Abstract
Reduced vaccination uptake is a growing and global public health concern. There is limited knowledge about the effect of maternal mental illness (MMI) on rates of childhood vaccination. This retrospective cohort study examined 479,949 mother-baby pairs born between 1993 and 2015 in the Clinical Practice Research Datalink (CPRD GOLD), a UK-based, primary health-care database. The influence of MMI on children’s vaccination status at two and five years of age was investigated using logistic regression adjusting for sex of the child, child ethnicity, delivery year, maternal age, practice level deprivation quintile and region. The vaccinations were: 5-in-1 (DTaP/IPV/Hib) and first dose MMR by the age of two; and all three doses of 5-in-1, first and second dose of MMR vaccines by the age of five. Exposure to MMI was defined using recorded clinical events for: depression, anxiety, psychosis, eating disorder, personality disorder and alcohol and substance misuse disorders. The likelihood that a child completed their recommended vaccinations by the age of two and five was significantly lower among children with MMI compared to children with mothers without mental illness [adjusted odds ratio (aOR) 0.86, 95% CI 0.84–0.88, p < 0.001]. The strongest effect was observed for children exposed to maternal alcohol or substance misuse (at two years aOR 0.50, 95% CI 0.44–0.58, p < 0.001). In the UK, an estimated five thousand more children per year would be vaccinated if children with MMI had the same vaccination rates as children with well mothers. Maternal mental illness is a hitherto largely unrecognised reason that children may be missing vital vaccinations at two and five years of age. This risk is highest for those children living with maternal alcohol or substance misuse.
Highlights
Despite the fact that in most countries vaccines are provided free at the point of access [1], 15% of children remain unvaccinated globally [2]
The cohort was identified from the CPRD mother-baby link; a previously developed algorithm [19] which identifies birth records for women and pairs those to babies if: the baby is registered at the same general practice as the mother; the baby’s birthday is within 60 days of delivery date and the baby shares a specific family identifier based on residential address [20]
We have conducted the largest contemporary cohort study to-date examining the association between maternal mental illness (MMI) and childhood vaccination uptake in a primary care cohort of over 400,000 mother-baby pair
Summary
Despite the fact that in most countries vaccines are provided free at the point of access [1], 15% of children remain unvaccinated globally [2]. People with mental illness are less likely to benefit from public health information campaigns [7, 8] but it is unclear whether mothers with mental illness are more or less influenced by messages about vaccination safety. This is important because mothers are usually the primary caregivers and take a central role in their children’s health [9] so the extent to which their children access preventative healthcare is of. These estimates indicate the prevalence of children exposed to different types of MMI in the UK as: non-affective psychosis 0.2%; affective psychosis 0.3%, depression as 18.4%, anxiety as 7.9%; eating disorders 0.1%; personality disorder 0.1% and alcohol and substance misuse as 0.3% [10]
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