Maternal mental health, substance use, and domestic violence in the year after delivery and subsequent behavior problems in children at age 3 years
Maternal mental health, substance use, and domestic violence in the year after delivery and subsequent behavior problems in children at age 3 years
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DOI：
10.1001/archpsyc.63.5.551
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发表时间：
2006-05-01
影响因子：
--
通讯作者：
Kahn, RS
中科院分区：
文献类型：
--
作者：
Whitaker, RC;Orzol, SM;Kahn, RS
背景：精神健康障碍、药物使用和家庭暴力往往同时发生。然而，检查母亲这些状况对其子女健康影响的研究只关注孤立的状况。目的：探讨母亲心理健康障碍、物质使用和家庭暴力对幼儿行为问题风险的累积效应。设计：一组出生队列（1998-2000），随访至3岁。背景：美国十八个大城市。参与者：3年后，从4242名以人口为基础的出生队列中随访了2756名（65%）。36%的人年收入低于贫困线。主要结局指标：分娩一年后，母亲被问及3类状况问题：(1)精神健康（重度抑郁发作和广泛性焦虑症），(2)物质使用（吸烟、酗酒和非法药物使用），(3)家庭暴力（情感和身体）。在3岁时，母亲们完成了儿童行为检查表中的问题。结果：50%的母亲至少有上述三种症状中的一种。儿童行为问题的患病率随着母亲报告的类别（0、1、2或3）的数量的增加而增加：攻击分别为7%、12%、17%和19% (P < .001)；焦虑/抑郁分别为9%、14%、16%和27% (P < 0.001)；注意力不集中/多动分别为7%、12%、15%和19% （P < 0.001）。在调整了社会人口统计学和产前因素以及父亲的精神健康和药物使用后，这种分级风险仍然存在。结论：儿童行为问题的风险随着母亲报告的心理健康、药物使用或家庭暴力等领域的数量增加而增加。预防幼儿的行为问题需要以家庭为导向的战略，解决父母及其子女的需要。
Context: Mental health disorders, substance use, and domestic violence often occur together. However, studies examining the impact of these conditions in mothers on the well-being of their children have focused only on isolated conditions.Objective: To examine the cumulative effect of maternal mental health disorders, substance use, and domestic violence on the risk of behavior problems in young children.Design: A birth cohort (1998-2000) followed up to age 3 years.Setting: Eighteen large US cities. Participants: At 3 years, 2756 (65%) were followed up from the population-based birth cohort of 4242. Thirty-six percent had annual incomes below the poverty threshold.Main Outcome Measures: One year after delivery, mothers were asked questions about conditions in 3 categories: (1) mental health (major depressive episode and generalized anxiety disorder), (2) substance use (smoking, binge drinking, and illicit drug use), and (3) domestic violence (emotional and physical). At 3 years, mothers completed questions from the Child Behavior Checklist.Results: Fifty percent of mothers had a condition in at least 1 of the 3 categories. The prevalence of child behavior problems increased with the number of categories (0, 1, 2, or 3) in which the mother reported a condition: respectively, 7%, 12%, 17%, and 19% for aggression (P < .001); 9%, 14%, 16%, and 27% for anxious/depressed (P < .001); and 7%, 12%, 15%, and 19% for inattention/hyperactivity (P < .001). This graded risk persisted after adjustment for sociodemographic and prenatal factors and for paternal mental health and substance use.Conclusions: The risk of child behavior problems increased with the number of areas-mental health, substance use, or domestic violence-in which the mother reported difficulties. Preventing behavior problems in young children requires family-oriented strategies that address the needs of both parents and their children.