Abstract
The general health of children of parents with mental illness is overlooked. To quantify the difference in healthcare use of children exposed and unexposed to maternal mental illness (MMI). This was a retrospective cohort study of children aged 0-17 years, from 1 April 2007 to 31 July 2017, using a primary care register (Clinical Practice Research Datalink) linked to Hospital Episodes Statistics. MMI included non-affective/affective psychosis and mood, anxiety, addiction, eating and personality disorders. Healthcare use included prescriptions, primary care and secondary care contacts; inflation adjusted costs were applied. The rate and cost was calculated and compared for children exposed and unexposed to MMI using negative binomial regression models. The total annual cost to NHS England of children with MMI was estimated. The study included 489 255 children: 238 106 (48.7%) girls, 112 741 children (23.0%) exposed to MMI. Compared to unexposed children, exposed children had a higher rate of healthcare use (rate ratio 1.27, 95% CI 1.26-1.28), averaging 2.21 extra contacts per exposed child per year (95% CI 2.14-2.29). Increased healthcare use among exposed children occurred in inpatients (rate ratio 1.37, 95% CI 1.32-1.42), emergency care visits (rate ratio 1.34, 95% CI 1.33-1.36), outpatients (rate ratio 1.30, 95% CI 1.28-1.32), prescriptions (rate ratio 1.28, 95% CI 1.26-1.30) and primary care consultations (rate ratio 1.24, 95% CI 1.23-1.25). This costs NHS England an additional £656 million (95% CI £619-£692 million), annually. Children of mentally ill mothers are a health vulnerable group for whom targeted intervention may create benefit for individuals, families, as well as limited NHS resources.
Highlights
The general health of children of parents with mental illness is overlooked
Using Swedish registers, we recently demonstrated that children are at greater risk of injury when exposed to maternal common or addiction disorders compared with serious MMI.[6]
When we did adjust for a measure of socioeconomic deprivation, we found similar sized effects
Summary
The general health of children of parents with mental illness is overlooked. Much attention has been paid to the risk of mental illness in children and adolescents exposed to parental mental illness, but it is increasingly clear that the overall health (including physical health) of these young people requires further investigation.[1]. Previous work, including our recent studies,[1,6,7] suggests that mothers with mental illness are less likely to take up preventive public health services,[8,9,10,11] including childhood vaccinations,[7,8,12,13] and may be more likely to use acute health services[6,12,14,15,16,17] for their children than mothers without mental illness These analyses focus on maternal depression[9,12,13,17] and secondary care outcomes.[14,15,16,17] For example, in a UK registry study (N = 25 252), children of mothers with depression used in-patient and emergency services significantly more often than children of mothers without depression (odds ratio 1.67, 95% CI 1.32–2.11).[17]
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