Children living with parental mental illness more likely to be placed in out-of-home care
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Key takeaways:
- Children with parental mental illness were four times as likely to be placed in an out-of-home care setting.
- Children whose parents had mental illness and had education only to age 16 had a 15 times higher risk.
Children living with parents with mental illness were four times as likely to be placed in out-of-home care than their peers, according to findings from a Swedish study published in Pediatrics.
This might be to protect them in the short term and may provide benefits in the longer term. However, it is well-recognized that, as a group, children in out-of-home care (OHC) are more likely to have poorer health and life outcomes and OHC may also have adverse influences on parental mental health and family life,” the researchers wrote.
The researchers identified 1,249,463 children in the Swedish national registers of children born from 2000 to 2011 and linked to their parents. They used the International Classification of Diseases codes to identify time-dependent parental mental illness, which included nonaffective and affective psychosis, substance misuse, depression, anxiety and stress, eating disorders, personality disorders, ADHD, autism spectrum disorders and intellectual disability.
They found that children living with mentally ill parents were four times as likely to be placed in OHC than children who were not (95% CI, 4.24-4.61). The groups most at-risk were children aged 0 to 1 year (HR = 5.77; 95% CI, 5.42-6.14), children exposed to maternal illness (HR = 4.56; 95% CI, 4.37-4.76) and children exposed to parental intellectual disability (HR = 4.73; 95% CI, 4.09-5.46.
Compared with children without parental mental illness and those with university-educated parents, children whose parents had mental illness and had education only to age 16 had a 15 times higher risk for OHC (95% CI, 13.75-16.54).
“Children with parental mental illness are more likely to be placed in OHC compared with other children, especially during the first year of life,” the researchers wrote. “The risk is highest if the mother is diagnosed with schizophrenia, intellectual disability, or substance misuse. Family socioeconomic deprivation significantly worsens the likelihood of OHC, and we lack information about longer term risks and benefits of this intervention. Continuous efforts are needed to support families with parental mental illness and prevent OHC.”
In an editorial, Gabriel Otterman, MD, MPH, PhD, senior consultant pediatrician and medical director of the Child Protection Team at Uppsala University Children’s Hospital in Uppsala, Sweden, and Suzanne Haney, MD, MS, vice chair of faculty affairs in the department of pediatrics at the University of Nebraska Medical Center, applauded the “methodologically robust analysis” of the study and called for future research to include validation studies on the detailed causes of OHC placement.
“Screening is only the first step, and as experts in their communities, pediatricians should have ready access to needed referrals once concerns are identified,” they wrote. “As part of a system-based approach, pediatricians who can observe the real-world implications of social inequity are also uniquely situated to advocate with child welfare and state lawmakers to reshape practices and policies to better support these families.”
References:
Nevriana A, et al. Pediatrics. 2024;doi: 10.1542/peds.2023-061531.
Otterman G, et al. Pediatrics. 2024;doi:10.1542/peds.2023-063611.
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