Abstract
Children whose parents have mental health disorders are at increased risk for deliberate self-harm (DSH). However, the effect of timing of parental mental health disorders on adolescent DSH risk remains under-researched. The aim of this study was to investigate how parental hospital admissions for mental health disorders and/or DSH in different developmental periods impact on the child’s DSH risk in adolescence. A nested case-control sample was compiled from a total population cohort sample drawn from administrative health records in Western Australia. The sample comprised 7,151 adolescents who had a DSH-related hospital admission (cases), and 143,020 matched controls who hadn’t had a DSH-related hospital admission. The occurrence of parental hospital admissions related to mental health disorders and/or DSH behaviours was then analysed for the cases and controls. The timing of the parental hospital admissions was partitioned into four stages in the child’s life course: (1) pre-pregnancy, (2) pregnancy and infancy, (3) childhood, and (4) adolescence. We found that adolescents of a parent with mental health and/or DSH-related hospital admissions in all developmental periods except pregnancy and infancy were significantly more likely than controls to have a DSH-related hospital admission. Compared to parental hospital admissions that occurred during childhood and adolescence, those that occurred before pregnancy conferred a higher risk for adolescent DSH: adjusted odds ratio (aOR) = 1.25 for having only one parent hospitalised and 1.66 for having both parents hospitalised for mental health disorders; aOR = 1.97 for having any parent hospitalised for DSH, all being significant at the level of p < .001. This study shows that timing is important for understanding intergenerational transmission of DSH risk. The pre-pregnancy period is as critical as period after childbirth for effective intervention targeting adult mental health disorders and DSH, highlighting the important role of adult mental health services in preventing DSH risk in future generations.
Highlights
One in five children has a parent with a mental health disorder [1]
Compared to parental hospital admissions that occurred during childhood and adolescence, those that occurred before pregnancy conferred a higher risk for adolescent deliberate self-harm (DSH): adjusted odds ratio = 1.25 for having only one parent hospitalised and 1.66 for having both parents hospitalised for mental health disorders; aOR = 1.97 for having any parent hospitalised for DSH, all being significant at the level of p
This study has shown that parental mental health and/or DSH-related hospital admissions that occurred before pregnancy have a greater impact on adolescent DSH risk, compared to those that occurred during childhood and adolescence
Summary
One in five children has a parent with a mental health disorder [1]. Children whose parents have mental health disorders are themselves at increased risk of developing a mental health disorder, including intentional self-injurious behaviours, with or without suicidal intent, known as deliberate self-harm (DSH) [2]. Risk factors for DSH in adolescents include maternal pregnancy and birth complications [6, 7], parental mental health disorders [8, 9], and social disadvantage [10,11,12]. Limited research has investigated the impact of the timing of parental mental health disorders on adolescent DSH risk. Previous research has shown that the earlier the child’s exposure to parental mental health disorders, the greater the impact on the child’s psychosocial development [13]. Children exposed to parental suicidal death in early childhood have an elevated risk of DSH-related hospital admissions, compared to parental suicidal death experienced in later childhood and adolescence [15]
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