Children Whose Parents Have Been Homeless Are Twice as Likely to Have Psychiatric Disorders

A new nationwide Danish study suggests that the high risk of health problems common among homeless populations can span generations, and increase the likelihood of psychiatric disorders in their children.

Researchers assessed more than 1 million children and adolescents aged 0 to 16 years and found that children with at least one parent who had a history of homelessness were more than twice as likely to have a psychiatric disorder as those whose parents had not been homeless (15.1 cases per 1000 person-years [95% CI] versus 6.0 cases per 1000 person-years [95% CI], respectively).

Sandra Nilsson MSc

Sandra Nilsson MSc

“These findings have important implications for public health and policy because they suggest a need for improvement in the support of socially marginalized families to help prevent psychiatric illness in offspring,” the authors, led by Sandra Feodor Nilsson, MSc, of the University of Copenhagen, wrote.

Data suggested that similar incidence rate ratios (IRR) of psychiatric disorders were found in children who had 2 parents or only a father with a history of homelessness. However, IRR was higher when a child’s mother had a history of homelessness, versus when just their father had the same history.

Parental history of homelessness was also associated with a high risk of substance abuse disorders in offspring, again, with higher IRRs in children whose mothers had a history of homelessness. In addition to attachment and substance abuse disorders, the risk of psychosis and attention-deficit hyperactivity disorder (ADHD) in the fully adjusted model were also found to be higher when only the mother had a history of homelessness than when only the father had the same history.

If both parents had a history of homelessness, the child was most likely to have a high IRR for attachment disorder. After adjustment for parental psychiatric disorders, increased risks were found for most psychiatric outcomes, including autism spectrum disorders, mental retardation, tics and Tourette’s disorders. Notable exceptions included affective disorders and eating disorders, according to the authors.

“There are many reasons why parental homelessness would increase the risk of mental disorders in offspring,” wrote Wayne Hall, of the Centre for Youth Substance Abuse Research at the University of Queensland, Australia, in a response letter, published in The Lancet.

“Homelessness makes parenting difficult and it is usually accompanied by social adversity and poverty. Unstable housing interferes with children’s schooling and prevents them from developing friendships and social relationships with peers. There could also be genetic risks of developing mental disorders that increase the risk of parental homelessness and their offspring’s risk of developing these disorders,” Hall added.

The study adds to mounting evidence that adversity, especially early on in life, can have lingering effects, and in some cases can even span generations.

According to the authors, the study’s strengths lie in its basis on a nationwide and almost complete cohort of children and adolescents with accurate linkage to their parents’ use of public homeless shelters. As such, the cohort is likely generalizable to children younger than 16 years old in other high-income countries with well-developed social support systems, the authors wrote.

“Denmark has a well-developed social welfare system; the predicament of children with homeless parents is likely to be much worse in countries that have radically cut social welfare and health services in times of austerity,” Hall wrote.

On the other hand, the study was restricted in its ability to control for important confounders like availability of alternative family support, undiagnosed mental disorders in parents, and the parents’ and children’s pre-existing risks for developing psychiatric disorders.

“Nonetheless, the study findings clearly show that the children of homeless parents are at increased risk of developing attachment and substance use disorders,” Hall wrote. “These mental disorders are likely to further diminish the life chances of these children by reducing their educational attainments and subsequent employment opportunities.”

The study, Risk of psychiatric disorders in offspring of parents with a history of homelessness during childhood and adolescence in Denmark: a nationwide, register-based, cohort study, was published December, 2017 in The Lancet.

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