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April 17, 2018

Mothers Who Lose Child Custody Have Higher All-Cause Mortality
Joel Yager, MD reviewing Wall-Wieler E et al. Am J Epidemiol 2018 Mar 28

Results from a large epidemiological study comparing sisters who did or did not lose custody of their children

Decisions to remove children from their mothers ordinarily occur under extreme circumstances and have wide-ranging consequences; for example, mothers whose children are removed from their care have higher suicide rates. To examine whether overall increased maternal mortality was among these consequences, investigators analyzed registry data on sister pairs from 1974 families in Manitoba, Canada.

Each sister had a child born between 1992 and 2015, but only one sister had a child taken into custody by child protective services. Average follow-up lasted for approximately 8.5 years; the average age of mothers who died was 31.

Analyses adjusted for age, health, sociodemographic factors, and family characteristics and used inverse probability weighting to account for individual differences. Mothers who lost children to custody were at nearly 3.5 times higher risk than their sisters for premature death due to avoidable causes (i.e., causes were preventable and treatable) and nearly 3 times higher risk for death from unavoidable causes. The added risk was unrelated to the number of children taken into custody. Compared with mothers who experienced the death of a child, those losing a child to custody had almost three times greater risk for avoidable mortality but one third of the risk for unavoidable mortality.

COMMENT
This study did not address contributing causes to maternal death that followed the mother's loss of custody. Dire psychiatric, substance-use, and social conditions that carry increased mortality risk often contributed to custody decisions, but the impact of losing children might also have precipitated or hastened circumstances leading to death. Clinicians should be sensitive to these possibilities in treatment planning.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Joel Yager, MD at time of publication
Editorial Boards Bulletin of the Menninger Clinic; Eating Disorders Review; International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry
CITATION(S):
Wall-Wieler E et al. Mortality among mothers whose children were taken into care by child protection services: A discordant sibling analysis. Am J Epidemiol 2018 Mar 28; [e-pub]. (https://doi.org/10.1093/aje/kwy062)

Joel Yager, MD
Associate Editor

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“Shared Physical Custody: Summary of 40 Studies on Outcomes for Children”
Nielsen, Linda. Journal of Divorce & Remarriage, 2014. DOI: 10.1080/10502556.2014.965578.

Abstract: “One of the most complex and compelling issues confronting policymakers, parents, and professionals involved in making custody decisions is this: What type of parenting plan is most beneficial for the children after their parents separate? More specifically, are the outcomes any better or worse for children who live with each parent at least 35 percent of the time compared to children who live primarily with their mother and spend less than 35 percent of the time living with their father? This article addresses this question by summarizing the 40 studies that have compared children in these two types of families during the past 25 years. Overall the children in shared parenting families had better outcomes on measures of emotional, behavioral, and psychological well-being, as well as better physical health and better relationships with their fathers and their mothers, benefits that remained even when there were high levels of conflict between their parents.”