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Original Investigation
June 22, 2020

Association of Parental Mental Illness With Child Injury Occurrence, Hospitalization, and Death During Early Childhood

Author Affiliations
  • 1Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan
  • 2Department of Epidemiology, University of Washington, Seattle
  • 3Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 4Kaiser Permanente Washington Health Research Institute, Seattle
  • 5Department of Biostatistics, University of Washington, Seattle
  • 6Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
JAMA Pediatr. 2020;174(8):e201749. doi:10.1001/jamapediatrics.2020.1749
Key Points

Question  Are young children whose parents have severe mental illness, including schizophrenia, bipolar disorder, and major depressive disorder, at greater risk of injury compared with children of parents without severe mental illness?

Findings  In this cohort study of the 1 999 322 singleton births in Taiwan from 2004 to 2014, children of parents with severe mental illness had higher rates of injury events, injury hospitalization, and injury death in early childhood compared with children of parents without severe mental illness.

Meaning  In this study, parental severe mental illness was associated with increased risk of several child injury outcomes during early childhood, suggesting that effective treatment, parenting support, and injury prevention strategies for parents with severe mental illness may be needed.


Importance  Injury is a leading cause of childhood morbidity and mortality worldwide. Serious mental illness (SMI) is a major contributor to the global burden of disease.

Objective  To compare injury event rates in children from birth to 5 years of age among Taiwanese children with and without parents with SMI, including schizophrenia, bipolar disorder, and major depressive disorder.

Design, Setting, and Participants  This population-based, retrospective cohort study of an 11-year Taiwanese birth cohort used data from the Taiwan National Health Insurance Research Database (covering 99% of Taiwanese citizens), the Maternal and Child Health Database, and birth and death certificate databases. The study included 1 999 322 singletons with Taiwanese citizenship born from January 1, 2004, to December 31, 2014, and followed up from birth to their fifth birthday, December 31, 2014, or the date of death, yielding a total of 7 741 026 person-years. Data analysis was performed from April 20, 2017, to September 24, 2019.

Exposures  Physician-diagnosed parental SMI defined using outpatient and inpatient records from 6 years before the child’s birth to 5 years after delivery.

Main Outcome and Measures  Rates of medically attended injury events, injury hospitalization, and injury death retrieved from outpatient records, inpatient records, and death certificates. Generalized estimating equation for log-linear models estimated injury incidence rate ratios (IRRs) comparing parental SMI-exposed children and unexposed children.

Results  The study cohort included 1 999 322 singletons (52.1% males without parental SMI and 52.2% males with parental SMI). Incidence rates of child injury-related outcomes were higher among children exposed to parental SMI (294.8 injury events per 1000 person-years) compared with children who were unexposed (256.1 injury events per 1000 person-years). After adjustment for sociodemographic factors, children with parental SMI had higher rates of injury events (IRR, 1.14; 95% CI, 1.13-1.15), injury hospitalization (IRR, 1.49; 95% CI, 1.42-1.57), and injury death (IRR, 1.82; 95% CI, 1.38-2.39) compared with unexposed children. The results were confirmed in sensitivity analyses. Appendicitis, a negative control outcome, was not associated with parental SMI (IRR, 1.10; 95% CI, 0.94-1.28). In addition, children with and without parental SMI had similar patterns of preventive health care. The mean (SD) number of prenatal visits was 8.09 (2.50) for children with parental SMI and 8.17 (2.47) among unaffected children. The mean (SD) number of well-child visits was 5.70 (2.24) for children with parental SMI and 5.80 (2.21) among unaffected children.

Conclusions and Relevance  In this study, children with parental SMI had increased risk of injury, particularly serious injury. Excess risk may be reduced by providing effective mental health treatment, parenting support, and home safety education to parents with SMI who are raising young children.

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