Early Mortality and Primary Causes of Death in Mothers of Children with Intellectual Disability or Autism Spectrum Disorder: A Retrospective Cohort Study

Introduction

Mothers of children with intellectual disability or autism spectrum disorder (ASD) have poorer health than other mothers. Yet no research has explored whether this poorer health is reflected in mortality rates or whether certain causes of death are more likely. We aimed to calculate the hazard ratios for death and for the primary causes of death in mothers of children with intellectual disability or ASD compared to other mothers.

Methods

The study population comprised all mothers of live-born children in Western Australia from 1983–2005. We accessed state-wide databases which enabled us to link socio-demographic details, birth dates, diagnoses of intellectual disability or ASD in the children and dates and causes of death for all mothers who had died prior to 2011. Using Cox Regression with death by any cause and death by each of the three primary causes as the event of interest, we calculated hazard ratios for death for mothers of children intellectual disability or ASD compared to other mothers.

Results and Discussion

During the study period, mothers of children with intellectual disability or ASD had more than twice the risk of death. Mothers of children with intellectual disability were 40% more likely to die of cancer; 150% more likely to die of cardiovascular disease and nearly 200% more likely to die from misadventure than other mothers. Due to small numbers, only hazard ratios for cancer were calculated for mothers of children with ASD. These mothers were about 50% more likely to die from cancer than other mothers. Possible causes and implications of our results are discussed.

Conclusion

Similar studies, pooling data from registries elsewhere, would improve our understanding of factors increasing the mortality of mothers of children with intellectual disability or ASD. This would allow the implementation of informed services and interventions to improve these mothers'' longevity.     

Institutional patterns favoring high fertility in underdeveloped areas

Abstract

Data presented indicate that the sex ratio of the Navajo Tribe has shifted since the 1940's and now shows a preponderance of women rather than men. The reasons for this shift, which roughly parallel a similar shift in the general population of the United States, are : (1) a decline in maternal mortality rates; (2) an increase in male mortality rates, particularly from accidents; and (3) greater out‐migration of men than women. Some of the consequences of the changing ratio include: increasing proportion of young widows with dependent children; a growing desire for labor force participation on the part of women; out‐marriage of Navajo women; and, in the future, the probable isolation of elderly widows who may become the responsibility of social welfare agencies.     

What has faith got to do with it? Religion and child survival in Ghana

Using pooled children data from the 1998 and 2003 Ghana Demographic and Health Surveys, this study examines religious differences in child survival in Ghana. Guided by the particularized theology and selectivity theses, a piecewise constant hazard model with gamma-shared frailty is used to explore if there are denominational differences in child mortality, and whether these could be explained through other characteristics. At the bivariate level, children whose mothers identified as Muslim and Traditional were found to have a significantly higher risk of death compared with their counterparts whose mothers identified as Christians. In the multivariate models, however, the religious differences disappeared after the mediating and confounding influence of socioeconomic factors were controlled. The findings provide support for the selectivity hypothesis, which is based on the notion that religious variations mainly reflect differential access to social and human capital rather than religious theology per se.     

Familial Accumulation of Social Anxiety Symptoms and Maladaptive Emotion Regulation

BackgroundSocial anxiety is thought to be strongly related to maladaptive emotion regulation (ER). As social anxiety symptoms accumulate in families, we hypothesize that maladaptive ER is also more prevalent in families with anxious children. Thus, we analyze differences in emotion regulation of both child and mother in relation to social anxiety, as well as both their ER strategies in dealing with anxiety. Further, a positive relation between child and maternal ER strategies is assumed.MethodChildren (aged 9 to 13 years) with social, anxiety disorder (SAD; n = 25) and healthy controls (HC, n = 26) as well as their mothers completed several measures of social anxiety and trait ER strategies towards anxiety. As ER of children is still in development, age is considered as covariate.ResultsSAD children and their mothers reported more maladaptive ER strategies than HC dyads. Maternal maladaptive ER was related negatively to child adaptive ER which was further moderated by the child’s age.DiscussionMaladaptive ER strategies seem to contribute to the exacerbation of social anxiety in both mother and child. Mothers reporting maladaptive ER may have difficulties supporting their child in coping with social anxiety while simultaneously also experiencing heightened levels of anxiety. Deeper understanding of interactional processes between mothers and children during development can assist the comprehension of factors maintaining SAD. Implications for future research and possible consequences for interventions are discussed.     

Email submissions from outside the United Kingdom

ObjectivesTo identify whether psychiatric disturbance in parentally bereaved children and surviving parents is related to service provision.DesignProspective case-control study.SettingTwo adjacent outer London health authorities. Participants45 bereaved families with children aged 2 to 16 years.ResultsParentally bereaved children and surviving parents showed higher than expected levels of psychiatric difficulties. Boys were more affected than girls, and bereaved mothers had more mental health difficulties than bereaved fathers. Levels of psychiatric disturbance in children were higher when parents showed probable psychiatric disorder. Service provision related to the age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death.ConclusionsService provision was not significantly related to parental wishes or to level of psychiatric disturbance in parents or children. There is a role for general practitioners and primary care workers in identifying psychologically distressed surviving parents whose children may be psychiatrically disturbed, and referring them to appropriate services.

Key messages

• Parentally bereaved children show high levels of psychological disturbance, with boys being more vulnerable than girls
• Surviving mothers show more psychiatric morbidity than surviving fathers
• Psychological distress in bereaved parents is associated with psychological difficulties in their children
• Service provision for bereaved children is not determined by mental health difficulties in either parents or children, or by parental wishes; it is influenced only by the manner of parental death and the age of the child
• The mismatch between need and service provision indicates a role for general practitioners and primary care workers in identifying distressed or disturbed families in need of public or voluntary service help

     

Health inequalities: new concerns about the children of single mothers.

OBJECTIVES--To show that the exclusion from conventional class based analyses of child mortality of children whose parents are classified as "unoccupied" produces a misleading picture of health inequalities. DESIGN--Reanalysis of data published in the childhood supplement of the registrar general''s decennial supplement on occupational mortality in England and Wales, which compares numerator data for registrations of deaths in children over the age of 1 but below their 16th birthday in 1979, 1980, 1982, and 1983 with data about children aged 1-15 who were enumerated at the 1981 census. RESULTS--Parents who are classified as "unoccupied" largely consist of economically inactive single mothers. Their children are estimated to represent 89% of the 614,000 aged 1-15 classified as "unoccupied" in the childhood supplement. They have the worst mortality record of all social groups--an age specific death rate of 68.8/100,000 a year, 42% worse than in social class V (48.4/100,000) and worse than that of social class I (22.8) by a factor of 3. At older ages (10-15 years) these children have a relative risk of death of 4.14 relative to classes I and II; the risk is 2.58 in children 0-4 and 2.56 in those 5-9. Relative risks of child mortality in social classes I and II in comparison to classes IV and V suggests a progressive shallowing from 2.08 at ages 1-4 to 1.37 at ages 10-15. When unoccupied parents were combined with classes IV and V and compared with classes I and II, however, inequalities seemed to be pervasive throughout childhood; the relative risks were 2.21 for those aged 1-4 and 1.98 for those aged 10-15. CONCLUSION--Children classified as unoccupied are almost certainly living in poverty as well as experiencing relatively high risks of mortality. Class based analyses which exclude them therefore produce a misleading picture of inequalities in child health. The implications for health policy are profound. Strategies to promote the nation''s health should acknowledge the importance of material and social deprivation more explicitly.     

Mental health problems of homeless children and families: longitudinal study

Objective: To establish the mental health needs of homeless children and families before and after rehousing. Design: Cross sectional, longitudinal study. Setting: City of Birmingham. Subjects: 58 rehoused families with 103 children aged 2-16 years and 21 comparison families of low socioeconomic status in stable housing, with 54 children. Main outcome measures: Children’s mental health problems and level of communication; mothers’ mental health problems and social support one year after rehousing. Results: Mental health problems remained significantly higher in rehoused mothers and their children than in the comparison group (mothers 26% v 5%, P=0.04; children 39% v 11%, P=0.0003). Homeless mothers continued to have significantly less social support at follow up. Mothers with a history of abuse and poor social integration were more likely to have children with persistent mental health problems. Conclusions: Homeless families have a high level of complex needs that cannot be met by conventional health services and arrangements. Local strategies for rapid rehousing into permanent accommodation, effective social support and health care for parents and children, and protection from violence and intimidation should be developed and implemented.

Key messages

• Homeless children and their mothers have a high level of mental health problems
• Homeless families experience many risk factors, such as domestic violence, abuse, and family and social disruption
• In two fifths of children and a quarter of mothers, mental health problems persisted after rehousing
• In contrast with a comparison group of families of low socioeconomic status, a substantial proportion of homeless families remained residentially and socially unstable

     

Spina Bifida and Potatoes

The results of a retrospective survey of the dietetic and other habits of the mothers of 83 children with spina bifida (mostly schoolchildren with meningomyelocele) were compared with 85 carefully matched controls. The survey was particularly concerned with the consumption of or contact with potatoes by the mothers. No significant differences were found in the amount of potatoes eaten as reported by the mothers (mean for spina bifida group 3·60 1b (1630 g), and for controls 3·98 1b (1800 g) per week). Of the seven other comparisons associated with potatoes only one (obtaining them from the chip shop or restaurant) was significant, the mothers of the children with spina bifida being more likely to obtain some of them from this source.When examining other aspects of diet it was found that the mothers of spina bifida children reported a lower consumption of a number of important foods, though the deficiency was not significant in any instance. These mothers were also significantly more likely to have been prescribed drugs other than iron and vitamins early in pregnancy and to have reported a wider variety of illnesses.The results in general do not support the hypothesis that the quantity of potatoes taken is important. They do lend support to the view that poor dietary habits are associated with a higher incidence of spina bifida irrespective of social class. Furthermore, general ill health in the mother may be implicated.     

Sociodemographic and motivational characteristics of parents who volunteer their children for clinical research: a controlled study.

OBJECTIVE--To determine the sociodemographic and motivational characteristics of parents who volunteer their children for clinical research. DESIGN--A questionnaire was administered to parents who volunteered their children for a randomised, double blind, placebo controlled trial of a drug to treat asthma and to a control group of parents whose children were eligible for the trial but had refused the invitation. SETTING--A children''s hospital in Australia. SUBJECTS--68 Parents who had volunteered their children and 42 who had not; a response rate of 94% and 70%, respectively. MAIN OUTCOME MEASURES--Responses of parents to questionnaire designed to assess their perceptions, attitudes, and health seeking behaviour as well as sociodemographic data. RESULTS--Volunteering parents were less well educated with only 15% (10/68) of mothers and 16% (11/68) and of fathers having had a tertiary or university education compared with 26% (11/42) of mothers and 45% (19/42) in the non-volunteering group. Fewer volunteering parents had professional or administrative jobs than did non-volunteering parents (mothers 6% (4/68); fathers 9% (6/68) v mothers 14% (6/42); fathers 31% (13/42)). Volunteering parents had less social support, and they displayed greater health seeking behaviour and consumed more habit forming substances. They were motivated by a desire to help others and to contribute to medical research, but they were also searching for more information and better ways to help their own children. CONCLUSION--Parents who volunteer their children for medical research are significantly more socially disadvantaged and emotionally vulnerable.     

The death of children following negligence: Social aspects

Although the figure of unreported cases of neglected children is much higher than that of physical ill-treatment of children, neglect has rarely received attention, in most cases only when traces of physical ill-treatment were proven at the same time.Symptomatic are in the first place intense emaciation as well as dry puckered, scaly and extremely dirty skin, lack of subcutaneous fatty tissue and of Bichat's fat pad, matted hair, aged face, sunken eyes, and eczema from urine with ulcerations in the buttock and thigh regions. In addition one finds signs of localized hypothermia or rickets.My own observations cover 54 cases in which neglect and malnutrition have caused the death of the children involved. All the children had been living in extremely bad social conditions. The backgrounds of the children's mothers were also socially poor. Most of the mothers were too young to fulfil their duties. The fathers, where known, were alcoholics, unwilling to work and seldom cared for their family. They too were often too young to cope with their role as father.In this day and age, which has provided us with a much better understanding of the importance of the early development of the child for its later social attitude, mothers with all their problems and difficulties should not be left on their own. Motherlike behaviour is not necessarily programmed with the birth of a child. Mother duties must be learned as early as possible. This process should begin during pregnancy at the latest.A few proposals will be made.     

Allocation of accumulated resources among close kin: Inheritance in Sacramento,California, 1890–1984

We analyze the legacies of 1538 testate decedents from Sacramento, California 1890–1984. Spouse and/or children received an average 92% of the state. The few women who were survived by a spouse more often excluded their husbands in favor of their children than did husbands exclude wives. We explain this difference in spousal treatment in terms of the reproductive potential of the two sexes at the average age of death. Fathers and mothers without spouses bequeathed the majority of assets to children. Seventy-one percent of parents with two or more children treated them absolutely equally. Sex ratio among offspring was equal. There was no evidence of a general sex preference or a wealth by sex-preference interaction. Decedents with two or more daughters treated them more equitably than did decedents with two or more sons— additional evidence that treatment of daughters is less subject to environmental and individual variation than is the treatment of sons. Decedents without biological children treated adopted children like biological children. Smaller legacies to the few adopted children in families with biological children can be explained by increased sibship size.     

Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991.

OBJECTIVE: To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. DESIGN: Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. SETTING: England and Wales. SUBJECTS: Children aged 0-15 years. MAIN OUTCOME MEASURES: Death rates from injury and poisoning. RESULTS: Death rates from injury and poisoning have fallen for children in all social classes. The decline for children in social classes IV and V (21% and 2% respectively), however, is smaller than that for children in social classes I and II (32% and 37%). As a result of the differential decline in injury death rates, socioeconomic mortality differentials have increased. In the four years 1979-80 and 1982-83 the injury death rate for children in social class V was 3.5 times that of children in social class I. For the four years 1989-92 the injury death rate for children in social class V was 5.0 times that of children in social class I. Poisson regression modelling showed that the trend in the decline in death rates across the social classes was unlikely to have arisen by chance alone. CONCLUSIONS: Socioeconomic inequalities in child injury death rates have increased. If these gradients persist, the Health of the Nation''s target is likely to be met for children in the non-manual social classes but not for those in the manual social classes.     

Experiences of racism and the changing nature of white privilege among lone white mothers of mixed-parentage children in the UK

In a context where mixed relationships are often seen as a visible indicator of increased tolerance, this paper holds up a lens to the particular experiences of racism negotiated by lone white mothers of mixed-parentage children. Based on qualitative interviews with thirty mothers, this paper illustrates how, through their parenting, racism and racial injustice became more visible to the mothers in the study. It is argued that, as well as experiencing racism directed at their children in a range of contexts (including the extended family, school and the local area), lone white mothers of mixed-parentage children are frequently facing social disapproval themselves. Drawing on the notion of whiteness as a seemingly unmarked and invisible category, this paper argues that mothers' experiences can challenge and complicate dominant conceptualizations of white privilege.     

Stress and coping among mothers of twins in rural southwestern Nigeria.

High rates of twinning have been reported in Africa. This study sought to learn whether mothers of twins experience different stress levels than those who have only singletons. Both twin mothers (101) and singleton mothers (101) were interviewed. Using a scale of 15 stressors the researchers found that the mean stress score was significantly higher for twin mothers than singleton mothers. Higher stress scores were also associated with parity and perceptions of problems in caring for children and inversely related to perceived levels of social support. Confronting stressors or simply accepting them were the two main ways that mothers coped with their problems.     

The Role of Remarriage in a Microevolutionary Process: Considerations from a 19th-Century Italian Community

In this study, we investigate the extent to which social norms and cultural constraints might affect the genetic contribution of remarriage to future generations in a mid–19th century Italian population. By reconstructing the life histories of the inhabitants of Casalguidi, 1,028 marriages were recorded and analyzed. Frequency and reproductive pattern of remarriages were found to play a quantitatively important role in the process of population renewal, featuring 20 percent of total unions and 12 percent of total children borne between 1820–58. Cultural patterns shaped the access to remarriage, but widows resulted more open than widowers in the partner choice. Furthermore, remarriages were more likely consanguineous than first unions because of socioeconomic reasons. As a result, a genotypic differentiation between the offspring of first marriage and remarriage was found. However, the lower intensity of female remarriage and the predominance of widowers' unions limited the potential differentiation in the gene pool of offspring.     

Follow-up of children born of bromocriptine-treated mothers

A survey carried out in France at the beginning of 1984 concerning development of children born of mothers treated with bromocriptine (BC) during part or all of the pregnancy showed the absence of any adverse effects of BC in 64 children born from 53 mothers. In 60 cases, BC was prescribed (2.5-7.5 mg/day) for hyperprolactinemia; 23 mothers were treated with BC for 4 weeks or less, and 23 others for 30 weeks or more. After a follow-up of between 6 months and 9 years, all children are normal. Psychological development in the 23 children born to mothers treated with BC during more than 30 weeks of pregnancy actually appears more precocious, with excellent scholastic performance in the oldest.     

Development in Japanese macaques (Macaca fuscata): Sexually dimorphic behavior during the first year of life

We have documented several sexually dimorphic patterns of behavior that develop during the first year of life in infant Japanese macaques and their mothers. Mothers treated their infants differently by sex—mothers of males broke contact with them and retrieved them more frequently than did mothers of females. And mothers of male infants moved more frequently than did mothers of female infants. Male infants played more, played in larger groups, and mounted more frequently; female infants groomed and spent more time close to other monkeys in larger social groups than did males. Female infants were also punished by other group members more frequently than were male infants. We conclude that male and female Japanese macaque infants receive differential treatment early in life by both their own mothers and other animals, and males and females in turn treat their mothers and other animals differently. There appears to be a reciprocal relationship between the behavior of infants, mothers and other social partners that contributes to the development of sexually dimorphic patterns of behavior.     

Emotional disturbance in unplanned versus planned children.

In 2 studies, 2 samples of planned and unplanned children (mean ages, 13.45 and 13.27), matched for education and divided into middle and lower class, were compared for emotional disturbances. Also, in the 2nd study, mothers were compared for neuroticism and attitudes to the child, and family size was determined. The comparisons were made on the basis of personality inventories completed by the children, questionnaires completed by their teachers, and personality and attitude surveys taken by their mothers. Hypotheses were: 1) unplanned children would be significantly more emotionally disturbed than planned ones (confirmed), 2) mothers of unplanned children would be significantly more neurotic and rejecting than mothers of planned ones (not confirmed), 3) unplanned children would belong to significantly larger families (confirmed). Unplanned children scored higher for emotional disturbance, particularly the lower class children; it is suggested that the greater the adversity of circumstance of the family, the more negative the effects of unplanned status will be on emotional adjustment.     

Comparison of child-rearing problems between mothers with multiple children who conceived after infertility treatment and mothers with multiple children who conceived spontaneously.

The purpose of this study was to clarify the characteristic child-rearing problems for mothers of multiple children who conceived after infertility treatment as compared to mothers of multiple children who conceived spontaneously. The subjects were 990 mothers of multiple children: 359 who conceived after infertility treatment and 631 who conceived spontaneously. Mothers who conceived after infertility treatment were more delighted when informed of a multiple pregnancy than those who conceived spontaneously. In addition, with respect to anxiety during twin pregnancies, mothers of twins who conceived after infertility treatment showed lower rates of anxiety about nursing the infants and economic concerns than those of twins who conceived spontaneously. However, after delivery, mothers who conceived after infertility treatment showed a higher rate of depressive symptoms than those who conceived spontaneously. After adjusting for each associated factor using logistic regression, the risk of depressive symptoms in mothers who conceived after infertility treatment was significantly associated with disabled multiple children and the methods for alleviating stress. The odds ratio indicated that mothers with at least one disabled child were twice as likely to have depressive symptoms as mothers with no disabled children. Furthermore, the odds ratio indicated that mothers who used no methods for alleviating stress were twice as likely to have depressive symptoms than those who did.     

Neural-tube defects: importance of a history of abortion in aetiology.

The overall incidence of anencephaly and spina bifida (ASB) in 69,056 pregnancies was 4.7/1000 births. ASB was more common (8.4/1000 births) among children of mothers who had had two or more abortions, but the increased risk was confined to spina bifida. A history of abortion was more common in older women and women of higher parity, but this was not matched by a similar increase in the incidence of ASB. The incidence of ASB was related to social class, but the prevalence of previous abortions was similar in all classes. The results suggest that expectant mothers with a history of two or more abortions have an increased risk of producing a child with spina bifida. The abortions are considered to be a manifestation of previous abnormal conceptions rather than the primary cause.