OP02 Mental health disorders in children at risk of significant harm: a record linkage study of a child protection register and electronic health records*

Résumé fourni par la source

Background Children with experience of maltreatment, abuse or neglect have a higher prevalence of poor mental health. In Scotland and the United Kingdom, child protection services identify children who are most at risk of significant harm on the Child Protection Register (CPR) and intervene to reduce their risk. We aimed to describe the prevalence and incidence of mental health disorders among children at risk of harm and with involvement with Child Protection Services. Methods We analysed records from Aberdeen City Council’s CPR which were linked to electronic health records for the total population of children in the broader NHS Grampian health board region aged 0-17 years between 2012 and 2022. Deterministic record linkage was required due to the absence of a single unique identifier. We have described mental health disorders among children on the CPR using measures of mental health prescribing and referrals to child and adolescent mental health services (CAMHS). We have also calculated age- and sex-specific incidence rates for comparison with the general population. Results During the study period 1,498 children were registered on the CPR, with 69% successfully linked to their health records. 20% were registered before birth and the median age at registration was 3 years. Incidence rates in all measures of mental health disorder were consistently higher in CPR-registered children across all ages and genders compared to the general population. The largest absolute difference was for boys aged 5-9 on the CPR who had 31.8 additional mental health prescriptions per 1,000 person-years compared to the general population (50.4 vs. 18.6 prescriptions per 1,000 person-years, IRR: 2.7, 95% CI: 2.1-3.4). Girls aged 0-4 years on the CPR had the largest relative difference, with a rate of CAMHS referral 5.4 times higher than the general population (12.3 vs. 2.3 referrals per 1,000 person-years, IRR: 5.4, 95% CI: 2.9-9.1). Conclusion Our reproducible record linkage of the CPR to health records reveals an increased incidence risk of mental health disorders during childhood in children with a CPR registration. These methods can be employed in other geographical areas and coverage over multiple Local Authorities would reduce a limitation of this study which could not capture the effects of migration. Operationally, our methods and findings can inform future public mental health surveillance, as well as clinical mental health service prioritisation. We also believe these findings have relevance to wider policy aiming to reduce childhood exposure to risk of harm.

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