Maternal Mental Health Disorders and Reports to Child Protective Services: A Birth Cohort Study

Background. Existing literature has documented a strong relationship between parental mental illness and child maltreatment, but little is known about the prevalence of mental illness among childbearing women. In the present study, linked administrative records were used to identify the prevalence of maternal mental health (MH) disorders documented at birth and determine the associated likelihood of maltreatment reports during infancy. Materials and Methods. Vital records for California's 2006 birth cohort were linked to hospital discharge and Child Protective Services (CPS) records. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) billing codes from the mother's delivery hospitalization were used to determine diagnosed maternal MH disorders for 551,232 infants born in 2006, and reports of alleged maltreatment were documented from CPS records. Vital birth records were used to control for sociodemographic factors. Finally, the associated risk of reported maltreatment during the first year of life was examined using generalized linear models. Results. Among infants in this statewide birth cohort, 2.8% were born to a mother with a documented MH disorder, of which 41.3% had documented maternal substance abuse issues versus less than 0.5% of infants born to mothers without a diagnosed MH disorder. Further, 34.6% of infants born to mothers with a MH disorder were reported to CPS within one year, and a majority of those reports were made within the first month of life (77.2%). In contrast, among children born to mothers without a MH disorder, 4.4% were reported to CPS during infancy. After controlling for sociodemographic factors, the rate of CPS reports during infancy for infants born to mothers with a MH disorder but no substance use disorder was 2.6 times that of infants born to mothers without a MH disorder (95% CI = 2.47, 2.73). Among infants born to mothers with MH and substance use disorders, the rate of CPS reports during infancy was 5.69 times that of infants born to mothers without a MH disorder (95% CI = 5.51, 5.87). Conclusions. Administrative records provide a method for identifying infants born to mothers with MH disorders, enabling researchers to track rates over time and generate population-level data to inform policy development and improve service delivery.