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Research ArticleRegular Article

The Psychiatric Genetic Data of Children in Proceedings to Terminate Parental Rights

Maya Sabatello, Beverly J. Insel, Bruce G. Link, Jo C. Phelan and Paul S. Appelbaum
Journal of the American Academy of Psychiatry and the Law Online February 2021, JAAPL.200066-20; DOI: https://doi.org/10.29158/JAAPL.200066-20
Maya Sabatello
Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Research Foundation for Mental Hygiene, New York, NY. , School of Public Policy, University of California, Riverside, CA. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY.
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Beverly J. Insel
Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Research Foundation for Mental Hygiene, New York, NY. , School of Public Policy, University of California, Riverside, CA. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY.
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Bruce G. Link
Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Research Foundation for Mental Hygiene, New York, NY. , School of Public Policy, University of California, Riverside, CA. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY.
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Jo C. Phelan
Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Research Foundation for Mental Hygiene, New York, NY. , School of Public Policy, University of California, Riverside, CA. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY.
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Paul S. Appelbaum
Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Research Foundation for Mental Hygiene, New York, NY. , School of Public Policy, University of California, Riverside, CA. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY.
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    Figure 1.

    Decisions to terminate parental rights, by genetic evidence and likelihood of psychiatric disorder. The graph displays the predicted probabilities for termination of parental rights, depending on the presence of genetic evidence (i.e., genetics, family history, both, none) and the likelihood of the child (Samantha) having a psychiatric disorder. Analysis was controlled for child symptoms, child race, and subjects’ age, educational status, race, gender, ethnicity, marital status, and parental status. Tic marks indicate 95% confidence intervals (interaction p = .020, df = 3).

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    Table 1

    Demographic Characteristics

    Female/male165/135 (55.0/45.0)
    Age, y, mean ± SD48.6 ± 16.8
     18-2947 (15.7)
     30-59159 (53.0)
     60+94 (31.3)
    Race
     African American33 (11)
     White233 (77.7)
     Asian or Pacific Islander10 (3.3)
     American Indian or Alaskan Native3 (1.0)
     Native Hawaiian or other Pacific Islander0 (0.0)
     Mixed racea9 (3.0)
     Missing12 (4.0)
    Hispanic
     Yes38 (12.7)
     No262 (87.3)
    State of residence
     Northeast51 (17.0)
     Midwest75 (25.0)
     South109 (36.3)
     West65 (21.7)
    Highest education level attained
     ≤ High school graduate100 (33.3)
     Up to 2 years of college101 (33.7)
     4 years of college/postgraduate99 (33.0)
    Marital status
     Divorced/separated41 (13.7)
     Never married101 (33.7)
     Married/widowedb158 (52.7)
    Income
     ≤ $19,99942 (14.0)
     $20,000–$49,99999 (33.0)
     $50,000–$99,99982 (27.3)
     $100,000 or more40 (13.3)
     Prefer not to say/missing37 (12.3)
    • Data are presented as n (%) unless otherwise noted. N = 300 subjects.

    • ↵a Mixed-race participants selected both White and another racial category. In the analysis, the race category was collapsed into White/non-White participants. Mixed-race participants were classified as non-White.

    • ↵b Married includes domestic/civil partnership. Married/widowed participants were grouped together because the views of these participants, who are in a relationship or whose relationship was involuntarily ended, are likely to be different than participants who are divorced or are in the process of getting a divorce.

    • View popup
    Table 2

    Subjects Randomized to Each Vignette Condition

    Genetic Evidence
    Family HistoryGenetic TestBothNone
    No Symptoms
     African American17141718
     White18141720
    Symptoms
     African American21262123
     White18151922
    Total74697483
    • View popup
    Table 3

    Responses to Survey Questions

    Decision to terminate mother’s parental rights
     Parental rights should not be terminated196 (65.3)
     Parental rights should be terminated.104 (34.7)
    Should child be returned to her mother's home?
     She should be returned to her mother's home at this time60 (30.8)
     She should not be returned to her mother's home at this time135 (69.2)
    Likelihood the child has a psychiatric disorder
     Unlikely100 (41.2)
     Likely143 (58.9)
    Causal attribution for the child’s psychiatric condition:
     The way the person was raised
      Unlikely78 (26.1)
      Likely221 (73.9)
     Stressful circumstances in the person’s life
      Unlikely22 (7.3)
      Likely278 (92.7)
     A chemical imbalance in the brain
      Unlikely120 (40.1)
      Likely179 (59.9)
     A genetic or inherited problem
      Unlikely105 (35.4)
      Likely192 (64.7)
     The person’s own bad character
      Unlikely213 (71.5)
      Likely85 (28.5)
    Interventions child should undergo:
     Go to a general medical doctor
      No165 (55.4)
      Yes133 (44.6)
     Go to a psychiatrist
      No141 (47.3)
      Yes157 (52.7)
     Go to a therapist or counselor
      No54 (18.1)
      Yes245 (81.9)
     Be evaluated for prescription medication
      No182 (60.9)
      Yes117 (39.1)
     Be evaluated for admission to a mental hospital
      No271 (91.6)
      Yes25 (8.5)
    Mental health treatment will improve situation
     Unlikely57 (19.1)
     Likely242 (80.9)
    • Data are presented as n (%). N = 300 subjects.

    • View popup
    Table 4

    Associations between Genetic Evidence and Dependent Variables

    Dependent VariablesaGenetic Test and Family HistorybFamily History OnlyGenetic Test Only
    OR (95% CI)pOR (95% CI)pOR (95% CI)p
    Mother’s parental rights should be terminated
     Yes0.52 (0.26–1.05).070.73 (0.37–1.43).351.05 (0.53–2.08).88
    Should child be returned to her mother’s home?
     Yes0.49 (0.20–1.22).130.80 (0.34–1.90).610.76 (0.30–1.91).56
    Likelihood the child has a psychiatric disorder
     Likely8.77 (3.70–20.77)< .00015.46 (2.50–11.92)< .00019.21 (3.98–21.32)< .0001
    Causal attributions for the child’s psychiatric condition:
     The way the person was raised
      Likely0.78 (0.38–1.63).510.76 (0.37–1.57).461.18 (0.54–2.58).68
     Stressful circumstances in the person’s life
      Likely0.89 (0.25–3.12).851.96 (0.43–8.87).380.72 (0.21–2.50).60
     A chemical balance in the brain
      Likely4.29 (2.16–8.51)< .00015.92 (2.93–11.97)< .00015.81 (2.82–11.98)< .0001
     A genetic or inherited problem
      Likely7.22 (3.40–15.32)< .00014.54 (2.25–9.13)< .00016.47 (3.05–13.73)< .0001
     The person’s own bad behavior
      Likely0.61 (0.30–1.24).170.69 (0.34–1.38).290.48 (0.23–1.00).0495
    Interventions child should undergo:
     Go to a general medical doctor
      Yes1.36 (0.70–2.62).361.48 (0.77–2.83).241.82 (0.93–3.57).08
     Go to a psychiatrist
      Yes1.89 (0.97–3.69).061.64 (0.85–3.17).141.97 (0.99–3.90).052
     Go to a therapist or counselor
      Yes2.25 (0.97–5.18).061.55 (0.70–3.45).283.17 (1.27–7.94).01
     Be evaluated for prescription medication
      Yes3.03 (1.47–6.22).0031.69 (0.81–3.51).163.27 (1.57–6.81).002
     Be evaluated for admission to a mental hospital
      Yes0.54 (0.15–1.95).350.25 (0.05–1.23).091.70 (0.61–4.75).32
    Likelihood professional mental health treatment will improve child's situation
     Likely2.74 (1.18–6.40).022.03 (0.90–4.60).092.63 (1.10–6.25).03
    • ↵a The baseline comparison condition in the analysis is no genetic evidence (i.e., neither genetic test results nor family history).

    • ↵b Controlling for vignette child symptoms, vignette maternal race, and subjects’ race, education attainment, age, ethnicity, marital status, parental status, and gender.

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Journal of the American Academy of Psychiatry and the Law Online: 50 (2)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 50, Issue 2
1 Jun 2022
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The Psychiatric Genetic Data of Children in Proceedings to Terminate Parental Rights
Maya Sabatello, Beverly J. Insel, Bruce G. Link, Jo C. Phelan, Paul S. Appelbaum
Journal of the American Academy of Psychiatry and the Law Online Feb 2021, JAAPL.200066-20; DOI: 10.29158/JAAPL.200066-20

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The Psychiatric Genetic Data of Children in Proceedings to Terminate Parental Rights
Maya Sabatello, Beverly J. Insel, Bruce G. Link, Jo C. Phelan, Paul S. Appelbaum
Journal of the American Academy of Psychiatry and the Law Online Feb 2021, JAAPL.200066-20; DOI: 10.29158/JAAPL.200066-20
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