Absence of protective ethnic density effect on Ecuadorian migrants’ mental health in a recent migration setting: a multilevel analysis

Purpose

We aimed to study the association between the Ecuadorians’ ethnic density (EED) of the areas of residence (AR) with the mental health of Ecuadorians in Spain.

Methods

Multilevel study of 568 Ecuadorian adults in 33 AR randomly selected from civil registries and interviewed at home. Possible psychiatric case (PPC) was measured by scoring ≥5 in General Health Questionnaire-28. Ecuadorians’ ethnic density was dichotomized in high and low EED (<6 %). Multilevel logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI).

Results

Prevalence of PPC, 24 % (95 %CI 20–28 %), varied by area of residence. Ecuadorians’ ethnic density varied by area of residence ranging from 0.9 to 19.5 %. PPC prevalence in High Ecuadorians’ ethnic density AR was 29.5 and 20.4 % in low EED AR (p 0.013). Ecuadorians from High EED AR had higher odds of PPC than those from Low EED AR (OR 1.65 95 %CI 1.01–2.72). Adjusting for individual confounders (largely self-perceived discrimination), OR decreased to 1.48 (95 %CI 0.87–2.55). The final model, adjusted by area of residence and educational level, yielded an OR 1.37 (95 %CI 0.78–2.40).

Conclusions

No protective association between the Ecuadorians’ ethnic density of the Area of residence and Ecuadorian migrants’ mental health was found. Mechanisms underlying beneficial ethnic density effects may be absent in recent migration settings.     

Ethnicity,socioeconomic position and severity of problems as predictors of mental health care use in 5- to 8-year-old children with problem behaviour

Background

Empirical research on mental health care use and its determinants in young school-aged children is still scarce. In this study, we investigated the role of ethnicity, socioeconomic position (SEP) and perceived severity by both parents and teachers on mental health care use in 5- to 8-year-old children with emotional and/or behavioural problems.

Methods

Data from 1,269 children with a high score (>P90) on the Strengths and Difficulties Questionnaire (SDQ) in the school year 2008–2009 were linked to psychiatric case register data over the years 2010–2011. Cox proportional hazards models were used to predict mental health care use from ethnicity, SEP and perceived severity of the child’s problems.

Results

During the follow-up period, 117 children with high SDQ scores (9.2 %) had used mental health care for the first time. Ethnic minority children were less likely to receive care than Dutch children (HR Moroccan/Turkish: 0.26; 95 % CI 0.13–0.54, HR other ethnicity: 0.26; 95 % CI 0.12–0.58). No socioeconomic differences were found. After correction for previous care use, ethnicity and parental perceived severity, impact score as reported by teachers was significantly associated with mental health care use (HR 1.58; 95 % CI 1.01–2.46).

Conclusions

Ethnicity is an important predictor of mental health care use in young children. Already in the youngest school-aged children, ethnic differences in the use of mental health care are present. A distinct predictor of care use in this age group is severity of emotional and behavioural problems as perceived by teachers. Therefore, teachers may be especially helpful in the process of identifying young children who need specialist mental health care.     

Service use in adolescents at risk of depression and self-harm: prospective longitudinal study

Purpose

Although depression and self-harm are common mental health problems in adolescents, there are barriers to accessing help. Using a community-based sample, this study investigates predictors of service contacts for adolescents at high risk of depression and self-harm.

Methods

Three thousand seven hundred and forty-nine (3,749) 12- to 16-year-olds in UK secondary (high) schools provided baseline and 6 months’ follow-up data on mood, self-harm and service contacts with a range of primary and secondary healthcare services.

Results

Although most adolescents at high risk of depression or self-harm had seen their general practitioner (GP) in the previous 6 months, less than one-third had used primary or secondary healthcare services for emotional problems. 5 % of adolescents who reported self-harm had seen specialist child and adolescent mental health services in the previous 6 months. In longitudinal analyses, after adjustment for confounders, both depression and self-harm predicted the use of any healthcare services [adjusted odds ratio (AOR) = 1.34 (95 % CI 1.09, 1.64); AOR = 1.38 (95 % CI 1.02, 1.86), respectively] and of specialist mental health services [AOR = 5.48 (95 % CI 2.27, 13.25); AOR = 2.58 (95 % CI 1.11, 6.00), respectively]. Amongst those with probable depression, 79 % had seen their GP and 5 % specialist mental health services in the preceding year.

Conclusions

Most adolescents at high risk of depression or self-harm see their GP over a 6-month period although only a minority of them access specialist mental health services. Their consultations within primary care settings provide a potential opportunity for their identification and for signposting to appropriate specialist services.     

Food insufficiency is associated with psychiatric morbidity in a nationally representative study of mental illness among food insecure Canadians

Purpose

Studies suggest that people who are food insecure are more likely to experience mental illness. However, little is known about which aspects of food insecurity place individuals most at risk of mental illness. The purpose of this study was to establish the prevalence of mental illness among food insecure Canadians, and examine whether mental illness differs between those who are consuming insufficient amounts of food versus poor quality foods.

Methods

This analysis utilized the publically available dataset from the Canadian Community Health Survey cycle 4.1. Bivariable and multivariable logistic regression were used to examine the associations between food insecurity and mental health disorder diagnosis, while adjusting for potential confounders. Stratified analyses were used to identify vulnerable sub-groups.

Results

Among 5,588 Canadian adults (18–64 years) reporting food insecurity, 58 % reported poor food quality and 42 % reported food insufficiency. The prevalence of mental health diagnosis was 24 % among participants with poor food quality, and 35 % among individuals who were food insufficient (hunger). After adjusting for confounders, adults experiencing food insufficiency had 1.69 adjusted-odds [95 % confidence interval (CI): 1.49–1.91] of having a mental health diagnosis. Stratified analyses revealed increased odds among women (a-OR 1.89, 95 % CI 1.62–2.20), single parent households (a-OR 2.05, 95 % CI 1.51–2.78), and non-immigrants (a-OR 1.88, 95 % CI 1.64–2.16).

Conclusion

The prevalence of mental illness is alarmingly high in this population-based sample of food insecure Canadians. These findings suggest that government and community-based programming aimed at strengthening food security should integrate supports for mental illness in this population.     

The influence of state mental health perceptions and spending on an individual’s use of mental health services

Purpose

To explore the possible contextual effects of state-level mental health perceptions and public spending for mental health treatment on an individual’s use of mental health services, independent of the individual’s own perceptions.

Methods

Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used. A total of 216,514 participants from 35 states and the District of Columbia were included in the study. Logistic regression and multilevel modeling were used to estimate the effects of individual-level characteristics and three state-level factors—per capita spending on community mental health services, aggregated perceptions of the effectiveness of mental health treatment and the stigma of mental illness—on the individual’s current use of mental health services.

Results

Adjusting for the individual’s perceptions and characteristics, state-level perception of treatment effectiveness was positively associated with the use of mental health services [odds ratio (OR) for 5 % increase in the percentage perceiving effectiveness = 1.08; 95 % confidence interval (CI): 1.01, 1.16]. This association was strongest for individuals who experienced 1–4 days of mental distress in the past 30 days (OR = 1.17; 95 % CI 1.06, 1.29). State-level public spending on community mental health services was also positively associated with an individual’s use of mental health services (OR for a $40 increase in spending = 1.09; 95 % CI 1.01, 1.17); however, state-level perceptions of mental-illness stigma was not.

Conclusions

Our findings suggest there may be contextual effects of state-level perceptions of treatment effectiveness and state spending on community mental health services on the use of mental health services.     

Adolescents’ multiple,recurrent subjective health complaints: investigating associations with emotional/behavioural difficulties in a cross-sectional,school-based study

Background

Adolescence has been documented as the peak age of onset for mental health perturbations, clinical disorders and unsubstantiated health complaints. The present study attempted to investigate associations between multiple, recurrent subjective health complaints (SHC) with emotional/behavioural difficulties, as measured by the Strengths and Difficulties Questionnaire scale (SDQ), among Greek adolescents.

Methods

Questionnaires were administered in a large, nation-wide, random, school-based sample of Greek adolescents, aged 12–18 years. Data from 1170 participants were analyzed. Adolescents with multiple, recurrent SHC were compared in terms of their emotional/behavioural difficulties to their peers with lower levels of health complaints. SDQ scales were separately investigated for their associations with multiple, recurrent SHC, after adjustment for gender, age and socioeconomic status (ses). Further analysis included multiple logistic regression models with multiple, recurrent SHC as the dependent variable and gender, age, ses and SDQ Total difficulties score as independent factors. Potential gender and age interactions were also explored.

Results

Almost half of the study participants reported multiple, recurrent SHC. Adolescents with multiple, recurrent SHC had higher scores on all SDQ scales, except from the Prosocial behavior scale, compared to their peers with lower levels of health complaints. Emotional Symptoms, Conduct Problems, Hyperactivity/Inattention and Peer Problems were associated with greater likelihood of having multiple, recurrent SHC, after adjustment for gender, age and ses. The multiple logistic regression models revealed that older adolescents and girls, as well as those with increased Total difficulties score had an increased risk for multiple, recurrent SHC reporting. No significant interaction between SDQ scales and gender or age was found.

Conclusions

Our study highlights the magnitude of psychological burden among adolescents experiencing multiple, recurrent SHC. Professionals in school and clinical settings should be cautious for impaired emotional/behavioural functioning when assessing adolescents with multiple, recurrent SHC, so as early identification of at-risk individuals and timely, appropriate referrals are facilitated.     

Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study

Background

Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders.

Methods

The entire school population of 16–17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991–1993 (n?=?2300). Adolescents with positive screenings (n?=?307) and matched non-depressed controls (n?=?302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17–19 years after the baseline study (n?=?375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants’ ages of 18 and 35 years.

Results

Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose–response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR?=?1.63, CI 0.55–4.85; 2–4 symptoms: OR?=?2.77, 95% CI 1.04–7.39;?≥?5 symptoms: OR?=?5.75, 95% CI 1.98–16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p?<?0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose–response relationship (p?<?0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p?<?0.05).

Conclusions

Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.

     

A prediction model for the incidence of civil detention for crisis patients with psychiatric illnesses; the Amsterdam study of acute psychiatry VII

Objective

Given raised numbers of civil detentions in the Netherlands and other European countries, it is important to assess the patient risk profile with respect to the incidence of those far-reaching treatment decisions. The aim of the ASAP study is to develop a comprehensive prediction model that considers all possible patient-related predictors known from earlier research.

Methods

We took a random sample of 252 from the 2,682 patients coming into contact with two psychiatric emergency teams in Amsterdam between September 2004 and September 2006. We recorded socio-demographic and clinical characteristics, aspects of social support and psychiatric history. We interviewed the patients using the Verona Service Satisfaction Scale (Verona-EU) and the Birchwood Insight Scale. During a two-year follow-up period we noted their use of mental health care facilities.

Results

Stepwise logistic regression analyses with resulted in a final prediction model (P ≤ 0.001) including preceding involuntary admission (OR 9.4, 95 % CI 3.6–24.7, P ≤ 0.001), domestic situation alone (OR 4.5, 95 % CI 1.9–11.0, P = 0.001) and VSSS score satisfactory (OR 0.2, 95 % CI 0.0–0.8, P = 0.030) as predictors of civil detention during 2 years of follow-up.

Conclusion

With the presented prediction model it will be possible to identify patients at a high risk of civil detention: patients with a history of previous involuntary admissions who live alone and are not satisfied with the mental health care they got before. This suggests the possibility that timely preventive measures can be taken comprising the adjustment or intensification of the treatment plan for this specific group of patients.     

Medication Adherence Is Associated with Having a Caregiver Among Cardiac Patients

Background

Medication non-adherence is a significant contributor to suboptimal control of blood pressure and lipids.

Purpose

This study determined if having a paid and/or family caregiver was associated with medication adherence in patients hospitalized for cardiovascular disease.

Methods

Consecutive patients admitted to the cardiovascular service at a university medical center who completed a standardized questionnaire about medication adherence and caregiving (paid/professional or family member/friend) were included in this analysis (N?=?1,432; 63 % white; 63%male).

Results

Among cardiac patients, 39 % reported being prescribed ≥7 different medications, and one in four reported being non-adherent to their medication(s). Participants who reported having/planning to have a paid caregiver were 40 % less likely to be non-adherent to their medications compared to their counterparts. The association remained significant after adjustment for demographic confounders and comorbid conditions (OR?=?0.49; 95 %CI?=?0.29–0.82).

Conclusion

Cardiac patients with a paid caregiver were half as likely to be non-adherent to medications as those without caregivers.     

Prevalence and correlates of probable adolescent mental health problems reported by parents in Vietnam

Purpose

The purpose of the present study was to estimate the prevalence of probable mental health problems in an epidemiologic study of Vietnamese adolescents. A secondary aim was to examine the correlates of probable mental health caseness.

Methods

Interviewers visited 1,914 households that were randomly selected to participate in a multi-agency study of mental health in select provinces of Vietnam. Semi-structured interviews assessed adolescent mental health problems using the Strengths and Difficulties Questionnaire (SDQ) parent informant version, and additionally the interviewers collected information on demographic variables (age, gender, ethnic group, religious affiliation, social capital). The final sample included data on 1,368 adolescents (aged 11?C18?years).

Results

The average score on the total problem composite of the SDQ scale was 6.66 (SD?=?4.89), and 9.1% of the sample was considered a case (n?=?124). Bivariate analyses were conducted to determine which demographic variables were related to the SDQ case/non-case score. All variables except gender were significant in bivariate analyses, and therefore were entered into a logistic regression. Results indicated that age, religion, and wealth remained significant predictors of probable caseness.

Conclusions

Overall, prevalence estimates of mental health problems generated by the SDQ were consistent with those reported in the US and other Western and non-Western samples. Results of the current study suggest some concordance of risk and protective factors between Western and Vietnamese youth (i.e., age and SES).     

Neighborhood disadvantage in context: the influence of urbanicity on the association between neighborhood disadvantage and adolescent emotional disorders

Purpose

Inconsistent evidence of a relationship between neighborhood disadvantage and adolescent mental health may be, in part, attributable to heterogeneity based on urban or rural residence. Using the largest nationally representative survey of US adolescent mental health available, we estimated the association between neighborhood disadvantage and adolescent emotional disorders and the extent to which urbanicity modified this association.

Methods

The National Comorbidity Survey Replication Adolescent Supplement (NCS-A) sampled adolescents aged 13–17 years (N = 10,123). Households were geocoded to Census tracts. Using a propensity score approach that addresses bias from non-random selection of individuals into neighborhoods, logistic regression models were used to estimate the relative odds of having a DSM-IV emotional disorder (any past-year anxiety disorder, major depressive disorder or dysthymia) comparing similar adolescents living in disadvantaged versus non-disadvantaged neighborhoods in urban center, urban fringe, and non-urban areas.

Results

The association between neighborhood disadvantage and emotional disorder was more than twice as large for adolescents living in urban centers versus non-urban areas. In urban centers, living in a disadvantaged neighborhood was associated with 59 % (95 % confidence interval 25–103) increased adjusted odds of emotional disorder.

Conclusions

Urbanicity modifies the relationship between neighborhood disadvantage and emotional disorder in adolescents. This effect modification may explain why evidence of a relationship between neighborhood disadvantage and adolescent mental health has been inconsistent. Recognizing the joint influence of neighborhood socioeconomic context and urbanicity may improve specificity in identifying relevant neighborhood processes.     

Mental health of internally displaced preschool children: a cross-sectional study conducted in Bogotá, Colombia

Purpose

Ongoing armed conflicts, like the one in Colombia, have forcibly displaced millions of people including many young children. This study aimed to assess the mental health of internally displaced preschoolers in Bogotá Colombia and to identify correlates of mental health in these children.

Methods

Cross-sectional study conducted among 279 children attending four kindergartens in a deprived neighbourhood in Bogotá. Child mental health was assessed with the Child Behaviour Checklist (CBCL) 1.5–5 years, a parent-report. Univariate analyses and multivariate logistic regressions were performed to assess the association between displacement and child mental health and to identify correlates of mental health in displaced children.

Results

Displaced children (n = 90) more often met borderline cut-off scores for the CBCL scales than non-displaced children (n = 189) (e.g. total problems 46.7 vs. 22.8 %; p < 0.001). The association between displacement and presence of CBCL total problems remained after adjustment for socio-demographic factors (Adjusted OR 3.3, 95 % CI 1.5; 6.9). Caretaker’s mental health partly explained the association. In displaced children, caretaker’s mental health (p < 0.01) and family functioning (p < 0.01) were independently associated with child mental health. Exposure to traumatic events and social support was also associated with child mental health; however, associations were not independent.

Conclusion

In this deprived neighbourhood in Bogotá, preschool children registered as internally displaced presented worse mental health than non-displaced peers. Family functioning and caretaker’s mental health were strongly and independently associated with displaced children’s mental health.     

Clinical Value of Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratio After Aneurysmal Subarachnoid Hemorrhage

Background

Inflammation and thrombosis are associated with the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are emerging as novel inflammatory markers in stroke. We aimed to identify the association of NLR and PLR with delayed cerebral ischemia (DCI) and 3-month outcome after aSAH.

Methods

Two hundred and forty-seven patients diagnosed with aSAH within 24 h of symptoms onset were enrolled. Clinical, neuroradiological, laboratory, and follow-up data were collected from electronic database. Functional outcome was assessed by modified Rankin Scale. Admission NLR, PLR, and combined NLR-PLR associated with outcomes were evaluated by logistic regression analysis, and we used receiver operating characteristic curves to detect the overall predictive accuracy of these markers.

Results

Fifty-five (22.3 %) patients had unfavorable outcome and 47 (19 %) developed DCI. Both NLR and PLR were correlated with WFNS grade (ρ = 0.35[p < 0.001], ρ = 0.28[p < 0.001]) and modified Fisher grade (ρ = 0.25[p = 0.001], ρ = 0.28[p = 0.003]) and independently related to DCI (OR 2.18, 95 %CI 1.51–3.15, p = 0.016; OR 2.21, 95 %CI 1.61–3.32, p = 0.008) and functional outcome (OR 1.89, 95 %CI 1.52–3.17, p = 0.015; OR 1.77, 95 %CI 1.48–3.21, p = 0.018) at 3 months after aneurysm repair. They had comparable predictive ability in DCI occurrence (area under the curve [AUC] 0.65, 95 %CI 0.55–0.74, p = 0.002; AUC 0.68, 95 %CI 0.60–0.76, p < 0.001) and poor outcome (AUC 0.70, 95 %CI 0.63–0.77, p < 0.001; AUC 0.65, 95 %CI 0.58–0.72, p = 0.001). However, combination of the two indexes showed a better predictive value than each alone (AUC 0.73, 95 %CI 0.66–0.81, p < 0.001 for DCI; AUC 0.76, 95 %CI 0.70–0.83, p < 0.001 for poor outcome).

Conclusions

NLR and PLR as novel inflammatory biomarkers are independent predictors of DCI development and functional outcome after acute aSAH. When combined together, they may help to identify high-risk patients more powerfully.

     

Gender differences in association between psychological distress and detailed living arrangements among Japanese older adults,aged 65–74 years

Purpose

Past studies have shown that living alone is detrimental to older adults’ mental health. However, there has been little focus on how older adults’ psychological distress differed by more detailed living arrangement, as well as by gender. The present study investigates various living arrangements in association with psychological distress among older men and women.

Methods

Data from community-dwelling Japanese older adults were collected through a mail survey (n = 1,807, aged 65–74 years, 51.5 % men). Psychological distress level was measured using Kessler’s six-item psychological distress scale. Living arrangements were categorized into four groups; “living with spouse only”, “living with spouse and other family”, “living with other family without spouse” or “living alone”. Multiple logistic regression analyses were used to examine the associations of living arrangements with psychological distress level.

Results

Older adults living alone were observed to have higher psychological distress. In addition, gender-stratified analyses showed that higher distress levels were observed among older men living with family, but without a spouse (OR: 2.85, 95 % CI: 1.51–5.39). In contrast, higher distress was observed among older women living with spouse and other family (OR: 1.53, 95 % CI: 1.03–2.28).

Conclusions

Psychological distress in older Japanese adults was associated with living arrangements, but such associations differed by gender. The association of living with a spouse on older men’s mental health was striking, while living with any family was found to be rather important for older women, aged 65–74 years.     

An examination of the effects of intra and inter-individual changes in wellbeing and mental health on self-rated health in a population study of middle and older-aged adults

Purpose

Self-rated health is frequently used as an indicator of health and quality of life in epidemiological studies. While the association between self-rated health and negative mental health is well established, associations with indictors of positive wellbeing are less clear. Data from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project were used to compare the effects of vitality and mental health on self-rated health.

Methods

Participants (n = 40,712) provided information on vitality, mental health and self-rated health, were aged 45–95 years at baseline, and were followed between 1 and 10 years (M = 5.6; SD = 2.9).

Results

In comparison with mental health, multi-level modelling indicated between- and within-person change in vitality was more strongly associated with self-rated health. Bivariate dual change score modelling of the cross-lagged associations between vitality and self-rated health indicated vitality to be a stronger predictor of change in self-rated health. Self-rated health was unrelated to change in vitality.

Conclusion

Vitality accounted for most of the mental health effect on self-rated health and was identified as a significant predictor of change in self-rated health over a 10-year period. Promoting wellbeing and psychological functioning may have significant protective effects on negative health outcomes throughout the adult lifespan and into late life.     

Mental and substance use disorders from early adolescence to young adulthood among indigenous young people: final diagnostic results from an 8-year panel study

Objective

Our objective was to investigate change in prevalence rates for mental and substance abuse disorders between early adolescence and young adulthood in a cohort of indigenous adolescents who participated in an 8-year panel study.

Method

The data are from a lagged, sequential study of 671 indigenous adolescents (Wave 1) from a single culture in the Northern Midwest USA and Canada. At Wave 1 (mean age 11.3 years, Wave 4 (mean age 14.3 years), Wave 6 (mean age 16.2 years), and at Wave 8 (mean age 18.3 years) the tribally enrolled adolescents completed a computer-assisted personal interview that included DISC-R assessment for 11 diagnoses. Our yearly retention rates by diagnostic wave were: Wave 2, 94.7 %; Wave 4, 87.7 %; Wave 6, 88.0 %; Wave 8, 78.5 %.

Results

The findings show a dramatic increase in lifetime prevalence rates for substance use disorders. By young adulthood, over half had met criteria of substance abuse or dependence disorder. Also at young adulthood, 58.2 % had met lifetime criteria of a single substance use or mental disorder and 37.2 % for two or more substance use or mental disorders. The results are compared to other indigenous diagnostic studies and to the general population.

Conclusions

A mental health crisis exists within the indigenous populations that participated in this study. Innovations within current mental health service systems are needed to address the unmet demand of adolescents and families.     

Maternal smoking during pregnancy and neural tube defects in offspring: a meta-analysis

Purpose

This study aims to examine the association between maternal smoking during pregnancy and neural tube defects (NTDs) in offspring.

Methods

We retrieved published studies on the association between maternal smoking during pregnancy and NTDs risk in offspring. Meta-analysis was applied to calculate the overall odds ratios (ORs) and their 95 % confidence intervals (CIs). The publication bias was assessed by the Egger’s regression asymmetry test and Begg’s rank correlation test.

Results

The overall effect of maternal smoking during pregnancy on NTDs was 1.03 (OR?=?1.03, 95 % CI?=?0.80–1.33). When subgroup analysis was conducted by geographic regions, the overall effects were 1.39 (OR?=?1.39, 95 % CI?=?1.18–1.64), 0.88 (OR?=?0.88, 95 % CI?=?0.66–1.17) in Europe and USA; when subgroup analysis was conducted by NTDs types, the overall effect was 1.55 (OR?=?1.55, 95 % CI?=?1.06–2.26) for spina bifida.

Conclusions

Women who smoked during pregnancy had mildly elevated risk of having infants with NTDs.