Preventive Health Care Among Children of Women With Schizophrenia: A Population-Based Cohort Study

Clare L. Taylor, PhD; Hilary K. Brown, PhD; Natasha R. Saunders, MD; Lucy C. Barker, MD; Simon Chen, MPH; Eyal Cohen, MD; Cindy-Lee Dennis, MD; Joel G. Ray, MD; Simone N. Vigod, MD, MSc, FRCPC

J Clin Psychiatry 2023;84(2):22m14497

ABSTRACT

Objective: To compare well-baby visit and vaccination schedule adherence up to age 24 months in children of mothers with versus without schizophrenia.

Methods: Using administrative health data on births in Ontario, Canada (2012–2016), children of mothers with schizophrenia (ICD-9: 295; ICD-10: F20/F25; DSM-IV schizophrenia or schizoaffective disorder) (n = 1,275) were compared to children without maternal schizophrenia (n = 520,831) on (1) well-baby visit attendance, including an enhanced well-baby visit at age 18 months, and (2) vaccine schedule adherence for diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B (DTaP-IPV-Hib), and measles, mumps, rubella (MMR). Cox proportional hazard regression models were adjusted for each of maternal sociodemographics, maternal health, and child health characteristics in blocks and all together in a fully adjusted model.

Results: About 50.3% of children with maternal schizophrenia had an enhanced 18-month well-baby visit versus 58.6% of those without, corresponding to 29.0 versus 33.9 visits/100 person-years (PY), a hazard ratio (HR) of 0.82 (95% CI, 0.76–0.89). The association was dampened after adjustment for maternal sociodemographics, maternal health, and child health factors in blocks and overall, with a fully adjusted HR of 0.91 (95% CI, 0.84–0.98). Full vaccine schedule adherence occurred in 40.0% of children with maternal schizophrenia versus 46.0% of those without (22.6 vs 25.9/100 PY), yielding a HR of 0.86 (95% CI, 0.78–0.94). The association was dampened when adjusted for maternal sociodemographics and child health characteristics and became nonsignificant when adjusted for maternal health characteristics. The fully adjusted HR was 0.95 (95% CI, 0.87–1.04).

Conclusions: Increased efforts to ensure that children with maternal schizophrenia receive key early preventive health care services are warranted.

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

References (55)

WHO CoSDoHWHO. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Commission on Social Determinants of Health Final Report. World Health Organization; 2008.
Record RB. Ottawa: Canadian Paediatric Society. CPS website. www.cps.ca/en/tools-outils/rourke-baby-record. Updated November 17, 2017. Accessed August 31, 2020.
Williams R, Clinton J. Canadian Paediatric Society, Early Years Task Force. Getting it right at 18 months: in support of an enhanced well-baby visit. Paediatr Child Health. 2011;16(10):647–654. PubMed CrossRef
Bocquier A, Ward J, Raude J, et al. Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies. Expert Rev Vaccines. 2017;16(11):1107–1118. PubMed CrossRef
Gidding HF, Flack LK, Sheridan S, et al; ACIR linkage Investigator Team. Infant, maternal and demographic predictors of delayed vaccination: a population-based cohort study. Vaccine. 2020;38(38):6057–6064. PubMed CrossRef
Gilbert NL, Gilmour H, Wilson SE, et al. Determinants of non-vaccination and incomplete vaccination in Canadian toddlers. Hum Vaccin Immunother. 2017;13(6):1–7. PubMed CrossRef
Guttmann A, Saunders NR, Kumar M, et al. Implementation of a physician incentive program for 18-month developmental screening in Ontario, Canada. J Pediatr. 2020;226:213–220.e1. PubMed CrossRef
Périnet S, Kiely M, De Serres G, et al. Delayed measles vaccination of toddlers in Canada: associated socio-demographic factors and parental knowledge, attitudes and beliefs. Hum Vaccin Immunother. 2018;14(4):868–874. PubMed CrossRef
Van Berckelaer AC, Mitra N, Pati S. Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants. BMC Pediatr. 2011;11(1):36. PubMed CrossRef
Guttmann A. Uptake of Ontario’s Enhanced 18-Month Well-Baby Visit: An AHRQReport. Institute for Clinical Evaluative Sciences; 2016.
Goldner EM, Hsu L, Waraich P, et al. Prevalence and incidence studies of schizophrenic disorders: a systematic review of the literature. Can J Psychiatry. 2002;47(9):833–843. PubMed CrossRef
Vigod SN, Seeman MV, Ray JG, et al. Temporal trends in general and age-specific fertility rates among women with schizophrenia (1996–2009): a population-based study in Ontario, Canada. Schizophr Res. 2012;139(1–3):169–175. PubMed CrossRef
Howard LM, Kumar R, Thornicroft G. Psychosocial characteristics and needs of mothers with psychotic disorders. Br J Psychiatry. 2001;178(5):427–432. PubMed CrossRef
Hameed MA, Lewis AJ. Offspring of parents with schizophrenia: a systematic review of developmental features across childhood. Harv Rev Psychiatry. 2016;24(2):104–117. PubMed CrossRef
Vigod SN, Kurdyak PA, Dennis CL, et al. Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study. BJOG. 2014;121(5):566–574. PubMed CrossRef
Henriksson KM, McNeil TF. Health and development in the first 4 years of life in offspring of women with schizophrenia and affective psychoses: Well-Baby Clinic information. Schizophr Res. 2004;70(1):39–48. PubMed CrossRef
Sanchez-Gistau V, Romero S, Moreno D, et al. Psychiatric disorders in child and adolescent offspring of patients with schizophrenia and bipolar disorder: a controlled study. Schizophr Res. 2015;168(1-2):197–203. PubMed CrossRef
Taylor CL, Stewart R, Ogden J, et al. The characteristics and health needs of pregnant women with schizophrenia compared with bipolar disorder and affective psychoses. BMC Psychiatry. 2015;15(1):88. PubMed CrossRef
Howard LM, Thornicroft G, Salmon M, et al. Predictors of parenting outcome in women with psychotic disorders discharged from mother and baby units. Acta Psychiatr Scand. 2004;110(5):347–355. PubMed CrossRef
Howard LM, Goss C, Leese M, et al. Medical outcome of pregnancy in women with psychotic disorders and their infants in the first year after birth. Br J Psychiatry. 2003;182(1):63–67. PubMed CrossRef
Osam CS, Pierce M, Hope H, et al. The influence of maternal mental illness on vaccination uptake in children: a UK population-based cohort study. Eur J Epidemiol. 2020;35(9):879–889. PubMed CrossRef
Williams R, Clinton J, Price D, et al. Ontario’s enhanced 18-month well-baby visit: program overview, implications for physicians. Ont Med Rev. 2010;2:23–27.
Maaten S, Guttman A, Kopp A, et al. Care of women during pregnancy and childbirth. Primary Care in Ontario ICES Atlas Toronto: Institute for Clinical Evaluative. Toronto: Institute for Clinical Ecaluative Sciences; 2006.
Williams J, Young W. A summary of studies on the quality of health care administrative databases in Canada. Patterns of Health Care in Ontario: the ICES Practice Atlas. 2nd ed. Ottawa: Canadian Medical Association; 1996;339:45.
Schwartz KL, Tu K, Wing L, et al. Validation of infant immunization billing codes in administrative data. Hum Vaccin Immunother. 2015;11(7):1840–1847. PubMed CrossRef
Kurdyak P, Lin E, Green D, et al. Validation of a population-based algorithm to detect chronic psychotic illness. Can J Psychiatry. 2015;60(8):362–368. PubMed CrossRef
Minkovitz CS, Strobino D, Scharfstein D, et al. Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics. 2005;115(2):306–314. PubMed CrossRef
Farr SL, Dietz PM, Rizzo JH, et al. Health care utilisation in the first year of life among infants of mothers with perinatal depression or anxiety. Paediatr Perinat Epidemiol. 2013;27(1):81–88. PubMed CrossRef
Bland J, Clements J. Protecting the world’s children: the story of WHO’s immunization programme. World Health Forum. 1998;19(2):162–173. PubMed
Ontario PH. Publicly Funded Immunization Schedules for Ontairo. Health.gov website. https://www.health.gov.on.ca/en/pro/programs/immunization/docs/Publicly_Funded_ImmunizationSchedule.pdf. Accessed December 27, 2021.
Johns Hopkins University. The Johns Hopkins ACG System. Q-corp.org website. https://q-corp.org/sites/qcorp/files/Johns%20Hopkins%20ACG%20System.pdf. 2012. Accessed August 31, 2020.
Saunders NR, Ray JG, Diong C, et al. Primary care of mothers and infants by the same or different physicians: a population-based cohort study. CMAJ. 2020;192(36):E1026–E1036. PubMed CrossRef
Arat A, Burström B, Östberg V, et al. Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia: a systematic review. BMC Public Health. 2019;19(1):290. PubMed CrossRef
Arat A, Norredam M, Baum U, et al. Organisation of preventive child health services: key to socio-economic equity in vaccine uptake? Scand J Public Health. 2020;48(5):491–494. PubMed CrossRef
McLeod L, Buckley G, Sweetman A. Ontario primary care models: a descriptive study. CMAJ Open. 2016;4(4):E679–E688. PubMed CrossRef
Feudtner C, Feinstein JA, Zhong W, et al. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014;14(1):199. PubMed CrossRef
Liu N, Farrugia MM, Vigod SN, et al. Intergenerational abortion tendency between mothers and teenage daughters: a population-based cohort study. CMAJ. 2018;190(4):E95–E102. PubMed CrossRef
Bursac Z, Gauss CH, Williams DK, et al. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):17. PubMed CrossRef
Lyngsøe BK, Vestergaard CH, Rytter D, et al. Attendance of routine childcare visits in primary care for children of mothers with depression: a nationwide population-based cohort study. Br J Gen Pract. 2018;68(667):e97–e104. PubMed CrossRef
Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. J Affect Disord. 2015;171:142–154. PubMed CrossRef
Kavanaugh M, Halterman JS, Montes G, et al. Maternal depressive symptoms are adversely associated with prevention practices and parenting behaviors for preschool children. Ambul Pediatr. 2006;6(1):32–37. PubMed CrossRef
Zajicek-Farber ML. The contributions of parenting and postnatal depression on emergent language of children in low-income families. J Child Fam Stud. 2010;19(3):257–269. CrossRef
Jones MN, Brown CM, Widener MJ, et al. Area-level socioeconomic factors are associated with noncompletion of pediatric preventive services. J Prim Care Community Health. 2016;7(3):143–148. PubMed CrossRef
Kaufman EA, McDonell MG, Cristofalo MA, et al. Exploring barriers to primary care for patients with severe mental illness: frontline patient and provider accounts. Issues Ment Health Nurs. 2012;33(3):172–180. PubMed CrossRef
Dolman C, Jones I, Howard LM. Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Women Ment Health. 2013;16(3):173–196. PubMed CrossRef
Guttmann A, Manuel D, Dick PT, et al. Volume matters: physician practice characteristics and immunization coverage among young children insured through a universal health plan. Pediatrics. 2006;117(3):595–602. PubMed CrossRef
Guttmann A, Shipman SA, Lam K, et al. Primary care physician supply and children’s health care use, access, and outcomes: findings from Canada. Pediatrics. 2010;125(6):1119–1126. PubMed CrossRef
Gearing RE, Alonzo D, Marinelli C. Maternal schizophrenia: psychosocial treatment for mothers and their children. Clin Schizophr Relat Psychoses. 2012;6(1):27–33. PubMed CrossRef
Radley J, Grant C, Barlow J, et al. Parenting interventions for people with schizophrenia or related serious mental illness. Cochrane Database Syst Rev. 2021 Oct 19;10(10):CD013536. PubMed CrossRef
Holt N, Mygind A, Bro F. Danish MMR vaccination coverage is considerably higher than reported. Dan Med J. 2017;64(2):A5345. PubMed
Mayer-Amberg N, Woltmann R, Walther S. An integrated care initiative to improve patient outcome in schizophrenia. Front Psychiatry. 2016;6:184. PubMed CrossRef
Glazer KB, Zeitlin J, Howell EA. Intertwined Disparities: Applying the Maternal-Infant Dyad Lens to Advance Perinatal Health Equity. Elsevier; 2021:151410.
Wan MW, Moulton S, Abel KM. A review of mother-child relational interventions and their usefulness for mothers with schizophrenia. Arch Women Ment Health. 2008;11(3):171–179. PubMed CrossRef
Moore Simas TA, Flynn MP, Kroll-Desrosiers AR, et al. A systematic review of integrated care interventions addressing perinatal depression care in ambulatory obstetric care settings. Clin Obstet Gynecol. 2018;61(3):573–590. PubMed CrossRef
Wendt AC, Stamper G, Howland M, et al. Indirect psychiatric consultation for perinatal bipolar disorder: a scoping review. Gen Hosp Psychiatry. 2021;68:19–24. PubMed CrossRef