Suicide Attempts and Completions among Mothers Whose Children Were Taken into Care by Child Protection Services: A Cohort Study Using Linkable Administrative Data

Elizabeth Wall-Wieler, Leslie L. Roos, PhD, […], and Deepa Singal, PhD

Objective:

The objective of this study is to examine suicide attempts and completions among mothers who had a child taken into care by child protection services (CPS). These mothers were compared with their biological sisters who did not have a child taken into care and with mothers who received services from CPS but did not have a child taken into care.

Methods:

A retrospective cohort of mothers whose first child was born in Manitoba, Canada, between April 1, 1992, and March 31, 2015, is used. Rates among discordant biological sisters (1872 families) were compared using fixed-effects Poisson regression models, and mothers involved with CPS (children in care [n = 1872] and received services [n = 9590]) were compared using a Poisson regression model.

Results:

Compared with their biological sisters and mothers who received services, the adjusted incidence rate ratio (aIRR) of death by suicide was greater among mothers whose child was taken into care by CPS (aIRR = 4.46 [95% confidence interval (CI), 1.39-14.33] and ARR = 3.45 [95% CI, 1.61-7.40], respectively). Incidence rates of suicide attempts were higher among mothers with a child taken into care compared with their sisters (aIRR = 2.15; 95% CI, 1.40-3.30) and mothers receiving services (aIRR = 2.82; 95% CI, 2.03-3.92).

Conclusions:

Mothers who had a child taken into care had significantly higher rates of suicide attempts and completions. When children are taken into care, physician and social workers should inquire about maternal suicidal behaviour and provide appropriate mental health.

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The impact of being placed in care of child protection services (CPS) on children has been examined extensively. These children have worse health and social outcomes than those of children in the general population.^1–5 Several population-based studies have also identified these children as being at higher risk for suicide and suicide attempts.^5–7 Less known are the outcomes of mothers whose children are placed in care by CPS. While mothers with mental illness have significantly greater involvement with CPS, women have reported that they developed mental health conditions, or their existing mental health conditions worsened, after custody loss.^8,9 Being a mother has been identified as being protective against suicide; however, experiencing the death of a child increases this risk, particularly if the child is young.¹⁰ Parents who lose custody of their children have been shown to experience this situation as a ‘living death’.¹¹ The purpose of this study is to examine whether mothers who lost custody of their children due to involvement with CPS have higher rates of suicide attempts and completions than mothers not separated from their children.

Previous observational studies investigating rates of suicide in at-risk populations have controlled for individual mental health, socioeconomic status, and various demographic variables, as these factors have been linked to suicide and suicide attempts.^12,13 Mothers whose children are taken into care often have very different life circumstances than mothers in the general population. To account for some of these differences, we used to comparison groups. The first comparison is between mothers who had a child taken into care and their biological sisters who did not have a child taken into care. This was done because suicide attempts and completions often cluster within families due to shared genetic and environmental factors, and family fixed-effects models of discordant siblings account for stable family characteristics.^14–16 The second comparison was between mothers who had a child taken into care and mothers who received services from CPS but were not separated from their child or children. This comparison was made as the instability that resulted in involvement with CPS may also contribute to differences in suicide attempts and completions. While the comparison groups are imperfect, both capture important similarities.¹⁷

Read more: https://journals.sagepub.com/doi/10.1177/0706743717741058

CITE

Wall-Wieler E, Roos LL, Brownell M, Nickel N, Chateau D, Singal D. Suicide Attempts and Completions among Mothers Whose Children Were Taken into Care by Child Protection Services: A Cohort Study Using Linkable Administrative Data. The Canadian Journal of Psychiatry. 2018;63(3):170-177. doi:10.1177/0706743717741058