{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:42:29Z","timestamp":1787161349142,"version":"build-2736575974"},"reference-count":28,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2026,8,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Measles, mumps and rubella (MMR) remain a global public health concern, with suboptimal vaccine uptake in the UK. While parental psychological distress may influence health behaviours towards children, most studies focus on mothers, and the joint influence of both parents remains unclear. We examined whether co-occurring parental psychological distress is associated with childhood MMR non-immunisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from 12\u2009307 children in the nationally representative UK Millennium Cohort Study. Missing data were handled using multiple imputation. Parental psychological distress at 9 months postpartum was assessed using the modified Rutter Malaise Inventory and classified as neither parent distressed, mother distressed only, father distressed only or both parents distressed. Parent-reported MMR immunisation status at age 3 years was categorised as immunised or unimmunised. Survey-weighted logistic regression was used, adjusting for potential sociodemographic and household confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Children exposed to psychological distress in both parents had higher odds of non-immunisation (adjusted OR 1.97, 95%\u2009CI 1.20 to 3.23). The predicted probability of non-immunisation was 10.5% among children with both parents distressed, compared with 5.7% among those with lower distress (absolute difference ~5%). Distress in only one parent was not associated with uptake. The association with non-immunisation was stronger when both parents were distressed, although estimates were imprecise. There was no evidence that the association differed across household income groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Co-occurring parental psychological distress may represent a family-level marker of vulnerability associated with underimmunisation. Despite historical data, the findings highlight the importance of family-level factors in understanding current immunisation challenges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jech-2026-226443","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:20:23Z","timestamp":1787160023000},"page":"jech-2026-226443","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Family-level psychological distress and risk of childhood MMR non-immunisation: a UK Millennium Cohort Study analysis"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0414-396X","authenticated-orcid":false,"given":"Akihiro","family":"Oishi","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Japanese Red Cross Otsu Hospital, Otsu, Japan"},{"name":"Department of Public Health, Institute of Science Tokyo, Bunkyo-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"McMunn","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2936-3994","authenticated-orcid":false,"given":"Yvonne","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeo","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Public Health, Institute of Science Tokyo, Bunkyo-ku, Tokyo, 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