Parental mental health problems

1 Overview

Domain / Phenotype

Parental mental health problems (MHPs)

Sex

Both

Age Range

Parent (Adults)

Individual

Parent

Coding System

READ SNOMED CT ICD-10 ICD-9 HES-AE speciality field HES-OP speciality field CPRD GOLD speciality field

Data Sources

CPRD Aurum CPRD GOLD HES-APC HES-AE HES-OP

2 Definition

This domain contains indicators of mutually exclusive symptom clusters aligning with disorder classifications laid out by DSM-5/ICD-10, excluding substance misuse.

DSM-5 defines mental health problems as symptoms characterised by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Some codes for self-harm (e.g., overdose) may be represented across both parental mental health problems (MHPs) and parental substance misuse (SM) domains.

MHPs indicators are ascertained using Read codes, prescriptions, ICD-10 codes, or by meeting the higher cut-off score on a validated self-report instrument or validated algorithms with prescriptions [1]. Validated codes for parental MHPs and parental SM are also available via the HDR UK CALIBER phenotype library, with the mapping process described by Kuan et al.

3 Clinical Codelist

Download MHPs Codelist (8716 codes)

See the ACEsinEHRs Control documentation for code processing rules and release information.

Indicator Structure & Taxonomy

Domain	Indicator Code	Indicator Name	No. Codes
MHPs	MHPs	Common mental health problems	-
MHPs	MHPs1	Depression incl. antidepressants†	818
MHPs	MHPs2	Self-harm or suicide attempts	744
MHPs	MHPs3	Anxiety disorder NOS incl. anxiolytics†	549
MHPs	MHPs4	Panic disorder (incl. agoraphobia, health anxiety)	24
MHPs	MHPs5	Obsessive-compulsive disorders	27
MHPs	MHPs6	PTSD incl. acute stress disorder	72
MHPs	MHPs7	Sleep-wake disorders	33
MHPs	MHPs8	Mental health problems NOS	17
MHPs	MHPs9	Referred/seen by a mental health professional (≥tier 3 profession)	180
MHPs	MHPs10	Puerperal mental health problem NOS	5
MHPs	MHPs11	Anorexia nervosa	13
MHPs	MHPs12	Eating disorders NOS (incl. Bulimia)	49
MHPs	MHPs13	Psychosis incl. mental health sections NOS	339
MHPs	MHPs14	Antipsychotics (1st-2nd gen & NOS)	324
MHPs	MHPs15	Bipolar disorders	66
MHPs	MHPs16	Personality disorders (e.g. BPD)	177
MHPs	MHPs17	Neurodevelopmental conditions and conduct disorders	245

Browse & Search Clinical Codelist (Preview)

Parental mental health problems | ALL CODING SYSTEMS

Code	Description	Coding System	Indicator
F32.9	Major depressive disorder, single episode, unspecified	ICD-10	MHPs1
SN83986005	Severe anxiety	SNOMED CT	MHPs3
X10.	Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics	ICD-10	MHPs2

4 Implementation

Certain specific indicators within this domain require rule-based algorithms to accurately incorporate questionnaire cut-offs and prescription co-occurrences.

Algorithm 1 Depression (Continuous Data Cut-offs)

Include if continuous data meets the cut-off assigned to each code (see code list). For example: DASS-21 (sub-scales): ≥14; EDPS: ≥13; HADS (sub-scale): ≥11; HDRS (sub-scale): ≥14; PHQ-9: ≥10; SDS (Zungs's): ≥50.

R Script / Logic

# Include cases exceeding continuous score cut-offs for depression
mmhps_depres_anx <- merged_data %>% 
  filter(Domain=="mMHPs" & scale=="1" & data1 > cut_off)

Algorithm 2 Anxiety (Continuous Data Cut-offs)

Include if continuous data meets the cut-off assigned to each code (see code list). For example: DASS-21: ≥10; HADS (sub-scale): ≥11; HDRS (sub-scale): ≥18; SAS (Zungs's): ≥45 score; GAD-7: ≥8.

R Script / Logic

# Logic follows same structure as Algorithm 1
mmhps_depres_anx <- merged_data %>% 
  filter(Domain=="mMHPs" & scale=="1" & data1 > cut_off)

Algorithm 3 Symptoms, Prescriptions & Service Interventions

Codes referring to anxiety symptoms (e.g., "worrying") or depression (e.g., "feeling low") are only considered a case of depression or an anxiety disorder when the patient was also given antidepressants and/or anxiolytic medication within 3-months or initiated psychological treatment within 2-years. Comparison estimates with and without this algorithm are provided by Abel et al.

Rule: Include symptoms/medications as an anxiety or depression indicator, if a previous diagnostic code or tier 3 intervention code exists (within 2-years), or if there is a co-occurrence of a prescription consistent with a symptom within 3-months (e.g., anxiolytics & anxiety symptoms). Use the Indicator (specific)==INSERT Antidepressant or Anxiolytic to separate medication from other mMHPs.

R Script / Logic

# Identify co-occurrences of symptoms and treatments within specific timeframes
mmhps_treatment_algo <- merged_data %>% 
  mutate(
    is_confirmed_mhp = ifelse(
      (has_symptom & has_medication & abs(days_between) <= 90) |
      (has_symptom & has_intervention & abs(days_between) <= 730),
      TRUE, FALSE
    )
  )

5 Publications

Core research outputs associated with the Parental mental health problems domain.

Family adversity and health characteristics associated with intimate partner violence in children and parents presenting to health care: a population-based birth cohort study in England.

Syed S, Gilbert R, Feder G, Howe LD, Powell C, Howarth E, Deighton J, Lacey RE. The Lancet Public Health. 2023.

Identifying adverse childhood experiences with electronic health records of linked mothers and children in England: a multistage development and validation study.

Syed S, Gonzalez-Izquierdo A, Allister J, Feder G, Li L, Gilbert R. The Lancet Digital Health. 2022.

Case-finding for common mental disorders of anxiety and depression in primary care: an external validation of routinely collected data.

John A, McGregor J, Fone D, Dunstan F, Cornish R, Lyons RA, Lloyd KR. BMC Medical Informatics and Decision Making. 2016.

Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis.

Syed S, Ashwick R, Schlosser M, Gonzalez-Izquierdo A, Li L, Gilbert R. Archives of Disease in Childhood. 2021.

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