Depression reduces energy level and impairs the self-image of capability. It might also affect parents’ attention towards risks and reduce their efforts to prevent injuries. Head injuries, burns and poisoning can affect children strongly and be costly for healthcare systems. Previous research in general practice has revealed a need for training how to manage families in which the mother has depression.
Depression is the most common mental disorder and affects one in five women during pregnancy and after birth. Depression strongly affects these mothers but also often their families. A new study of registry-based data from more than 1 million children and their mothers in Denmark shows that the children of mothers with depression have many more injuries than the children of mothers without depression.
“This study examined childhood injuries such as head injuries, arm and leg injuries, poisoning and burns. The children of mothers with a first episode of depression or relapse depression had the highest risk of childhood injuries. This risk was highest in the first year of life. One explanation might be that depression can affect the parents’ ability to safeguard the home environment and supervise the children’s risk-taking behaviour. Depression and childhood injuries have great socioeconomic costs. Research has shown that both parents and doctors in general practice can be trained. A study found that nearly all doctors in a cluster of general practices found this topic relevant, but nearly half did not feel competent in this task,” explains Bente Kjær Lyngsøe, physician and PhD, Research Unit for General Practice, Department of Public Health, Aarhus University.
Dangerous items not kept out of reach
The study is part of a larger research project aiming to discover the effects of growing up with a parent with depression. Women’s risk of developing depression is twice that of men, and this risk increases even further during pregnancy and after childbirth. The researchers examined whether maternal depression was associated with more injuries among their children for the more than 1 million children born alive in Denmark between 1997 and 2013.
“The strongest association was among children of mothers with a first episode of depression. In the first year of life, these children had 70% more injuries than the children of mothers without depression. The children of mothers with relapse depression had 57% more injuries. The smallest but still statistically significant association was found for the children of mothers with continuous depression and the children of mothers with previously treated depression,” says Bente Kjær Lyngsøe.
The researchers explain that the increased risk might be interpreted as an indication that well-established treatment of depression might improve parents’ supervisory abilities and thereby avoid burns, suffocation, falling from a changing table and swallowing dangerous products. Other studies have also shown that people with depression tend to not keep dangerous items out of reach and do not install safety equipment to the same extent.
“However, the age and sex of the children also play a role in the risk of childhood injury. As the children get older, the risk declines, perhaps because the children become more motor competent and more aware of hazards. However, we still found a 15–20% higher risk until the children turned 10 years old,” explains Bente Kjær Lyngsøe.
For the oldest children, the girls of mothers with depression had a significantly higher injury risk than the boys of mothers with depression. Future studies should explore this sex difference more.
Leading cause of death among children and adolescents
Previous studies have indicated a similar pattern but were mainly based on self-reported information about injuries, which can influence the number of reported injuries. Several studies have also focused on active and current episodes of depression, whereas the new study also examined past episodes of depression and distinguished between the mothers who had been treated for a long time and those who recently developed depression.
“The symptoms of depression are often most severe in the beginning, when the symptoms are new and the treatment has not yet had any effect. We have previously shown that maternal depression is associated with lower attendance at routine childcare visits and vaccinations but higher use of all other visits and services in general practice. This study adds the findings that the children of mothers with depression have a higher risk of childhood injuries,” says Bente Kjær Lyngsøe.
Research on depression is part of the wider Program for Clinical Research Infrastructure (PROCRIN), which aims to integrate research and clinical practice. Depression is a common mental disorder and a major public health problem worldwide, negatively affecting the people who have depression and their children. Since serious injuries are the most common cause of death among children and adolescents, the researchers think that extra effort is essential.
“Focusing attention on these mothers and children is important, and experience shows that teaching and counselling these parents helps. Training doctors and staff in general practice has also been found feasible and has low costs. Many general practitioners do not feel they have the time or competence to approach the children of mothers with depression. Guidelines for managing depression do not include managing family problems or consequences. Enhanced political awareness of how depression can impact the entire network is needed. Training of healthcare personnel in contact with mothers who struggle with depression or children with recurring injuries might improve the long-term outcome for these families,” concludes Bente Kjær Lyngsøe.