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Abstract
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Excess risk is greatest in the first year of life
If health and social care systems are to rise to the challenge of reducing the prevalence of mental health problems they need to follow holistic and preventative measures, an approach promised in the national health service long term plan in the United Kingdom.1 Holistic measures mean that attention should fall not only on the individual with a diagnosis of mental illness, but also on the family environment and the wider social contexts in which people are born, grow, live, and age.
In a linked study, Nevriana and colleagues (doi:10.1136/bmj.m853) report a large analysis of preventable injuries in children whose parents were living with mental illness.2 This retrospective cohort study used national Swedish longitudinal health and administrative registers to examine associations between all types of maternal and paternal mental illness and risk of injuries from birth to adolescence. The study population was more than 1.5 million offspring born between 1996 and 2011. The analysis shows the value and limitations of studies that use big datasets.
On the one hand such analyses help to strengthen our understanding of healthcare delivery and patient outcomes, provide datasets that prompt many further research questions, and support the development of evidence based personalised medicine.3 This real world evidence is now increasingly being used to inform clinical practice and guidelines.4
The authors report that children of parents who experienced mental health problems (especially depression and substance misuse) were at a higher risk of injury throughout their childhood and adolescence than those of parents with no diagnosis of mental illness. The greatest risk recorded was 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), linked in particular to violence, poisoning, and burns. These findings are in line with previous studies conducted elsewhere, address some of the previous limitations in the evidence base, and should bring extra weight to inform preventative practice...
Language: en |