Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study.

BACKGROUND: Suicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20-64 from 2009 to 2021, emphasizing disparities related to SES. METHODS: This is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions. RESULTS: Our results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women. CONCLUSION: Mental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.

Suicide rates among health-care professionals in Norway 1980-2021.

BACKGROUND: Suicide rates have been high in several health-care professions. Suicide rates were described in physicians, dentists, veterinarians, psychologists, pharmacists, nurses, as well as theologians, other graduates and the general population in Norway. METHODS: Data on educational attainment were linked to data on suicide and all-cause mortality from 1980 to 2021. Suicide rates were reported per 100,000 person-years. The total number of person-years included in the study was 66.4 and 67.2 million for males and females, respectively. RESULTS: Between 1980 and 2021, male veterinarians (35.9, 95 % CI 19.3-52.4), physicians (25.7, 21.3-30.2) and nurses (22.2, 16.6-27.7) had higher suicide rates compared others with higher education (11.7, 10.7-12.7). For females, this was the case for psychologists (15.0, 8.2-21.7) and nurses (9.3, 8.3-10.3), vs. others with higher education (5.1, 4.2-6.0). Suicide rates declined over the four decades for most groups. For physicians, suicide rates declined and approached the suicide rate of others with higher education. Suicide rates among physicians increased with age, with physicians over 60 years having twice as high suicide rates compared to others with higher education. LIMITATIONS: The study included only educational status, not current occupation or employment status. This is a descriptive study, with some known risk factors for suicide not accounted for. CONCLUSIONS: Suicide rates for physicians declined over time, but not for nurses. From 2010 to 2021, nurses of both genders was the only group with higher suicide rates compared to other graduates. The increased suicide rates among veterinarians, nurses, female psychologists and elderly physicians are concerning.

General practitioner consultations for mental health reasons prior to and following bereavement by suicide.

PURPOSE: Prior research has shown that the majority of those bereaved by suicide express a need for mental health care services. However, there is a lack of knowledge about these individuals' use of primary health care. The objective of our study was to estimate the association between suicide bereavement and general practitioner (GP) consultations for mental health reasons. METHODS: A population-wide, register-based cohort study identifying 25,580 individuals bereaved by suicide. Estimations of increases in consultation rate were modeled through individual fixed-effects linear analyses adjusted for age and time-period. RESULTS: Overall, 35% of those bereaved by suicide had a GP consultation for mental health reasons during the first 1-2 months, and 53% after two years. In the month immediately after bereavement by suicide, there was a large increase in the consultation rate with a GP for mental health reasons. In the months that followed, the consultation rate gradually decreased. One year after bereavement, the consultation rate stabilized at a somewhat higher level than before the death. The increase in consultation rate was evident across all kinship groups, and the increase was greatest for partners and smallest for siblings. Women had more contact with the GP before the suicide and a greater increase in contact than men. CONCLUSION: Our findings suggest that many of those bereaved by suicide seek assistance from primary health care, and that some are in need of prolonged follow-up from the GP. Health governments should be aware of this and seek to strengthen the GPs knowledge of the needs and challenges associated with this patient group. Measures should also be taken to remove barriers to contact the health care system, especially for men and bereaved siblings.

Widening the knowledge of non-employment as a risk factor for suicide: a Norwegian register-based population study.

BACKGROUND: There is a known association between employment status and suicide risk. However, both reason for non-employment and the duration affects the relationship. These factors are investigated to a lesser extent. About one third of the Norwegian working age population are not currently employed. Due to the share size of this population even a small increase in suicide risk is of importance, and hence increased knowledge about this group is needed. METHODS: We used discrete time event history analysis to examine the relationship between suicide risk and non-employment due to either unemployment or health-problems, and the duration of these non-employment periods. We analyze data from the Norwegian population registry from 2004 to 2014, which includes all Norwegian residents in the ages 19-58 born between 1952 and 1989. In total the data consists of 1 063 052 men and 1 024 238 women, and 2 039 suicides. RESULTS: The suicide risk among the non-employed men and women is significantly higher than that of the employed. For the unemployed men, the suicide risk is significantly higher than the employed within the first 18 months. For the unemployed women we only find a significant association with suicide risk among those unemployed for six to twelve months. The suicide risk is especially increased among those with temporary health-related benefits. In the second year of health-related non-employment men have eightfold and women over twelvefold the OR for suicide, compared to the employed. CONCLUSION: There is an association between non-employment and suicide risk. Compared to the employed both unemployed men and men and women with health-related non-employment have elevated suicide risk, and the duration of non-employment may be the driving force. Considering the large share of the working age population that are not employed, non-employment status should be considered in suicide risk assessment by health care professionals and welfare providers.

Employment status and bereavement after parental suicide: a population representative cohort study.

OBJECTIVES: To examine employment status among adults bereaved by parental suicide at the time of bereavement and 2 and 5 years after the loss and to explore the importance of the gender of the adult child and the deceased parent. DESIGN: Population-based register study. SETTING: Norwegian population-based registries linked using unique personal identifiers. PARTICIPANTS: Norwegian residents aged 25-49 years in the period 2000-2014. Participants were divided into three groups: bereaved by parental suicide, bereaved by parental death of other causes and non-bereaved population controls. MAIN OUTCOME MEASURES: ORs for the risk of non-employment at the time of bereavement and 2 and 5 years after the loss. RESULTS: Those bereaved by parental suicide had a higher risk of non-employment already at the time of bereavement (OR 1.14, 95% CI 1.05 to 1.23). Stratified analyses showed that women accounted for this difference (OR 1.20, 95% CI 1.09 to 1.33), while no difference was found for men (OR 1.00, 95% CI 0.88 to 1.13). Looking at the gender of the parent, there was only a significant association of non-employment when losing a mother (OR 1.24, 95% CI 1.08 to 1.42), while not for losing a father (OR 1.09, 95% CI 0.99 to 1.20). Among those working at the time of bereavement, offspring bereaved by suicide were more likely to be non-employed at both 2 (OR 1.13, 95% CI 0.99 to 1.30) and 5 (OR 1.20, 95% CI 1.02 to 1.40) years after the loss compared with the general population. CONCLUSIONS: Women bereaved by parental suicide and those losing a mother to suicide were found to have a weaker attachment to the labour market already before losing their parent. Those who were employed when bereaved by suicide were somewhat more likely to be non-employed 5 years after the event.

Use of Health Services and Support Resources by Immediate Family Members Bereaved by Suicide: A Scoping Review.

The knowledge on health service use, systematic follow-up, and support for families bereaved by suicide remains scarce. This scoping review includes studies from 2010 to March 2022 that investigate the follow-up and support offered by health services, peer support services, and other resources available (e.g., internet-based resources) for families bereaved by suicide. We followed the scoping review framework provided by the Johanna Briggs Institute and performed a double-blinded screening process using Covidence. Data were extracted by four researchers and a thematic analysis was performed to summarize the results. The PRISMA Extension for Scoping reviews was used for reporting results. Of 2385 studies screened by title, 190 by abstract, and 93 by full-text reading, we included 63 original articles of which 24, 29 and 10 were quantitative, qualitative, or mixed-methods studies, respectively. The review shows that we have some knowledge about the need for, and experiences with, health services and support resources for immediate family members bereaved by suicide, but a lack of knowledge about their help-seeking behaviour, patient pathways, systematic follow-up, coordination between services, and long-term outcomes. We need more longitudinal observational studies of health service use and patient trajectories for people bereaved by suicide.

Met and unmet need for mental health care before and during the COVID-19 pandemic.

There is a concern that the coronavirus disease 2019 (COVID-19) pandemic will generate large unmet needs for mental health care. Using data from an epidemiological psychiatric diagnostic interview survey (n = 2159) conducted on a probability sample from the general population, the proportions of met and unmet need for mental health care among individuals with and without mental disorders were compared before and during the COVID-19 pandemic. The results showed no statistical difference in met and unmet need for mental health care, but point estimates were suggestive of a higher unmet need for care among those with a current mental disorder after the lock-down period.

Prevalence of mental disorders, suicidal ideation and suicides in the general population before and during the COVID-19 pandemic in Norway: A population-based repeated cross-sectional analysis.

BACKGROUND: Self-report data on mental distress indicate a deterioration of population mental health in many countries during the COVID-19 pandemic. A Norwegian epidemiological diagnostic psychiatric interview survey was conducted from January to September 2020, allowing for comparison of mental disorder and suicidal ideation prevalence from before through different pandemic periods. Prevalence of suicide deaths were compared between 2020 and 2014-2018. METHODS: Participants from the Trøndelag Health Study (HUNT) in Trondheim were recruited through repeated probability sampling. Using the Composite International Diagnostic Interview (CIDI 5.0) (n = 2154), current prevalence of mental disorders and suicidal ideation was examined in repeated cross-sectional analyzes. Data on suicide deaths was retrieved from the Norwegian Cause of Death Registry and compared for the months March to May in 2014-2018 and 2020. FINDINGS: Prevalence of current mental disorders decreased significantly from the pre-pandemic period (January 28th to March 11th 2020; 15•3% (95% CI 12•4-18•8)) to the first pandemic period (March 12th - May 31st; 8•7% (6•8-11•0)). Prevalences were similar between the pre-pandemic period and the interim (June 1st July 31st; 14•2% (11•4-17•5)) and second periods (August 1st-September 18th; 11•9% (9•0-15•6)). No significant differences were observed in suicidal ideation or in suicide deaths. INTERPRETATION: Except for a decrease in mental disorders in the first pandemic period, the findings suggest stable levels of mental disorders, suicidal ideation and suicide deaths during the first six months of the COVID-19 pandemic compared to pre-pandemic levels. Potential methodological and contextual explanations of these findings compared with findings from other studies are discussed. FUNDING: None.

Alcohol-related mortality following the loss of a child: a register-based follow-up study from Norway.

OBJECTIVES: The death of one's child is one of the most stressful events a person can experience. Research has shown that bereaved parents have a higher mortality than non-bereaved parents. This increased mortality might partly be caused directly by long-term stress. However, changes in health behaviour such as an increase in alcohol consumption might also play a role. This study examines the association between losing a child and alcohol-related mortality. In addition to Cox regression models using data covering the entire Norwegian adult population, we employ sibling fixed-effect models in order to partly control for genes and childhood experiences that might be associated with both losing a child and alcohol-related mortality. DESIGN: A follow-up study between 1986 and 2014 based on Norwegian register data. SETTING: Norway. PARTICIPANTS: The entire Norwegian adult population. PRIMARY OUTCOME MEASURE: Alcohol-related mortality. RESULTS: An increased alcohol-related mortality was found among parents who had experienced the death of a child. The HR of alcohol-related mortality among those bereaved of a child was 1.59 (95% CI 1.48 to 1.71) compared with non-bereaved parents, for women 2.03 (95% CI 1.78 to 2.32) and for men 1.46 (95% CI 1.34 to 1.59). After including sibling fixed effects, the HR of alcohol-related mortality among parents who had lost a child was 1.30 (95% CI 1.03 to 1.64). CONCLUSIONS: This study provides evidence of an elevated alcohol-related mortality among parents who have lost a child compared with non-bereaved parents. Although strongly attenuated, there is still an association when adjusting for genetic predisposition for alcohol problems as well as childhood environment using sibling fixed-effect models.

Parental mortality following the loss of a child to a drug-related death.

BACKGROUND: The drug-related death of a child has been linked to higher prevalence of complicated grief and mental health problems than bereavement by other causes of death. Whether this leads to an increased risk of mortality following the loss has not yet been examined. METHODS: Employing register data covering the years 1986-2015 and encompassing the entire Norwegian population, parents with at least one child aged 15 or older were analyzed using Cox regression. Drug-death bereaved parents were compared with both non-bereaved parents and parents bereaved by other causes of death. RESULTS: Parents bereaved by a drug-related death generally had a higher natural cause mortality throughout the follow-up. Drug-death bereaved parents had a particularly high external cause mortality in the first 2 years subsequent to bereavement when compared with non-bereaved parents (mothers: hazard ratio 4.82, 95% CI = 3.11-7.47; fathers: hazard ratio 2.50, 95% CI = 1.57-3.97). There was also an elevated, but significantly lower mortality risk from external causes 2 to 10 years subsequent to bereavement. This indicates that the associations observed are not solely due to selection. CONCLUSIONS: Parents bereaved by the drug-related death of a child had a higher mortality than both non-bereaved parents and parents bereaved by other causes of death. Drug-death bereaved parents had particularly high external cause mortality. Our results indicate that losing a child to a drug-related death is associated with adverse health outcomes and that these might be more severe than bereavement due to other causes of death.

Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017.

AIM: To examine rates of contact with primary and mental health care prior to suicide in men and women and across a range of age categories. METHOD: The authors performed a systematic review of 44 studies from 2000 to 2017 of which 36 reported rates on contact with primary health care and 14 reported on contact with mental health care prior to suicide. RESULTS: Contact with primary health care was highest in the year prior to suicide with an average contact rate of 80%. At one month, the average rate was 44%. The lifetime contact rate for mental health care was 57%, and 31% in the final 12 months. In general, women and those over 50 years of age had the highest rates of contact with health care prior to suicide. CONCLUSIONS: Contact with primary health care prior to suicide is common even in the final month before death. The findings presented in this study highlight the importance of placing suicide prevention strategies and interventions within the primary health care setting.

Use of primary health care services prior to suicide in the Norwegian population 2006-2015.

BACKGROUND: Studies report high rates of contact with general practitioners (GPs) in primary care in the time leading up to suicide, particularly among individuals with a history of mental health contact. However, the near lack of studies including population representative controls have prevented investigations into how the contact patterns of suicide victims compares to those of the general population. METHODS: By linking data from two national registries, this study investigated primary health care use in suicide victims aged 15 years and older during the period from 2007 to 2015 (n = 4926). Their rates of contact one year and one month prior to suicide were compared to the average rates in the general Norwegian population during the period by estimating relative risks across sex and age. Contact patterns one month prior to suicide were also investigated according to prior mental health consultations in primary care. RESULTS: The findings revealed a stable trend in contact with GPs in primary care during the observation period, with 79.6% of male and 89.0% of female suicide victims having consulted their GP within a year of the suicide. Corresponding rates one month prior to the suicide were 34.8 and 46.4%, respectively. At both points in time and across all age groups, suicide victims were considerably more likely to consult their GP than were the general population. Suicide victims without prior mental health contact were only modestly more likely to consult their GP within a month of the suicide as compared to the general population, while both the general population and suicide victims with prior mental health consultations had rates of contact well above those without, evident for both sexes. CONCLUSIONS: Contact with GPs in primary care prior to suicide is common in both sexes and across most age groups, in particular for victims with prior mental health consultations. Younger males show the overall lowest rates of contact, and increased alternative efforts to reach this group, in addition to larger population strategies, may pose the most prominent preventive measures.

A Registry Based Approach to Suicide Research: Opportunities and Limitations in the Norwegian Population Representative Registries.

Together with the other Nordic countries, Norway stands in a unique position internationally with its large population representative registries. By means of unique personal identification numbers assigned to all Norwegian citizens, as well as to immigrants who stay for more than 6 months, it is possible to construct individual record linkages covering an increasing number of years across different national registries. The Norwegian registries include, among others, information from the primary and specialist health care services, the prescription of drugs, and causes of death. In addition, they include sociodemographic information like year of birth, gender, immigration status, educational attainment, marital status, and the use of various social benefits. Norway is one of very few countries that have a nationwide registry on primary health care use. This registry gives the opportunity to explore the role of the primary health care services prior to suicide and in the follow-up of the suicide bereaved, which has been pointed out as one of the most promising areas for future suicide prevention. Linkages of Norwegian registries opens up new approaches in analyses and the possibility to explore a range of novel research themes, such as treatment trajectories and patterns of health care use prior to suicide and among the suicide bereaved. In this paper, we give a description of the Norwegian population representative registries applicable for suicide research. We discuss the analytic opportunities as well as the challenges and obstacles of a registry based research approach to suicide. The main strength of registry-based research on suicide is the ability to maintain data on the total population, the possibility to study small sub-populations or low-prevalent events, virtually continuous timelines in longitudinal data, few or no non-response or other missing data, no sample attrition, and the possibility of gaining access to large amounts of various health and sociodemographic information. In addition registry-based research allows investigation of hard-to-reach populations, such as groups of individuals with severe mental disorders or immigrants that traditionally have been difficult to recruit for participation in research projects. The opportunities presented in the article could motivate to do similar research in Canada and even inspire for cooperation between Norwegian and Canadian researchers on registry based research on suicide. In our opinion, registry-based research on suicide will play an increasingly important role in suicide research in the years to come.

Emotional and behavioral problems in late preterm and early term births: outcomes at child age 36 months.

BACKGROUND: Recent findings has shown that late preterm births (gestational weeks 34-36) and early term births (gestational weeks 37-38) is associated with an increased risk of several psychological and developmental morbidities. In this article we investigate whether late preterm and early term births is associated with an increased risk of emotional and behavioral problems at 36 months of age and whether there are gender differences in risk of these outcomes. METHODS: Forty-three thousand, two hundred ninety-seven children and their mothers participating in the Norwegian Mother and Child Cohort Study (MoBa). One thousand, eight hundred fifty-three (4.3%) of the children in the sample were born late preterm and 7,835 (18.1%) were born early term. Information on gestational age and on prenatal and postnatal risk factors was retrieved from the Medical Birth Registry of Norway. Information on emotional and behavioral problems was assessed by standardized questionnaires (CBCL/ITSEA) filled out by the mothers. Gender-stratified logistic regression analyses were used to explore the association between late preterm / early term and emotional and behavioral problems at 36 months of age. RESULTS: We found a gender-specific increased risk of emotional problems in girls born late preterm (OR 1.47 95%CI 1.11-1.95) and in girls born early term (OR 1.21 95%CI 1.04-1.42). We did not find an increased risk of emotional problems in boys born late preterm (OR 1.09 95%CI 0.82-1.45) or early term (OR 0.93 95%CI 0.79-1.10). Behavioral problems were not increased in children born late preterm or early term. CONCLUSION: Girls born late preterm and early term show an increased risk of emotional problems at 36 months of age. This finding suggests that gender should be taken into account when evaluating children born at these gestational ages.

Communication impairments in early term and late preterm children: a prospective cohort study following children to age 36 months.

OBJECTIVE: To investigate the risk of communication impairments at age 18 and 36 months in children born early term (gestational weeks 37-38) and late preterm (gestational weeks 34-36). STUDY DESIGN: A total of 39 423 children and their mothers participated in the Norwegian Mother and Child Cohort Study. The sample included 7109 children (18%) born early term and 1673 (4.2%) born late preterm. Information on gestational age and prenatal and postnatal risk factors was obtained from the Medical Birth Registry of Norway. Information on communication impairments was assessed using standardized questionnaires filled out by the mothers. Stepwise logistic regression analysis was applied to explore the associations between early term/late preterm birth and communication impairments at age 18 and 36 months. RESULTS: Compared with children born at term, children born early term and late preterm had an increased risk of communication impairments at age 18 and 36 months. In early term, the aOR was 1.27 (95% CI, 1.12-1.44) at 18 months for communication impairments and 1.22 (95% CI, 1.07-1.39) at 36 months for expressive language impairments. In late preterm, the aOR was 1.74 (95% CI, 1.41-2.14) at 18 months and 1.37 (95% CI, 1.09-1.73) at 36 months. CONCLUSION: Not only children born late preterm, but also those born early term, are at increased risk for communication impairments. Given the large number of children potentially affected, this may result in significant health care costs.

Impact of maternal negative affectivity on light alcohol use and binge drinking during pregnancy.

OBJECTIVES: To investigate whether maternal negative affectivity, a tendency to frequent negative emotions and views, is associated with light alcohol use and binge drinking during pregnancy. DESIGN: Cohort. SETTING: Norway 1999-2008. POPULATION: The study includes complete information on 66 111 pregnant women and their partners. METHODS: We used data from the Norwegian Mother and Child Cohort study (MoBa) representing 39% of the pregnant population. MAIN OUTCOME MEASURES: Light alcohol use (0.5-2 units one to four times per month) and binge drinking (an intake of 5 alcohol units or more) measured with the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). RESULTS: For each unit increase in maternal negative affectivity the odds for light alcohol use increased with 27% in the first trimester [95% confidence interval (CI) 1.19-1.36], and 28% in the second trimester (95% CI 1.18-1.39). With respect to binge drinking, each unit increase in maternal negative affectivity was associated with 55% higher odds in the first trimester (95% CI 1.44-1.67), and 114% higher odds in the second trimester (95% CI 1.70-2.69). CONCLUSIONS: Negative affectivity is associated with both light alcohol use and binge drinking during pregnancy. The mechanisms mediating the relation between negative affectivity and alcohol use in pregnancy should be investigated further.

Associations between temperament at age 1.5 years and obesogenic diet at ages 3 and 7 years.

OBJECTIVE: To investigate whether temperament in 1.5 year olds predicts their consumption of potentially obesogenic foods and drinks at 3 and 7 years of age. METHODS: Participants were 6997 mothers and infants from the Norwegian Mother and Child Cohort Study. Questionnaires were collected during pregnancy, at birth, and at 6 months and 1.5, 3, and 7 years of age. Predictor variables included children's temperament at 1.5 years of age (internalizing, externalizing, surgent) and mothers' negative affectivity. Outcome variables included children's consumption of sweet foods, sweet drinks, and fruits/vegetables at 3 and 7 years of age (dichotomized at the 85th percentile). RESULTS: Controlling for covariates, internalizing 1.5 year olds (anxious, dependent) were 77% and 63% more likely to consume sweet drinks daily at 3 and 7 years of age, respectively; they were 55% and 43% more likely to consume sweet foods daily at 3 and 7 years, respectively. Externalizing 1.5 year olds (hyperactive, aggressive) were 34% more likely to consume sweet drinks daily at 7 years of age; they were 39% and 44% more likely to consume sweet foods daily at 3 and 7 years, respectively, and they were 47% and 33% less likely to consume fruits/vegetables daily at 3 and 7 years of age, respectively. Surgent 1.5 year olds (active, sociable) were 197% and 78% more likely to consume 2 portions of fruits/vegetables daily at 3 and 7 years, respectively. The association of maternal negative affectivity was limited to the child's consumption of sweet foods at 3 and 7 years. CONCLUSION: Early child temperament is a risk factor for obesogenic diet in later childhood. Mechanisms explaining this association need to be explored.

Longitudinal analysis of emotional problems in children with congenital heart defects: a follow-up from age 6 to 36 months.

OBJECTIVE: To investigate whether children with varying severity of congenital heart defects (CHDs) have a higher risk of internalizing or externalizing emotional problems at 36 months of age. In addition, to analyze whether a history of emotional problems at 6 or 18 months of age increases the risk of emotional problems at 36 months in children with CHDs. METHODS: Prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health, was linked with a nationwide CHD registry, and 175 children with CHDs were identified in a cohort of 44,104 children aged 36 months. Maternal reports on child characteristics were assessed by questionnaires at child age 6, 18, and 36 months. RESULTS: Children with CHDs did not have elevated scores on internalizing or externalizing problems at 36 months of age compared with controls. Not even the children with CHDs with a history of emotional problems at age 6 or 18 months showed an increased risk. CONCLUSIONS: The absence of risk of emotional problems at 36 months of age in children with CHDs could be a consequence of the completion of the most extensive medical treatment.

Occurrence and predictors of developmental impairments in 3-year-old children with congenital heart defects.

OBJECTIVE: To examine the occurrence of developmental impairments in 3-year-old children with varying severity of congenital heart defects (CHD) and to identify predictors associated with developmental impairment in children with severe CHD. METHODS: Prospective data collected at birth, 6, 18, and 36 months from the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health, were linked with a nationwide medical CHD registry, and 175 three year olds with CHD in a cohort of 44,044 children were identified. Children with mild/moderate (n = 115) and severe (n = 60) CHD were compared with children without CHD (43,929) on motor, communication, and social impairments as reported by mothers in Norwegian Mother and Child Cohort Study questionnaires. Predictors of developmental impairment were analyzed for the group with severe CHD. RESULTS: Children with severe CHD had >3 times higher odds of communication and gross motor impairments compared with controls, and had 2 times higher odds of any developmental impairment compared with controls. Children with mild and moderate CHD had >2 times higher odds of gross motor impairment but did not otherwise differ from controls. Predictors of impairment identified were previous developmental impairments and smaller head circumference at birth. CONCLUSION: Children with severe CHD have increased odds of developmental impairments at age 3 years. Early developmental impairments are associated with later developmental impairments, suggesting lasting impairments and not merely temporary delay. Patient-specific conditions at birth should be considered and motor and communication support provided to potentially improve outcomes in children with CHD.