Onset of maternal psychiatric disorders after the birth of a child with intellectual disability: A retrospective cohort study
Introduction
Intellectual disability is diagnosed in people with an IQ of less than 70 and deficits in adaptive functioning which are present before 18 years (American Psychiatric Association, 2000). Children with intellectual disability have more challenging behaviours (Baker et al., 2002), more sleep disorders (Richdale et al., 2000) and more psychopathologies than typically developing children (Emerson, 2003). Their mothers also have increased expenses (Parish and Cloud, 2006) perceive more stigma against themselves or their child (Green, 2007) have lower employment levels (Shearn and Todd, 2000) and less informal and family support (Shearn and Todd, 2000) than other mothers. Therefore, it is not surprising that research has identified poorer mental health in mothers of children with intellectual disability compared to the parents of children with no disabilities (Bourke et al., 2008, Emerson et al., 2010, Olsson and Hwang, 2001).
In a previous study (Fairthorne et al., submitted for publication), we found that mothers with an outpatient psychiatric history were about twice as likely to have a child with intellectual disability compared to mothers of children with no intellectual disability. We hypothesised that this might be due to shared genetics of the mother and the child with intellectual disability or prenatal use of medication or life-style factors in women with a psychiatric disorder. In the current paper, we wanted to ascertain whether mothers of a child with intellectual disability and no previous psychiatric history were at increased risk of having a psychiatric disorder after the birth of their child. We reasoned that these comparisons would enable us to discern whether the burden of caring for a child with intellectual disability contributed to the increased rate of psychiatric disorders in their mothers. This being so, better informed services and interventions might be instituted with the aim of reducing the burden of these mothers and improving their mental health.
No previous research has attempted to differentiate whether the excess of psychiatric disorders in mothers of children with intellectual disability after the birth of their child is due to the increased burden of caring, a prior disposition to psychiatric disorders or to increased exposure to ante-natal risk factors for intellectual disability in women with a previous psychiatric disorder. Moreover, grouping mothers, according to the level of intellectual disability of their child and according to whether the cause is known would enable the most vulnerable groups of mothers to be identified.
Therefore, according to type and level of intellectual disability, we aimed to:
- 1.
Compare the incidence of any psychiatric diagnosis in mothers after the birth of a child with intellectual disability compared to mothers with no child with intellectual disability or autism spectrum disorder (ASD) where mothers had no record of a psychiatric disorder before the birth of their child.
- 2.
Compare the incidence of the most frequent psychiatric diagnostic categories, in mothers after the birth of a child with intellectual disability compared to mothers with no child with intellectual disability or ASD and where mothers had no record of a psychiatric disorder before the birth of their child.
Section snippets
Study population
The study population consisted of all women who gave birth to a live child in Western Australia (WA) between 1st January 1983 and 31st December 2005 inclusive. We linked de-identified data-sets from four statutory state-based registries and a state-wide disability database (Holman et al., 1999). The Hospital Morbidity Data System (HMDS) (Department of Health WA, 2011) provided us with admission dates and ICD-9 and ICD-10 codes for all hospital separations in WA from 1970 to 2010. The Mental
Results
In Table 1, composition of the comparator group of 271,249 (97.7%) mothers and case groups in terms of the socio-demographic variables are shown. As our previous research described, mothers less than 20 years were over-represented in the mild–moderate intellectual disability of unknown cause case group (Leonard et al., 2011) and over-represented in the lowest SES group. By frequency, the four primary diagnostic categories were Alcohol and substance abuse (N = 3923), Schizoid disorders (N
Discussion
We explored the incidence of primary psychiatric disorders in mothers with no previous psychiatric history, after the birth of their child with intellectual disability, compared to mothers of children with no intellectual disability, no ASD and no psychiatric history whilst adjusting for socio-demographic factors. In this way, we were able to determine if the burden of caring for their child with a disability had contributed to a higher incidence of psychiatric disorders in case mothers.
Conclusion and implications
In this study, we excluded mothers who had a hospitalisation or an outpatient contact for a psychiatric disorder in WA before the index birth. We made adjustments for maternal age, parity, socio-economic status and year band of the index birth, all of which might have been related to the odds of a subsequent psychiatric disorder. Therefore, it is reasonable to conclude that the elevated (and attenuated) incidence of psychiatric disorders we identified is mostly due to the burden of caring
Contributors
The study was conceived by Jenny Fairthorne and developed with the assistance of Peter Jacoby and Nick de Klerk. Jenny Fairthorne wrote the original draft and all authors participated in its subsequent development and approved the final submission.
Funding source
This research was funded by an Australian Post-graduate Award and a University of Western Australia Top-up Award.
Conflicts of interest
None.
Acknowledgement
The authors are grateful to the Disability Services Commission and the WA Department of Education for assistance with data collection for the IDEA database. This study was supported by Australian National Health and Medical Research Council (NHMRC) Program Grant #572742.
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