Accidental injury, self‐injury, and assault among children of women with schizophrenia: a population‐based cohort study

Abstract

We aimed to compare the risk for injury overall and by intent (accidental injury, self-injury, and assault) among children born to women with versus without schizophrenia. Methods: Using health administrative data from Ontario, Canada, children born from 2003 to 2017 to mothers with (n = 3769) and without (n = 1,830,054) schizophrenia diagnosed prior to their birth were compared on their risk for child injury, captured via emergency department, hospitalization, and vital statistics databases up to age 15 years. Cox proportional hazard models generated hazard ratios for time to first injury event (overall and by intent), adjusted for potential confounders (aHR). We stratified by child sex and age at follow-up: 0-1 (infancy), 2-5 (pre-school), 6-9 (primary school), and 10-15 (early adolescence) planning to collapse age categories as needed to obtain stable and reportable estimates. Results: Maternal schizophrenia was associated with elevated risk for child injury overall (105.4 vs. 89.4/1000 person-years (py), aHR 1.08, 95% CI 1.03-1.14), accidental injury (104.7 vs. 88.1/1000py, 1.08, 1.03-1.14), for self-injury (0.4 vs. 0.2/1000py, 2.14 1.18-3.85), and assault (1.0 vs. 0.3/1000py, 2.29, 1.45-3.62). By child sex, point estimates were of similar magnitude and direction, though not all remained statistically significant. For accidental injury and self-injury, the risk associated with maternal schizophrenia was most elevated in 10-15-year-olds. For assault, the risk associated with maternal schizophrenia was most elevated among children in the 0-1 and 2-5-year-old age groups. Conclusion:The elevated risk of child injury associated with maternal schizophrenia, especially for self-injury and assault, suggests that targeted monitoring and preventive interventions are warranted. K E Y W O R D S child, injuries, schizophrenia SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section. How to cite this article: Taylor CL, Brown HK, Saunders NR, et al. Accidental injury, self-injury, and assault among children of women with schizophrenia: a population-based cohort study.

In Utero Exposure to Maternal Injury and the Associated Risk of Cerebral Palsy

“…We also found no evidence of differences in the age of CP diagnosis by socioeconomic status or exposure status. We used injury codes developed by the international framework for injury surveillance by the Center for Disease Control and Prevention that were extensively used in various populations, including in pregnant women . Although we included injuries in pregnancy that sought medical attention only, leaving those with minor injuries out, we believe it would be small in proportion because pregnant women experiencing injuries would highly likely seek health care for maternal and fetal well-being…”

Self-mutilation in people with psychiatric diagnosis - literature review

“…Suicide attempts in the past, family history of self-harm and significant intensification of positive symptoms are also predictors of self-harm [18,20,24]. A study by Taylor et al indicates an increased risk of injuries in children of mothers with schizophrenia, including the risk of self-harm, which occurs mainly at the age of 10-15 years [25]. In treatment-resistant schizophrenia, there is almost twice as high mortality and frequent occurrence of self-injury in patients not taking clozapine compared to the group that received the drug.…”

“…wskazuje na zwiększone ryzyko urazów u dzieci matek ze schizofrenią, w tym na ryzyko samouszkodzeń, które występują głównie od 10-15 r.ż. [25]. W schizofrenii opornej na leczenie wykazano blisko dwukrotnie wyższą śmiertelność oraz częste występowanie samouszkodzeń ciała u pacjentów nieprzyjmujących klozapiny w porównaniu z grupą, która otrzymywała lek.…”

Clinical and sociodemographic features in offspring aged 0–3 years of mothers with schizophrenia spectrum disorders. A descriptive cross‐sectional study

“…17 Moreover, children exposed to maternal schizophrenia are more likely to be born preterm and to have a low birth weight. 18 Offspring are thus at risk for developing schizophrenia even before entering young adulthood, which otherwise is considered the period of greatest risk. 19 Although psychiatric research in children aged 0-3 years is limited compared to research in older children, 20 it appears, that in such high-risk populations differences in motor, cognitive, social, and behavioral functioning can be detected as early as 0-2 years.…”

“…In fact, stressors such as living in areas of large socioeconomic disadvantages and with elevated rates of violent crime, disrupted episodes of parenting, having a mother who is not in a partnered relationship, pregnancy complications, and abuse in childhood are all shown to be significantly associated with the development of psychotic illness in offspring 17 . Moreover, children exposed to maternal schizophrenia are more likely to be born preterm and to have a low birth weight 18 . Offspring are thus at risk for developing schizophrenia even before entering young adulthood, which otherwise is considered the period of greatest risk 19 …”