Early exposure to adverse childhood experiences (ACEs) in firstborn children can impact the mental health of all siblings in the family, a new study shows.
Researchers from University College London (UCL) and the University of Bristol found that children are nearly three-quarters (71%) more likely to develop mental health problems between the ages of five and 18, if the firstborn in the family experiences adversity during their first 1,000 days of life.
The researchers state that general practice teams could have a key role in identifying firstborn children experiencing ACEs and in supporting first-time parents to help reduce the impact of adverse events on the whole family, including future siblings. The findings are published in The Lancet Public Health.
Using data from linked GP and hospital records, the researchers analysed electronic health records from 333,048 first-time mothers and their 534,904 children (firstborns and siblings) born in England between 2002 and 2018.
The researchers grouped ACEs into six domains (child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments, and high-risk presentations of child maltreatment) experienced by the firstborn in the first 1,000 days.
Follow-up with the children took place up to 18 years post-birth, and the primary outcome was the number of children between five and 18 years old per mother with recorded mental health issues.
Over a third of the study’s firstborn children (37 per cent) were exposed to at least one ACE between one year before and two years after birth. The most common included living with maternal mental health problems (22 per cent) and adverse family environments (14.5 per cent) such as parent criminality and housing instability. Nearly a fifth of all mothers had at least one child with a mental health problem.
Mothers whose firstborns were exposed to ACEs had significantly more children with mental health problems (average 29.8 children per 100 mothers) than mothers whose firstborns were not (17.4 children per 100 mothers) – equating to a 71% higher rate.
In addition, the former group of mothers had 50 per cent higher rates of emergency hospital admissions and double the amount of mental health-related healthcare contacts among their children.
The risk of mental health issues arising between five and 18 years old was found to be similar between firstborns and later-born children.
Lead author Dr Shabeer Syed from UCL Great Ormond Street Institute of Child Health said: ‘Whilst previous research has focused on the impact of adverse childhood experiences on individual children, our study reveals a cascading health risk that extends beyond the individual, impacting on the health of siblings as well. This likely stems from the continuation of adverse childhood experiences within the family.’
The researchers highlight the ‘escalating rates’ of children and young people in contact with mental health services and suggest early and effective prevention strategies should be implemented.
The team say their study’s findings highlight the need for further research into the impact of early health visiting and primary care support.
Professor Jessica Deighton from UCL Psychology and Language Sciences added: ‘These findings indicate that, when we encounter children facing significant challenges like domestic abuse or poverty, we must expand our focus to the whole family, including siblings. To achieve this, we want to see increased funding for prevention schemes and harness community assets – such as GPs and local organisations – which are crucial for helping to identify and meet the needs of vulnerable young people.’
