Wall-Wieler, E., et al. (2018). Suicide Attempts and Completions among Mothers Whose Children Were Taken into Care by Child Protection Services: A Cohort Study Using Linkable Administrative Data. Canadian Journal of Psychiatry, 63(3): 170-177.
Manitoba has the highest rates of Canadian children in care (approximately 3% in 2011 census), and its suicide rate for female population was 4.8 per 100,000. This observational study aims to examine suicide attempts and completion rates among mothers in Manitoba who lost custody of their children due to involvement with CPS. Mothers were linked with children using hospital birth record information, using de-identified administrative data extracted from Manitoba Population Data Research Repository with individual-level information generated from physician claims, hospital discharge abstracts, vital statistics, Child and Family Services (CFS) case reports, and the Canadian census.
Both outcome variables (suicide completion and suicide attempt) were examined for each mother in any time between the index child was first taken into care (index date) and December 31, 2015. Suicide completion defined as death due to suicide as recorded in the vital statistics database, whereas suicide attempt refers to hospitalization with International Classification of Diseases diagnosis. Suicide attempt before index date, substance use diagnosis before index date, mood and anxiety disorder diagnosis before index date, socioeconomic status of neighbourhood, mother’s age, and child’s age were included as covariates.
Results from a fixed-effects Poisson regression models show the adjusted incidence rate ratio (aIRR) of death by suicide was greater among mothers whose child was taken into care compared to their biological sisters who did not have a child taken into care (aIRR 4.46), and compared to mothers who received CPS services but did not have a child taken into care (aIRR 3.45). Also, suicide attempts ratios were higher among mothers with a child taken into care compared to their biological sisters who did not have a child taken into care (aIRR 2.15), and mothers receiving CPS services but did not have a child taken into care (aIRR 2.82). Findings underscore that mothers who lost their child’s custody to CPS have higher levels of distress and psychiatric problems. This event is associated with feelings of guilt, shame, stigmatization, and loss of self-worth for mothers who lost their child`s custody to CPS, which may have contributed to higher rates of suicide attempts and completions. Furthermore, after separation from their child, mothers have reported the development of mental health conditions, or the worsening of their existing mental health conditions.
This study recommends that when removing a child deemed needed, service providers may ensure that biological mothers are receiving adequate mental health support. Such support could prevent mothers` mental health deterioration, and ensures that stress associated with the separation do not become another barrier to reunification.
This study used two-step fixed-effects Poisson regression models. Potential confounding effect was reduced by accounting for shared familiar characteristics, environment and genetic predisposition. Also, authors indicated several study limitations, such as limited suicide definition, unmeasured confounders (i.e., maternal education, domestic violence, mothers’ history of abuse and neglect, and Indigenous status), and mothers’ mood/anxiety, and substance use disorders history prior to index date.