Bilateral orofacial clefts are associated with increased risk of psychiatric morbidity relative to unilateral clefts

BACKGROUND: Orofacial clefts are associated with neurodevelopmental conditions. However, whether or not this risk is different among children with unilateral compared with bilateral clefts is not known. The aim of this study was to compare children with bilateral clefts to those with unilateral clefts regarding psychiatric disorders, suicide, and self-harm. METHODS: We utilized data on all children born in Sweden between 1973 and 2012 with unilateral cleft lip (UCL), bilateral cleft lip (BCL), unilateral cleft lip and palate (UCLP), and bilateral cleft lip and palate (BCLP). We performed Cox regression analyses with direct comparisons between bilateral and unilateral clefts and comparisons to matched community cohorts, adjusting for confounders. RESULTS: Children with BCL compared with UCL showed risk increases for any psychiatric disorder (adjusted Cox-derived hazard ratios [aHRs], 2.13; 95% confidence interval [CI], 1.04-4.36), including intellectual disability (aHR, 5.31; 95% CI, 1.29-21.78). Children with BCLP compared with UCLP demonstrated risk increases for any psychiatric disorder (aHR, 1.55; 95% CI, 1.20-2.01), including speech and language disorders (aHR, 1.99; 95% CI, 1.00-3.97), neurodevelopmental disorders (aHR, 1.66; 95% CI, 1.11-2.47), and other psychiatric disorders (aHR, 1.54; 95% CI, 1.11-2.15), including personality disorders (aHR, 5.76; 95% CI, 2.13-15.55). No significant associations were observed for suicide or self-harm. CONCLUSIONS: This large nationwide register study showed, for the first time, that individuals with bilateral clefts demonstrated elevated risks of psychiatric disorders compared with unilateral clefts. This is of clinical relevance to professionals as well as information that needs to be conveyed to families of children with orofacial clefts.