Maternal Mental Health Disorders and Reports to Child Protective Services: A Birth Cohort Study

Abstract

Background. Existing literature has documented a strong relationship between parental mental illness and child maltreatment, but little is known about the prevalence of mental illness among childbearing women. In the present study, linked administrative records were used to identify the prevalence of maternal mental health (MH) disorders documented at birth and determine the associated likelihood of maltreatment reports during infancy. Materials and Methods. Vital records for California’s 2006 birth cohort were linked to hospital discharge and Child Protective Services (CPS) records. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) billing codes from the mother’s delivery hospitalization were used to determine diagnosed maternal MH disorders for 551,232 infants born in 2006, and reports of alleged maltreatment were documented from CPS records. Vital birth records were used to control for sociodemographic factors. Finally, the associated risk of reported maltreatment during the first year of life was examined using generalized linear models. Results. Among infants in this statewide birth cohort, 2.8% were born to a mother with a documented MH disorder, of which 41.3% had documented maternal substance abuse issues versus less than 0.5% of infants born to mothers without a diagnosed MH disorder. Further, 34.6% of infants born to mothers with a MH disorder were reported to CPS within one year, and a majority of those reports were made within the first month of life (77.2%). In contrast, among children born to mothers without a MH disorder, 4.4% were reported to CPS during infancy. After controlling for sociodemographic factors, the rate of CPS reports during infancy for infants born to mothers with a MH disorder but no substance use disorder was 2.6 times that of infants born to mothers without a MH disorder (95% CI = 2.47, 2.73). Among infants born to mothers with MH and substance use disorders, the rate of CPS reports during infancy was 5.69 times that of infants born to mothers without a MH disorder (95% CI = 5.51, 5.87). Conclusions. Administrative records provide a method for identifying infants born to mothers with MH disorders, enabling researchers to track rates over time and generate population-level data to inform policy development and improve service delivery.

Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008–17

“…Although it is hard to distinguish the role that this involvement played in subsequent substance use or suicidal ideation, there has been documentation of greater Child Protective Services involvement among mothers with mental health diagnoses, with amplified effects among those with mental health and SUD disorders, compared to mothers without such diagnoses. 36 Our finding highlights a potential missed opportunity for coordination between child welfare and obstetric or mental health providers to offer support and resources. 37 Programs such as Healthy Start; Special Supplemental Nutrition Program for Women, Infants, and Children; and organizations focused on home visitation and intimate partner violence prevention may also regularly interact with pregnant and postpartum people and could consider ways to offer screening and linkage to needed care and resources.…”

Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion

“… 32 , 33 , 34 , 35 This decision is consistent with other recent studies using CPS records. 16 , 36 , 37 , 38 , 39 The screened-in referrals were stratified by maltreatment type (physical abuse or neglect) and included cases screened-in for an alternative response. Cases with concern for both physical abuse and neglect were included in both groups.…”

Adult Mental Health Outpatients Who Have Minor Children: Prevalence of Parents, Referrals of Their Children, and Patient Characteristics

“…For example, parents who have an anxiety disorder are less likely to grant their children autonomy and more likely to demonstrate lower levels of sensitivity (18), while children of parents with psychosis might be directly involved in a parent's delusions (19). After controlling for other risk factors at birth, Hammond et al (20) found that two thirds of infants of mothers with a psychotic disorder were reported to child protection services. This was four times that of infants of mothers without a mental illness.…”