Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden
Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden
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DOI：
10.1136/bmj.m853
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发表时间：
2020-04-08
影响因子：
105.7
通讯作者：
Kosidou, Kyriaki
中科院分区：
文献类型：
--
作者：
Nevriana, Alicia;Pierce, Matthias;Kosidou, Kyriaki
目的探讨父母精神疾病与子女伤害风险的关系。设计回顾性队列研究。设置瑞典人口登记。参与者：1996-2011年出生的54.2万名儿童与893 334名母亲和873 935名父亲有关。暴露情况通过与住院或门诊医疗保健登记的联系确定母亲或父亲的精神疾病（非情感性精神病、情感性精神病、酗酒或滥用药物、情绪障碍、焦虑和压力相关障碍、饮食障碍、人格障碍）。主要结局指标0-1岁、2-5岁、6-9岁、10-12岁和13-17岁儿童的伤害风险（交通伤害、跌倒、烧伤、溺水和窒息、中毒、暴力），比较父母有精神疾病的儿童和父母没有精神疾病的儿童，以比率差和经混杂因素调整的比率比计算。结果父母有精神疾病的儿童共随访201 670.5人年，父母无精神疾病的儿童共随访2 434 161.5人年。父母患有精神疾病的儿童受伤率高于父母没有精神疾病的儿童（对于0-1岁的任何伤害，这些儿童每10万人年有额外的2088人受伤；父母患有和没有精神疾病的儿童受伤数量分别为10 235和72 723）。在0-1岁时，父母患有精神疾病的儿童与父母没有精神疾病的儿童相比，每10万人年的交通伤害增加了18次，跌倒伤害增加了1716次。从出生到青春期，观察到伤害的调整率比更高，并且在生命的第一年风险最高（0-1岁时父母在登记册中记录的任何精神疾病与伤害之间的总体关联的调整率比为1.30,95%置信区间为1.26至1.33）。0-1岁儿童的调整比率从1.28（1.24 ~ 1.32）到3.54（2.28 ~ 5.48）不等。常见和严重的母亲和父亲的精神疾病与儿童受伤的风险增加有关，对常见精神障碍的估计略高。结论：父母精神疾病与子女受伤风险增加有关，尤其是在孩子出生后的头几年。努力增加患有精神疾病的父母获得父母支持的机会，并在二级保健中认识和治疗父母的围产期精神疾病，可能会预防儿童受伤。
OBJECTIVETo determine the association between parental mental illness and the risk of injuries among offspring.DESIGNRetrospective cohort study.SETTINGSwedish population based registers.PARTICIPANTS1 542 000 children born in 1996-2011 linked to 893 334 mothers and 873 935 fathers.EXPOSURESMaternal or paternal mental illness (non-affective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress related disorders, eating disorders, personality disorders) identified through linkage to inpatient or outpatient healthcare registers.MAIN OUTCOME MEASURESRisk of injuries (transport injury, fall, burn, drowning and suffocation, poisoning, violence) at ages 0-1, 2-5, 6-9, 10-12, and 13-17 years, comparing children of parents with mental illness and children of parents without mental illness, calculated as the rate difference and rate ratio adjusted for confounders.RESULTSChildren with parental mental illness contributed to 201 670.5 person years of follow-up, while children without parental mental illness contributed to 2 434 161.5 person years. Children of parents with mental illness had higher rates of injuries than children of parents without mental illness (for any injury at age 0-1, these children had an additional 2088 injuries per 100 000 person years; number of injuries for children with and without parental mental illness was 10 235 and 72 723, respectively). At age 0-1, the rate differences ranged from 18 additional transport injuries to 1716 additional fall injuries per 100 000 person years among children with parental mental illness compared with children without parental mental illness. A higher adjusted rate ratio for injuries was observed from birth through adolescence and the risk was highest during the first year of life (adjusted rate ratio at age 0-1 for the overall association between any parental mental illness that has been recorded in the registers and injuries 1.30, 95% confidence interval 1.26 to 1.33). Adjusted rate ratios at age 0-1 ranged from 1.28 (1.24 to 1.32) for fall injuries to 3.54 (2.28 to 5.48) for violence related injuries. Common and serious maternal and paternal mental illness was associated with increased risk of injuries in children, and estimates were slightly higher for common mental disorders.CONCLUSIONSParental mental illness is associated with increased risk of injuries among offspring, particularly during the first years of the child's life. Efforts to increase access to parental support for parents with mental illness, and to recognise and treat perinatal mental morbidity in parents in secondary care might prevent child injury.