Parental Jail Time May Sentence Kids to a Lifetime of Mental Illness

Deborah Brauser

September 18, 2019

Parental incarceration is associated with a significantly increased risk of mental illness in offspring that can start in childhood and extend into adulthood, new research shows.

A study of more than 1400 participants showed that children of incarcerated parents were twice as likely to have a childhood diagnosis of depression, attention deficit hyperactivity disorder (ADHD), and conduct disorder compared with their counterparts whose parents did not serve jail time.

These children were also more likely to experience an anxiety and/or illicit drug user disorder in adulthood, become parents before age 18, fail to complete high school, and do jail time themselves.

"Parental incarceration is a common experience that may perpetuate disadvantage from generation to generation," the researchers write.

Principal investigator William E. Copeland, PhD, professor of psychiatry at the University of Vermont Medical Center, Burlington, noted that the study highlights the need for better public policy.

"I think clinicians need to be advocating for change in our laws so we can reduce the number of people who are incarcerated, and therefore the number of kids affected," he told Medscape Medical News.

Dr William Copeland

In addition, a clinician working with a child who has an incarcerated parent should watch for possible early warning signs, he added. "It's not determined that kids are going to have these problems, and it's not determined what kind of problems these kids will have. It's seeing how all of this plays out specifically for an individual child."

The findings were published online August 23 in JAMA Network Open.

Long-Term Impact

Recent estimates suggest 8% of US children younger than 18 years experienced the incarceration of a parent or guardian in 2016, the investigators note

Copeland added that previous research has shown parental incarceration has a detrimental effect on children and can cause academic, behavioral, and emotional problems.

"For this study, we wanted to look at whether these effects persist and last into adulthood," he said.

Copeland leads the community-representative, longitudinal Great Smoky Mountains Study (GSMS), which included children in predominantly rural counties in North Carolina and was created to assess mental health prevalence.

For the study, investigators used data from a cohort of 1420 GSMS participants (51% boys).

Between January 1993 and December 2000, children were interviewed up to 8 times between the ages of 9 to 16 years old, along with their parents. The Child and Adolescent Psychiatric Assessment assessed psychiatric problems and parental incarceration.

From January 1999 to December 2015, 1334 of the participants were also followed up at ages 19, 21, 25, and 30 years.

By age 16, 23.9% of the participants had at least one parent who had been imprisoned. In addition, 22.2% of male and 25.5% of female participants experienced parental incarceration. The study also found that 48% of American Indian children, 43% of black children, and 21% of white children had an incarcerated parent.

Results showed that parental jail time was associated with childhood diagnoses of any depressive disorder, conduct disorder, oppositional defiant disorder, and ADHD.

Table 1. Association Between Parental Incarceration and Childhood Outcomes

Outcome

Adjusted OR*

95% CI**

P Value

Any psychiatric diagnosis

2.3

1.5 – 3.5

< .001

Any depressive disorder

2.5

1.3 – 4.6

.006

Conduct disorder

2.5

1.4 – 4.3

.001

Oppositional Defiant Disorder

2.7

1.6 – 4.4

< .001

ADHD

2.3

1.0 – 5.5

.06

*OR = odds ratio

**95% CI = confidence interval

It was also associated with low family socioeconomic status, family instability and dysfunction, and maltreatment (all, P < .001).

"After accounting for childhood psychiatric diagnoses and adversity exposure," the researchers report that parental incarceration was also associated with a slew of psychiatric, behavioral, legal, and social problems into adulthood.

Table 2. Association Between Parental Incarceration and Adult Outcomes

Outcome

Adjusted OR

95% CI

P Value

Drug use disorder

6.6

2.6 – 17.0

< .001

Anxiety disorder

1.7

1.0 – 3.0

.04

Felony charge

3.4

1.8 – 6.5

< .001

Incarceration

2.8

1.4 – 5.4

.003

Not completing high school

4.4

2.2 – 8.8

< .001

Early parenthood

1.7

1.0 – 3.0

.04

Socially isolated

2.2

1.2 – 4.0

.009

 

Intergenerational Transmission

There were no significant differences in outcomes between maternal vs paternal incarceration.

"Our study documented the long reach of childhood parental incarceration. With respect to psychiatric disorders, offspring's adult rates remained elevated more than a decade later," the investigators write.

The findings regarding other outcomes "painted a concerning picture of intergenerational transmission of criminal involvement and incarceration." They add that adverse outcomes were the same in children who had biological vs nonbiological parents who were incarcerated.

Copeland noted that clinicians caring for children with a parent in jail should "pay attention to early signs. If you see that a child is struggling with something like anxiety or depression or substance use, you can jump in as early as possible and help that child before something small turns into something larger," he said.

"It's just an increased level of vigilance for these children, and maybe even adults who are still dealing with something that happened a long time ago," Copeland added.

Asked whether the findings are generalizable to children who have been forcibly separated from parents at the US/Mexican border, Copeland said it was a possibility.

"That's not what we were testing here, and more work needs to be done to see if parental separation in any form is going to have these kinds of effects. But there's good reason to believe, and there's been a long history of research suggesting, that when a child is unexpectedly separated from their parent, there is significant distress that's likely to follow," he said.

Overlooked Population

Commenting on the findings for Medscape Medical News, Louis J. Kraus, MD, chief of child and adolescent psychiatry, Rush University Medical Center, Chicago, Illinois, said that these types of studies are important "because children that are at risk are often overlooked."

Kraus, who is also the delegate for child and adolescent psychiatry to the American Medical Association, was not involved with the current research.

"Children who have parents that have been or are currently incarcerated, are always going to be an at-risk population," he noted.

That said, he pointed out that the study had several limitations, including its observational design. He also noted there was no examination of the potential impact of the length of time served, the type of incarceration (jail vs prison), or between violent and nonviolent parental offenders.

Nevertheless, Kraus said the study is valuable and may help shed light on potential early interventions for at-risk children.

Studies such as this, he said, can "set the stage for future research in specific areas."

Kraus noted that the biggest takeaway from the study is that it raises awareness that children of incarcerated parents are at risk for mental health problems.

"In addition to child and adolescent psychiatrists, primary care physicians, pediatricians, and internists should be aware of the family adversities and the issues at hand. It should be part of a comprehensive medical assessment," he said.

"Asking about parental incarceration can sometimes be a sensitive topic, but I think it's an important question to discuss," he concluded.

The study was funded by grants from the National Institutes of Health and the Robert Wood Johnson Foundation. Copeland and Kraus have disclosed no relevant financial relationships. Disclosures for other study authors are listed in the original article.  

JAMA Netw Open. Published online August 23, 2019. Full text

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