Attendance of routine childcare visits in primary care for children of mothers with depression: a nationwide population-based cohort study

Br J Gen Pract. 2018 Feb;68(667):e97-e104. doi: 10.3399/bjgp18X694565. Epub 2018 Jan 15.


Background: Depression is a common and potentially debilitating illness worldwide. Attendance to routine childcare appointments is a key point of interest in the effort to improve the health and care for families facing depression.

Aim: To evaluate the association between maternal depression and offspring non-attendance to the Danish childcare and vaccination programme (CCP) for children from 0-5 years of age. The CCP consists of seven separate visits and several vaccinations. To investigate if exposure to recent and previous depression may affect attendance differently.

Design and setting: Population-based cohort study using Danish nationwide registers.

Method: Participants were all live-born children (n = 853 315) in Denmark in the period from 1 January 2000 until 31 August 2013, and their mothers. The outcome of interest was non-attendance of each one of the seven scheduled childcare visits and two vaccination entities in the CCP. Exposure was maternal (both previous and recent) depression. All information was obtained from Danish national registries.

Results: The risk of not attending CCP was higher for children of mothers with depression. For children of mothers with previous depression, the relative risk (RR) was 1.01 (95% confidence interval [CI] = 0.98 to 1.03) at the 5-week childcare visit, and 1.12 (95% CI = 1.09 to 1.14) at the 5-year childcare visit. For children of mothers with recent depression, the RR was 1.07 (95% CI = 1.03 to 1.13) at the 5-week visit, and 1.15 (95% CI = 1.13 to 1.17) at the 5-year visit. Furthermore, the risk of missing at least four of the seven childcare visits was higher for children of females with maternal depression (RR = 1.16, 95% CI = 1.13 to 1.19).

Conclusion: Maternal depression seems to compromise CCP attendance. These findings suggest a need for careful clinical attention to these vulnerable families, even years after a diagnosis of depression.

Keywords: Denmark; child care; delivery of health care; depression; general practice; maternal.

MeSH terms

  • Adult
  • Child Health*
  • Child of Impaired Parents / statistics & numerical data*
  • Child, Preschool
  • Cohort Studies
  • Denmark / epidemiology
  • Depression / epidemiology*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mothers / psychology
  • Mothers / statistics & numerical data*
  • Office Visits / statistics & numerical data*
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data
  • Primary Health Care*
  • Registries
  • Review Literature as Topic
  • Vaccination / statistics & numerical data*