Abstract
BACKGROUND: Maternal mental illness (MMI) affects almost a quarter of mothers and may impact a child's development and physical health. It remains unclear whether MMI is associated with altered utilization of vaccination services. Understanding this association could help to identify families in need of additional support.
METHODS: Using primary care data from England, we conducted a historical cohort study of 397,519 children born in England between 2006 and 2014 with linked maternal records. Associations between different types of MMI (common mental disorders, severe mental illness and alcohol and substance use disorder) with childhood immunisation were explored using logistic regression for differences in coverage and accelerated failure time models for differences in timeliness before the child's fifth birthday.
RESULTS: While there were no differences in vaccination coverage at the age of one, children of mothers with common mental disorders had lower odds of being vaccinated at the ages of two (OR 0.95, 95 %CI: 0.93-0.98) and five (OR 0.86, 95 % CI 0.84-0.89) in comparison to children of mothers with no record of MMI. Vaccination coverage was even lower for children of mothers with comorbid substance disorder and common mental disorder (OR 0.70, 95 % CI: 0.62-0.78 at the age of five). There were no significant differences in timeliness of vaccine receipt by MMI.
CONCLUSIONS: Inequalities in vaccination coverage associated with MMI grow with increasing age of the child. Extending support services for women with MMI beyond the child's first year of life could offer potential to improve vaccination uptake and reduce childhood infections.
| Original language | English |
|---|---|
| Article number | 126529 |
| Journal | Vaccine |
| Volume | 43 |
| Issue number | Pt 2 |
| Early online date | 19 Nov 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 19 Nov 2024 |
Data Availability Statement
The study uses data from the Clinical Practice Research Datalink (CPRD). CPRD does not allow the sharing of patient-level data. The data specification for the CPRD data set is available at: https://cprd.com/cprd-aurum-may-2022-dataset. The code lists can be found at: https://github.com/Eyedeet/vaccine_methods_ehr_public/tree/main/codelists.Acknowledgements
This work uses data provided by patients and collected by the NHS as part of their care and support (usemydata.org).We would like to thank the UCL Mental Health Data Science group for sharing their thoughts on study design and mental health exposure definitions used in the study. We would like to particularly thank Annie Jeffreys and Naomi Launders for sharing their mental health code lists for common mental disorders and severe mental illness.
Funding
This study is funded by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation (NIHR200929), a partnership between UK Health Security Agency and the London School of Hygiene and Tropical Medicine. The views expressed are those of the author(s) and not necessarily those of the NIHR, UK Health Security Agency or the Department of Health and Social Care. CWG is supported by a Wellcome Career Development Award (225,868/Z/22/Z). DPJO is supported by the University College London Hospitals NIHR Biomedical Research Centre and the NIHR North Thames Applied Research Collaboration . This funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
| Funders | Funder number |
|---|---|
| National Institute for Health and Care Research | NIHR200929 |
| Wellcome Trust | 225,868/Z/22/Z |
Keywords
- Childhood
- Inequality
- Maternal mental health
- Vaccination
ASJC Scopus subject areas
- Molecular Medicine
- General Immunology and Microbiology
- General Veterinary
- Public Health, Environmental and Occupational Health
- Infectious Diseases
