Primary prevention for offspring of parents with mental illness

Byline: T. Sathyanarayana Rao, Chittaranjan. Andrade Much literature has addressed caregiver burden in relation to depression, [sup][1] anxiety disorders, [sup][2] bipolar disorder, [sup][3] schizophrenia, [sup][4] dementia, [sup][5] and other mental illnesses. [sup][6] How are families, specifically children, affected when the patients are themselves the caregivers? This question is important because the offspring of parents with mental illness are at increased risk of medical, psychological, and social adversity for psychosocial and biological reasons, such as inadequate parental care, socioeconomic difficulties, genetic disadvantage, and psychotropic drug exposure in utero and during the puerperium. Much literature is available on certain of these issues, such as the effects on children resulting from the use of psychotropic medications during pregnancy and lactation. However, there is only a modest body of research on the medical health of these children during their preschool years. Two very recent studies on the early survival of children of parents with mental illness are briefly reviewed. One study addresses the sudden infant death syndrome (SIDS) in infants of parents with a history of psychiatric admission, and the other addresses the natural and unnatural causes of death in preschool children of parents with mental illness. Both studies highlight new areas for primary prevention; areas that would otherwise be neglected in routine clinical practice. Sudden Infant Death Syndrome Sudden infant death syndrome (SIDS) refers to sudden, unexplained death occurring during the first year of life. The risk of SIDS is known to be higher in infants of persons with mental illness. [sup][7],[8] Webb et al , [sup][9] investigated the possible reasons for this finding. The study was based on data collected on nearly 2.5 million singleton live births in Sweden between 1978 and 2004. There were 1531 cases of SIDS in the whole cohort, and the crude rate of SIDS was 0.6 per 1000 live births. The study threw up several important findings. Relative to the infants of women who were never admitted for psychiatric treatment, the risk of SIDS was trebled in infants of mothers with a history of psychiatric admission (OR, 3.1; 95% CI, 2.6-3.8). The risk was particularly high in mothers admitted for alcohol or drug-related disorders (OR, 6.5; 95% CI, 4.9-8.7), and was also high in mothers admitted with other diagnoses (OR, 2.3; 95% CI, 1.8-2.9). Relative to the infants of control fathers, the risk of SIDS was more than doubled in infants of fathers with a history of psychiatric admission (OR, 2.5; 95% CI, 2.0-3.1). The risk was significantly elevated with alcohol and drug-related diagnoses (OR, 2.8; 95% CI, 2.1-3.8), as well as with other diagnoses (OR, 2.1; 95% CI, 1.5-3.0). The risk of SIDS was elevated nearly seven-fold when both parents had a history of admission for any mental illness (OR, 6.8; 95% CI, 4.7-10.0). Again, the risk was higher in association with alcohol and drug-related admissions (OR, 9.5; 95% CI, 5.5-16.4) than with admissions for other diagnoses (OR, 5.4; 95% CI, 3.2-9.2). Curiously, the risks were not significant for parental affective and non-affective psychoses, specifically, but this could have been because the analyses were underpowered. Strikingly, the risk remained elevated even if the last maternal admission was five or more years before the infant's birth. After a national campaign to reduce SIDS, the risk factor prevalence (especially maternal antenatal smoking) remained high in parents with a history of mental illness, and therefore, the relative risk of SIDS increased. During 1992-2004, smoking and individual social adversity measures together accounted for approximately half of the excess risk associated with maternal psychiatric admission, whereas the risk associated with obstetric factors remained minimal. Preschool Mortality Chen et al,[10] provided a good review of the previous research and presented the first Asian data on preschool mortality in children of parents with mental illness. …