mother to prevent clustering. Using Poisson regression, we estimated incidence rate ratios (IRRs), adjusted for maternal age at delivery, socioeconomic status, number of older siblings, and number of children aged 0–4 years in the household. The study was approved by the Independent Scientific Advisory Committee for the Medicines and Healthcare products Regulatory Agency in February, 2014. FindingsCrude injury rates were higher for each injury type among children whose mothers had antenatal depression, postnatal depression, or both. Poisoning incidence per 10 000 person-years was 59·6 (95% CI 48·7–72·8) for children of mothers with antenatal depression, 64·4 (57·4–72·2) for children of mothers with postnatal depression, and 74·2 (63·2–87·1) for children of mothers with both, compared with 36·3 (34·8–37·8) for those unexposed to either antenatal or postnatal depression. Similar patterns were seen for fractures and burns. After adjustment, IRRs remained significant for poisonings and burns, with the greatest risk for children whose mothers had both antenatal and postnatal depression (poisonings 1·94, 95% CI 1·63–2·32; burns 1·32, 1·13–1·55). However, there was no significant association between fractures and perinatal depression. InterpretationAntenatal and postnatal depression were associated with a higher risk of child poisonings and burns, suggesting that maternal depression could be a modifiable risk factor for these types of injury. By using routinely collected health data we only identified women who sought medical attention for depression, and were unable to adjust for other variables such as child behaviour. Differences in the ascertainment of injury events between mothers with and without perinatal depression could lead to an overestimation of injury risk. Further work could include assessing certain injuries (eg, long-bone fractures) for which ascertainment is likely to be almost complete. FundingRB is funded by the National Institute for Health Research (NIHR) School for Primary Care Research and the University of Nottingham.