Serious mental health diagnoses in children on the Child Protection Register: a record linkage study

Purpose Children with experience of maltreatment, abuse or neglect are known to have a higher prevalence of poor mental health. Child Protection Services identify children most at risk of harm and in need of intervention. Mental healthcare usage in this population is not well understood as registration data is not routinely linked to health records. Methods We undertook data linkage to describe the population on the register, their mental healthcare usage and to calculate age- and sex-specific incidence rates of mental health outcomes. We analysed records from the Aberdeen City Council Child Protection Register and for mental health prescribing and referrals to child and adolescent mental health services (CAMHS) for the NHS Grampian region between 1st January 2012 and 31st December 2022. Results We identified 1,498 individuals with a Child Protection Register registration, of which 70% were successfully matched to health records. 20% of registrations occurred before birth and the median age of registration was 3 years. 10.1% of children with a registration ever received a mental health prescription, 5.1% for treatment of attention deficit hyperactivity disorder and 1.7% for treatment of depression. 18.9% received a referral to specialist outpatient Child and Adolescent Mental Health Services. Age- and sex- standardised incidence rates for mental health prescribing and referrals are higher for children with a child protection registration compared to the general population. Conclusion Children identified as being at significant risk of harm and involved with child protection services are at greater risk of seeking or receiving professional mental health support than their peers. Clinical services should investigate additional ways to support this population’s mental well-being as a priority. Efforts to reduce the exposure of children to potentially harmful environments at a societal level should also be pursued. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Health Foundation Networked Data Lab Programme ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This project was approved by the North Node Privacy Advisory Committee (NNPAC) (project ID: 6/105/22). NNPAC provides researchers with streamlined access to NHS Grampian data for research purposes and committee approval incorporates approvals from; the project sponsor, institutional ethics committee, the local Caldicott Guardian, and NHS Research & Development. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All analysis was carried out in the Grampian Data Safe Haven (project ID: DaSH520) on pseudonymised individual-level data. As per the Scottish Safe Haven Charter, only aggregate data can be released from the Grampian Data Safe Haven for publication, but all individual-level data will be archived for 5 years on project completion and may be accessed by application to the Grampian Data Safe Haven (email dash{at}abdn.ac.uk) on condition that appropriate project approvals are secured. Following the archiving period, this data will be deleted. Data analysis and figure generation were conducted using R (version 4.2.1) in RStudio (version 2023.06.2 build 561). Summary data supporting the findings and visualisations included in this work are available as supplementary materials of this work and in the project GitHub repository (URL: [https://github.com/will-ball/NDL3\_Child\_Protection][1]) [1]: https://github.com/will-ball/NDL3_Child_Protection