Adverse childhood experiences in firstborns and mental health risk and health-care use in siblings: a population-based birth cohort study of half a million children in England.

BACKGROUND

Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. We aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.

METHODS

We derived a population-based birth cohort in England using linked electronic health records for first-time mothers (aged 14-55 years) with their children (born 2002-18). We followed up the cohort from 1 year before birth up to 18 years after birth across the Clinical Practice Research Datalink GOLD and Aurum databases (primary care), Hospital Episode Statistics (secondary care), and the Office of National Statistics (death registrations) between April 1, 2001, and March 31, 2020. We included six different ACE domains, including child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments, and high-risk presentations of child maltreatment, in the records of the mother or the firstborn in the first 1000 days. The primary outcome was the number of children (aged 5-18 years) with recorded mental health problems per mother. We used adjusted and weighted negative binomial regression models to estimate incidence rate ratios.

FINDINGS

Of 333 048 firstborns and their mothers, 123 573 (37·1%) had any ACEs between 1 year before and 2 years after birth, and 65 941 (19·8%) of all mothers had at least one child with a mental health problem between ages 5 years and 18 years (median follow-up 11·4 years [IQR 9·2-14·1]). Mothers with firstborns with ACEs had 1·71 (95% CI 1·68-1·73) times as many children in total with mental health problems (mean 29·8 children per 100 mothers, 29·4-30·1) compared with mothers without firstborns with ACEs (mean 17·4 children per 100 mothers, 17·3-17·6), translating into a mean difference of 12·3 (95% CI 11·9-12·7) additional children with mental health problems per 100 mothers. These mothers also had increased incidence rates of children with all-cause emergency admissions and mental health-related contacts. There was no significant difference in the risk of mental health problems between firstborn and later-born children.

INTERPRETATION

ACEs in firstborns during the first 1000 days were associated with increased mental health problems and health-care needs in multiple children in the same family. The findings highlight the importance of early identification of vulnerable first-time parents and firstborns and increased policy focus on sustained support beyond the first 1000 days to promote healthier long-term family outcomes. Future evaluations of interventions should include the health outcomes of multiple children within families.

FUNDING

NIHR Policy Research Programme.