Younger maternal age, older paternal age and maternal smoking were associated with increased risk for attachment disorder in children, according to data presented at the American Academy of Child and Adolescent Psychiatry annual meeting.
“This was the first population-based study to examine the general family and parental risk factors associated with offspring attachment disorder and its aim was to fill a gap in the knowledge about this area,” Subina Upadhyaya, MPH, University of Turku, Finland, told Healio.com/Psychiatry, “National population-based register studies have several advantages over the clinical studies previously carried out in this area. They combine large sample sizes, lack of recall bias and a comprehensive list of potential confounders in a cost-effective prospective design. The availability of population-based epidemiological studies in different psychiatric disorders contributes to a better understanding of their prevalence, incidence, outcome and etiology.”
To assess associations between prenatal risk factors and attachment disorder in children, researchers evaluated 773 individuals born in Finland from 1996 through 2012 diagnosed with attachment disorder. Each patient was matched with four controls (n = 3,077) without any diagnosis of attachment disorder, severe or profound intellectual disability, or anxiety disorder.
Adjusted analysis indicated a stronger association between mothers diagnosed with psychiatric disorders and attachment disorder (OR = 8.3; 95% CI, 5.8-11.7), compared with fathers diagnosed with psychiatric disorders (OR = 4.8; 95% CI, 3.307.1).
Risk for attachment disorder was significantly higher when both parents were diagnosed with any psychiatric disorders (OR = 49; 95% CI, 31.6-75.9), compared with only mothers or fathers diagnosed.
Increased risk for attachment disorder was associated with maternal smoking (OR = 2.2; 95% CI, 1.6-2.9); blue collar workers (OR = 2.3; 95% CI, 1.3-4.1); single mothers (OR = 2.3; 95% CI, 1.4-3.6); living in an urban area (OR = 1.5; 95% CI, 1.1-2.1); and advanced paternal age (OR = 3.1; 95% CI, 1.6-6.2).
When potential confounders were added and adjusted to maternal age, the association between attachment disorder in offspring and maternal age younger than 20 years was not significant (OR = 1.4; 95% CI, 0.7-2.8).
“There are several novel findings on parental adversities and offspring attachment disorder that are important while planning early prevention and interventions in infant mental health. Parental psychopathology had an exceptionally strong association with offspring attachment disorder. If both parents had psychiatric disorder, there was an additional risk for offspring attachment disorder. The mechanisms can be explained by genetic factors, adversities related to parenting and parental risk behavior exposing the fetal brain to substance misuse. It is likely that these factors interact with and strengthen each other,” Upadhyaya told Healio.com/Psychiatry. “The findings on other parental risk factors also point towards their role in causing attachment disorder. Secure attachment during early childhood is considered to be one of the key elements for good mental health later in life, we need to help parents with psychiatric problems to develop a positive environment for their child early in their antenatal period.” – by Amanda Oldt
Upadhyaya S, et al. Prenatal risk factors associated with attachment disorder in children: A nationwide register-based study. Presented at: American Academy of Child and Adolescent Psychiatry annual meeting; Oct. 23-28, 2017; Washington, D.C.
Disclosure: Upadhyaya reports no relevant financial disclosures.
Editor’s Note: On Oct. 31, 2017, the study methods and findings were updated to reflect the most recent data.