Centre for Women's Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
Eur J Epidemiol. 2020 Sep;35(9):879-889. doi: 10.1007/s10654-020-00632-5. Epub 2020 Apr 24.
Reduced vaccination uptake is a growing and global public health concern. There is limited knowledge about the effect of maternal mental illness (MMI) on rates of childhood vaccination. This retrospective cohort study examined 479,949 mother-baby pairs born between 1993 and 2015 in the Clinical Practice Research Datalink (CPRD GOLD), a UK-based, primary health-care database. The influence of MMI on children's vaccination status at two and five years of age was investigated using logistic regression adjusting for sex of the child, child ethnicity, delivery year, maternal age, practice level deprivation quintile and region. The vaccinations were: 5-in-1 (DTaP/IPV/Hib) and first dose MMR by the age of two; and all three doses of 5-in-1, first and second dose of MMR vaccines by the age of five. Exposure to MMI was defined using recorded clinical events for: depression, anxiety, psychosis, eating disorder, personality disorder and alcohol and substance misuse disorders. The likelihood that a child completed their recommended vaccinations by the age of two and five was significantly lower among children with MMI compared to children with mothers without mental illness [adjusted odds ratio (aOR) 0.86, 95% CI 0.84-0.88, p < 0.001]. The strongest effect was observed for children exposed to maternal alcohol or substance misuse (at two years aOR 0.50, 95% CI 0.44-0.58, p < 0.001). In the UK, an estimated five thousand more children per year would be vaccinated if children with MMI had the same vaccination rates as children with well mothers. Maternal mental illness is a hitherto largely unrecognised reason that children may be missing vital vaccinations at two and five years of age. This risk is highest for those children living with maternal alcohol or substance misuse.
疫苗接种率下降是一个日益严重且全球性的公共卫生问题。目前，人们对产妇精神疾病（MMI）对儿童疫苗接种率的影响知之甚少。本回顾性队列研究调查了 1993 年至 2015 年间在英国初级保健数据库临床实践研究数据链接（CPRD GOLD）中出生的 479949 对母婴对。使用逻辑回归调整儿童的性别、儿童种族、分娩年份、母亲年龄、实践水平剥夺五分位数和地区后，研究了 MMI 对儿童两岁和五岁时疫苗接种状况的影响。接种疫苗包括：两岁时接种五联疫苗（DTaP/IPV/Hib）和第一剂 MMR 疫苗；五岁时接种所有三剂五联疫苗、第一剂和第二剂 MMR 疫苗。通过记录的临床事件来定义 MMI 暴露情况：抑郁、焦虑、精神病、饮食失调、人格障碍和酒精和物质使用障碍。与母亲无精神疾病的儿童相比，患有 MMI 的儿童完成推荐疫苗接种的可能性明显较低[调整后的优势比（aOR）0.86，95%可信区间（CI）0.84-0.88，p<0.001]。在两岁时，接触母亲的酒精或物质滥用的儿童的影响最强（aOR 0.50，95%CI 0.44-0.58，p<0.001）。在英国，如果患有 MMI 的儿童的疫苗接种率与健康母亲的儿童相同，估计每年会有五千多名儿童接种疫苗。产妇精神疾病是儿童在两岁和五岁时可能错过重要疫苗接种的一个迄今为止尚未得到广泛认识的原因。对于那些与母亲一起患有酒精或物质滥用的儿童，这种风险最高。
