Serious mental illness and disrupted caregiving for children - a nationwide, register-based cohort study

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Anne Ranning, MSc in Psychology, PhD student at Mental Health Centre Copenhagen

About the study

The aim of this study was to examine the proportions of children of parents with serious mental disorders who are placed in out-of-home care. Deficiencies in parenting and caregiving capacities among people with serious mental illness have been indicated by multiple studies. However, actual disruption of caregiving as when children are removed from their home and placed in care has not been thoroughly investigated.

Using the registers, we included all first-born singletons of the entire Danish population born after 1982 (n=782,092) and their parents. Rates of out-of-home placement of children with parents diagnosed with schizophrenia, bipolar disorder or depression, according to the criteria of ICD-10 and ICD-8, were analysed. The rates were compared with those of children with parents from the general population.

A parental diagnosis of schizophrenia was the most prominent risk factor for children to be placed outside the home, with an accumulated risk of 40% for children of mothers with schizophrenia and 20% for children of fathers with schizophrenia. Children of mothers (IRR= 23.75; 95% CI, 20.94, 26.93) and fathers (IRR= 7.85; 95% CI, 6.67, 9.25) with a diagnosis of schizophrenia had the overall highest incidence rate ratios (IRR) of being placed in care. Having a mother with bipolar disorder was the second most prominent risk factor (IRR=5.76; 95% CI, 4.50, 7.36), followed by a maternal diagnosis of unipolar depression (IRR=4.28; 95% CI, 3.73, 4.90). Risks were especially high during the child’s first year of life, indicating a critical period, especially for mothers with schizophrenia and their babies (IRR= 80.10; 95% CI, 68.02, 94.33). Taking care of an infant is highly demanding both physically and mentally, as parents must be constantly involved in fulfilling the baby’s needs to ensure normal development. This being a critical time for both parents and children things may more easily go wrong at this point.  Furthermore, studies have suggested that hormonal changes in women in relation to pregnancy and childbirth are likely to trigger psychiatric symptoms in mothers, who will in turn be less capable of taking care of infants.  Also, new mothers are more visible in the health care system at this time, thus difficulties in caregiving are possibly more likely to be discovered.

The article ”Serious mental illness and disrupted caregiving for children - a nationwide, register-based cohort study” was published in Journal of Clinical Psychiatry, 2015 Aug;76(8).

Facts about the study

  • The study was conducted as a prospective, register-based cohort study with follow-up from 1982-2010.
  • Mothers’ diagnoses posed greater risks for disrupted caregiving than fathers’.
  • The child’s first year of life was most critical regarding disrupted caregiving.
  • Children of parents with schizophrenia were at highest risk for disrupted caregiving compared to other diagnoses. 

Further information

Anne Ranning, MSc in Psychology, PhD student, Mental Health Centre Copenhagen, Capital Region of Denmark. Mobile:+45 3026 7320 Email: