Exposure to intimate partner violence and parental depression increases risk of ADHD in preschool children

Abstract

Question: Does exposure to parental depression or intimate partner violence (IPV) during the first 3 years of life have an effect on a child's subsequent mental health?

People: A total of 2422 children (52% boys, Hispanic/ Latino 45.5%, Black 40.6%, White 10.5%) visiting health centres served by the Child Health Improvement through Computer Automation (CHICA) paediatric primary care system, from birth to age 3 years, and again when aged between 37 and 72 months.

Setting: Four community health centres, Indianapolis, Indiana, USA; November 2004–June 2012.

Risk factors: Exposure to IPV and parental depression within the first 3 years of life. This information was collected using screening questions presented in a prescreener form which parents completed in the clinic waiting rooms. To screen for depression, The Patient Health Questionnaire (PHQ-2) was used until 2010, and then replaced by the anxiety subscale of the Edinburgh Postnatal Depression Scale (EPDS-3). IPV was screened using the questions ‘Has your partner kicked, hit or slapped you?’ and ‘Do you feel safe in your home?’

Outcomes: Child mental health diagnosis or psychotropic drug treatment received between the ages of 3 and 3. Diagnoses were identified using International Classification of Diseases-9 codes for attention deficit hyperactivity disorder (ADHD), disruptive behaviour disorder, depression, anxiety, sleep disturbance or adjustment disorder. Prescription information was taken from the Indiana Network for Patient Care and Regenstriel Medical Record Systems databases.

METHODS: Design: Prospective cohort study.

Follow-up period: Three years.

MAIN RESULTS: Within the first 3 years of the child's life, 1591 (65.7%) of parents reported neither IPV nor depression, 704 (29.1%) reported depression only, 69 (2.8%) reported IPV only and 58 (2.4%) reported IPV as well as depression. Between ages 3 and 6 years, 48 (2%) of children had received psychotropic medication, 80 children (3.3%) were diagnosed with ADHD, 209 (8.7%) with disruptive behaviour disorder, 9 (0.4%) with depression, 17 (0.7%) with anxiety, 7 (0.3%) with sleep disturbance and 41 (1.7%) with adjustment disorder. Prevalence of ADHD was higher in children exposed to parental depression compared with those not exposed (4.5% vs 2.8%, p≤0.03). Psychotropic drug prescriptions were higher in children exposed to parental depression compared with those who were not exposed (2.9% vs 1.6%, p≤0.03). Multivariate regression analysis revealed that increased exposure to IPV as well as depression was associated with increased risk of ADHD diagnosis compared with non-exposure (OR 4.0, 95% CI 1.5 to 10.9; see table). Exposure to parental depression was also associated with increased risk of child psychotropic medication prescription (OR 1.9, 95% CI 1.0 to 3.4). There were no significant associations with exposure to IPV only or with both exposures for any other mental health condition.

CONCLUSIONS: Exposure to parental IPV and parental depression within the first 3 years of life is associated with increased risk of ADHD diagnosis prior to 6 years. Early exposure to parental depression is associated with increased risk of psychotropic medication prescription.