Trajectories of family poverty and children's mental health: Results from the Danish National Birth Cohort

Longitudinal associations between socioeconomic status and psychosocial problems in preschool children

Socioeconomic status (SES) at different points in a child's lifetime may have different effects on health outcomes. This study aimed to examine longitudinal associations between SES and psychosocial problems in preschool children (n = 2509, Mage = 24.2 ± 1.3 months). The psychosocial problems of children were assessed using the Brief Infant-Toddler Social and Emotional Assessment at age 2 years and age 3 years and categorized as having yes/no psychosocial problems. Four groups of pattern of presence/absence of psychosocial problems between age 2 and 3 years were classified: (1) 'no problems', (2) 'problems at age two', (3) 'problems at age three', and (4) 'continuing problems'. Five indicators of SES (i.e., maternal education level, single-parent family, unemployment, financial problems, and neighborhood SES) were evaluated. Results showed around one-fifth (2Y = 20.0%, 3Y = 16.0%) of children had psychosocial problems. Multinomial logistic regression models revealed low and middle maternal education levels were associated with 'problems at age two'; low maternal education level and financial problems were associated with 'problems at age three'; low and middle maternal education level, single-parent family, and unemployment were associated with 'continuing problems'. No associations were observed between neighborhood SES and any pattern. Results suggest children in a lower SES, indicated by maternal education, single-parent family, and financial stress, had higher odds of developing and continuously having psychosocial problems in early childhood. These findings call for optimally timing interventions to reduce the impact of disadvantaged SES in early childhood on psychosocial health.

Developmental Trajectories of Irritability across the Transition to Toddlerhood: Associations with Effortful Control and Psychopathology

Preschool-age irritability is a transdiagnostic marker of internalizing and externalizing problems. However, researchers have generally been reluctant to examine irritability within a clinically salient framework at younger ages due to some instability during the "terrible twos" period. Developmentally sensitive and dense measurements to capture intra- and inter-individual variability, as well as exploration of developmental processes that predict change, are needed. This study aimed to examine (1) the trajectories of irritability at the transition to toddlerhood (12-24 months of age) using repeated measures, (2) whether effortful control was associated with individual differences in level and growth rate of irritability, and (3) whether individual differences in the irritability trajectories were associated with later psychopathology. Families were recruited when the child was 12-18 months old (N = 333, 45.65% female). Mothers reported on their toddler's irritability at baseline and every two months until a follow-up laboratory assessment approximately one year later. Effortful control was measured at baseline. Clinical internalizing/externalizing symptoms were measured at the follow-up assessment. Hierarchical linear models revealed an increase in irritability over time, yet there was relatively little within-person variability. Effortful control was only associated with the level of irritability and not growth rate. Level of irritability was associated with internalizing, externalizing, and combined symptoms, but growth rate was not. Findings suggest intraindividual stability in irritability at the transition to toddlerhood and the possibility that screening for elevated irritability at toddler age is meaningful.

Child mental health and income gradient from early childhood to adolescence: Evidence from the UK

Background

Children from low income families are likely to have poorer mental health than their more affluent peers. However, it is unclear how this association varies at different developmental stages and what the potential underpinning mechanisms are. This study investigates the relationship between family income and mental health problems from early childhood to adolescence in the UK, and examines the potential mediating role of family-related factors over time.

Methods

Data were drawn from the UK Millennium Cohort Study at ages 3, 5, 7, 11, 14 and 17 years. Child mental health was measured by the Strengths and Difficulties Questionnaire Total Difficulties Score, and the Internalising and Externalising subscales. Family income was operationalised as permanent income. Cross-sectional analyses were conducted at each age to examine the association between income and mental health problems, and to examine potential mechanisms based on the Parental Stress and Parental Investment theories.

Results

The samples included 8096 children aged up to 14 years, of which 5667 remained in the study at age 17. Results indicated a statistically significant association between lower family income and poorer mental health in all age groups after adjusting for confounding factors. The strength of the association was reduced after adjustment for Parental Stress and Parental Investment factors, with the larger attenuation driven by Parental Stress factors in most cases. Fully adjusted models suggested an increased independent association between maternal psychological distress and children's mental health as children grew older.

Conclusions

While lower family income is associated with a child's poorer mental health, much of this association is explained by other factors such as maternal psychological distress, and therefore the direct association is relatively small. This suggests that policies targeting income redistribution may reduce child mental health problems, and also benefit the wider family, reducing the prevalence of other associated risk factors.

Allostatic load in children: The cost of empathic concern

Early-life adversity affects long-term health outcomes but there is considerable interindividual variability in susceptibility to environmental influences. We proposed that positive psychological characteristics that reflect engagement with context, such as being concerned about people or performance on tasks (i.e., empathic concern), could moderate the interindividual variation in sensitivity to the quality of the early environment. We studied 526 children of various Asian nationalities in Singapore (46.6% female, 13.4% below the poverty line) with longitudinal data on perinatal and childhood experiences, maternal report on empathic concern of the child, and a comprehensive set of physiological measures reflecting pediatric allostatic load assessed at 6 y of age. The perinatal and childhood experiences included adversities and positive experiences. We found that cumulative adverse childhood experience was positively associated with allostatic load of children at 6 y of age at higher levels of empathic concern but not significantly associated at lower levels of empathic concern. This finding reveals evidence for the importance of empathic concern as a psychological characteristic that moderates the developmental impact of environmental influences, serving as a source for vulnerability to adversities in children.

Socioeconomic Status, Protective Factors, and Mental Health Problems in Transition from Adolescence to Emerging Adulthood: Results of the Longitudinal BELLA Study

Lower familial socioeconomic status (SES) is associated with more mental health problems in adolescence. The aim of this study was to identify factors that may protect adolescents from families with lower SES from developing mental health problems in emerging adulthood. Data of the population-based longitudinal BELLA study included n = 426 participants aged 13 to 17 years at t0 (2009-2012) and 18 to 24 years at t1 (2014-2017). Hierarchical multiple linear regressions with interaction terms were conducted, examining three selected protective factors (self-efficacy, family climate, and social support). Self-efficacy had a small protective effect for adolescents from families with lower SES for mental health problems in emerging adulthood. However, social support had a small protective effect for adolescents from families with higher SES. No moderating effect was found for family climate. Instead, better family climate in adolescents predicted fewer mental health problems in emerging adulthood with a small effect regardless the SES in adolescence. Results indicate the need for prevention measures for adolescents from families with lower SES for becoming mentally healthy emerging adults.

Educational attainment and anxiety in middle-aged and older Europeans

We examined the relationship between educational attainment (EA) and anxiety symptoms in a sample of 77,792 individuals (median age = 64 years, 55% female) from the Survey of Health, Ageing and Retirement in Europe. Using logistic regression, we estimated odds ratio (OR) with 95% confidence interval (CI) for the association between EA (7 educational levels based on International Standard Classification of Education) and anxiety symptoms (12 or more points from the shortened 5-item version of the Beck Anxiety Inventory), adjusting for sociodemographic and health-related factors. We further explored whether the relationship varied by region, sex and age group. Independent of sociodemographic and health-related factors, higher levels of EA were associated with lower odds of anxiety symptoms. The magnitude of this association plateaued at first stage of tertiary education (OR 0.40; 95% CI 0.35-0.47, p < 0.001). The association was stronger in females, middle-aged individuals and in Central and Eastern Europe while not apparent in Northern Europe. Our findings suggest that individuals with higher education might be protected against anxiety throughout life. The protective effect of education against anxiety symptoms is more pronounced in less egalitarian regions and in females.

Family Background Issues as Predictors of Mental Health Problems for University Students

Mental health problems are common among university students. Specific type of family background is one of the important factors contributing to these problems. This study aimed to evaluate the proportion of severe mental health problems and the associations between severity and types of problems and family backgrounds. This was a cross-sectional descriptive study. We reviewed the database and medical records of 125 university students aged over 18 years who attended the mental health consultation clinic for university students, 123 Primary Care Unit, Khon Kaen University, between 1 January and 31 December 2018. The characteristics of the participants were summarized using descriptive statistics. We performed an analysis using logistic regression to obtain the crude and adjusted odds ratio. The proportion of severe mental health problems was 50.4%. The most common problem was learning problems (54.4%). The severity of the problems reported by the students was associated with communication failure in the family (AOR = 3.30 [95% CI: 1.14-9.52], p = 0.027). All students who experienced domestic violence in their family had severe mental health problems. This study re-appraised the utility of the context of the family as a predictor of current problems of university students.

The moderating role of trajectories of family hardiness in the relationship between trajectories of economic hardship and mental health of mothers and children

Trajectories of perceived economic hardship are related to clinical levels of mental health issues in mothers and children from low-income families. Cross-sectionally, family hardiness has been found to have a moderating effect on the relationship between stressors and mental health severity. Recent advances in family resilience theory highlight the importance of considering trajectories of family resilience. Trajectories of family hardiness and their moderating effect on the relationship between trajectories of perceived economic hardship and symptoms of depression and anxiety in low-income mothers and children were investigated in 511 mother-child dyads in Singapore. Three trajectories of family hardiness were delineated, namely the high stable, low rapidly increasing and moderate increasing group. The trajectories of family hardiness were found to moderate the relationship between trajectories of perceived economic hardship and symptoms of mental health in low-income mothers and children. The same moderation effect was not found when perceived economic hardship and family hardiness were investigated cross-sectionally. These findings highlight the importance of considering the family's trajectory of hardiness over time when working with low-income families. In addition, given that different trajectories of family hardiness were protective for different aspects of mental health, further studies to understand these relations are necessary.

Trajectories of perceived economic hardship: Relations with mother's and child's mental health and the role of self-esteem

Trajectories of poverty influence the mental health of mothers and children. Previous studies utilize objective measures despite the importance of subjective measures of poverty. Furthermore, chronic economic hardship may erode personal resources such as self-esteem which increases vulnerability to mental health issues. Trajectories of perceived family economic hardship and their relationship with common mental health disorders, as mediated by self-esteem, were investigated in 511 mother-child dyads from Singapore. Three distinct groups of economic hardship trajectories were delineated, namely the low stable, high stable and moderate decreasing group. The high stable group was found to be associated with a greater likelihood of mother's depression, mother's anxiety and child's anxiety when compared to the low stable group. The moderate decreasing group was found to be associated with a greater likelihood of mother's anxiety when compared to the low stable group. Mother's self-esteem was found to mediate all the significant relations found. These findings indicate the existence of distinct trajectories of perceived economic hardship within low-income families and their relation with mental health outcomes in mothers and children. The mediation of these relations by mother's self-esteem suggests the importance of enhancing self-esteem in mothers from low-income backgrounds.

The mental health of children and young people living in big cities in a revolving postpandemic world

PURPOSE OF REVIEW

The world's population is increasingly urban, with most children and young people growing up and living in cities. Evidence suggests that urbanicity is linked to an increased risk for the development of mental health disorders. Rather than an accumulation of risk factors, urbanization is a complex process that profoundly structures living conditions. In this sense, it is timely to discuss what are the social and structural determinants of mental health of children and young people in such settings.

RECENT FINDINGS

Three domains of determinants of mental health were selected for discussion: economics and living conditions, crime and violence, and urban layouts. For each, we debated realities faced by urban children and young people, providing an overview of recent evidence on implications for mental disorders and well being. We also discuss the potential impacts of the covid-19 pandemic on each domain, as well as recommendations for future action.

SUMMARY

Structural factors are of major relevance for the mental health of children and young people living in cities. The agenda of mental health promotion and prevention must include whole-of-society interventions aimed at improving living conditions, including economic and social capital, violence prevention and urbanistic planning.

Parenting Challenges and Opportunities among Families Living in Poverty

Poverty-related stressors have been found to impact parenting behaviors which can result in adverse outcomes for children. The current qualitative study focused on understanding the challenges of caregivers (N = 70) living in poverty. The sample was diverse and included mothers, fathers, and grandparents raising grandchildren. Stories of caregivers were gathered to improve the understanding of families living in poverty in an effort to work towards changing how our world supports families that are vulnerable. Results indicate that families experiencing poverty and related risk factors experience challenges in the realm of child safety, education, and racism/prejudice. Families also discussed ways to improve their environment which included increased financial resources, increased access to high-quality healthcare and childcare, and positive environmental change. Note that the current study outlines the complexity of parenting in poverty and that associated challenges are intertwined. Recommendations are made to address systemic barriers at the individual and community level in an effort to better support caregivers experiencing adversity and parenting in the 21st century.

Inverse probability weighting to handle attrition in cohort studies: some guidance and a call for caution

BACKGROUND

Attrition in cohort studies challenges causal inference. Although inverse probability weighting (IPW) has been proposed to handle attrition in association analyses, its relevance has been little studied in this context. We aimed to investigate its ability to correct for selection bias in exposure-outcome estimation by addressing an important methodological issue: the specification of the response model.

METHODS

A simulation study compared the IPW method with complete-case analysis (CCA) for nine response-mechanism scenarios (3 missing at random - MAR and 6 missing not at random - MNAR). Eighteen response models differing by the type of variables included were assessed.

RESULTS

The IPW method was equivalent to CCA in terms of bias and consistently less efficient in all scenarios, regardless of the response model tested. The most effective response model included only the confounding factors of the association model.

CONCLUSION

Our study questions the ability of the IPW method to correct for selection bias in situations of attrition leading to missing outcomes. If the method is to be used, we encourage including only the confounding variables of the association of interest in the response model.

The relationship between multidimensional poverty, income poverty and youth depressive symptoms: cross-sectional evidence from Mexico, South Africa and Colombia

Whereas monetary poverty is associated with increased risk of depressive symptoms in young people, poverty is increasingly understood as a multidimensional problem. However, it is yet to be understood how the associations between different dimensions of poverty and youth mental health differ across countries. We examine the relationship between multidimensional, as well as income poverty, and depressive symptoms in young people (age 11-25 years) across three middle-income countries. Based on harmonised data from surveys in Colombia, Mexico and South Africa (N=16 173) we constructed a multidimensional poverty index that comprised five deprivations We used Poisson regression to examine relationships between different forms of poverty with depressive symptoms across the countries. Multidimensional poverty was associated with higher rates of depressive symptoms in the harmonised dataset (IRR (incidence rate ratio)=1.25, 95% CI 1.10 to 1.42), in Mexico (IRR=1.34, 95% CI 1.11 to 1.64) and Colombia (IRR=2.01, 95% CI 1.30 to 3.10) but not in South Africa, a finding driven by a lack of associations between child labour and health insurance coverage with depressive symptoms. There was only an association with income poverty and depressive symptoms in South Africa, not in Colombia or Mexico. Depressive symptoms were associated with individual deprivations such as school lag, child labour and lack of access to health services in the harmonised dataset, but not with household deprivations, such as parental unemployment and housing conditions, though the opposite pattern was observed in South Africa. Our findings suggest that the importance of specific dimensions of poverty for mental health varies across countries, and a multidimensional approach is needed to gain insights into the relationship between youth depression and poverty.

Birth order and socioeconomic disadvantage predict behavioural and emotional problems at age 3 years

AIM

The aim of this study was to describe sociodemographic and family predictors for behavioural and emotional problems in pre-schoolers.

METHODS

This was a cross-sectional study including 30,795 children in the Stockholm region whose parents had completed the Strength and Difficulties Questionnaire (SDQ) prior to a routine visit to a well-baby clinic at age 3 years. Multivariate logistic regression was used to analyse predictors for having a high total SDQ difficulties score.

RESULTS

Young parental age and a low level of parental education predicted high total SDQ score in a stepwise pattern. Being a first-born child was associated with a high SDQ score with an adjusted odds ratio of 2.10 (95% C.I. 1.84-2.41), compared with having older siblings. A sole physical custody arrangement predicted a high total SDQ score after parental separation. The percentage of children with a high total SDQ score increased with the Care Need Index (CNI) of the well-baby clinic.

CONCLUSIONS

This study identified socioeconomic disadvantage and being the first-born child as the main predictors of poor mental health at age 3 years. Well-baby clinics with socioeconomically disadvantaged catchment areas should be provided with adequate resources and methods for equitable prevention.

The gendered relationship between maternal depression and adolescent internalizing symptoms

It is well-established that adolescents whose mothers are depressed are themselves more likely to experience internalizing symptoms (e.g., depressive and anxiety symptoms). Even as extensive work shows that internalizing symptoms are more prevalent among adolescent girls compared to boys, it is unclear if the maternal-offspring mental health relationship is gender-neutral or gender-specific: Does maternal depression act as an equalizing force for adolescents' risk of internalizing symptoms, or does it contribute to adolescent gender differences? This study analyzes whether adolescent gender moderates the association between maternal depression and adolescent internalizing symptoms using data from the Year-15 survey of the Fragile Families and Child Wellbeing Study, which follows a cohort of children born in large U.S. cities, primarily to unmarried parents. This sample of 2159 primary caregiver mothers and adolescent offspring (ages 14-18 years) has numerous social risk factors for internalizing symptoms, affording the opportunity to carefully assess the possibly gendered nature of mother-adolescent linkages. Adjusted ordinary least squares regression models showed that maternal depression is associated with significantly higher adolescent depressive and anxiety symptoms. However, the relationship between maternal depression and adolescent internalizing symptoms is substantially larger for daughters compared to sons. The gendered nature of these concurrent mother-adolescent symptoms highlights the need to consider the effect of gender on other risk processes within families. Moreover, the strong clustering of internalizing symptoms among mothers and daughters highlights the value of prevention and treatment efforts that attend to adult and adolescent mental health simultaneously.

Is there a social gradient in how youth with mental disorder perform academically? Findings from a Swedish longitudinal register-based study

Background

It is well established that academic achievement and other school-related outcomes are associated with mental health status in children and youths. However, few studies have examined the influence of socioeconomic background on the relationship between poor childhood/adolescent mental health and school performance. From an equity perspective, it is important to explore how school-related outcomes are affected for young people with mental disorder and if these outcomes differ depending on gender and socioeconomic background. This study aimed to investigate social gradients in the prospective association between childhood/adolescent mental disorder and academic achievement.

Methods

This register based study used data from the Umeå SIMSAM Lab of linked Swedish registers on all children born between 1990 and 1994 and their parents (N = 642 558). The outcome was school grades achieved upon compulsory school graduation (age 15/16). Mental disorder was indicated by number of hospitalisations due to ICD classified mental disorders and prescription of psychoanaleptic drugs. Indicators of socioeconomic position were parental level of education and family income in four categories respectively. Parental history of mental disorder was controlled for. Linear regressions, including interaction analyses, were performed.

Results

Mental disorder in childhood/adolescence was related to lower grades, particularly in boys. The drop in academic achievement among youth with mental disorder was more pronounced among girls in mid SEP categories than among their less and more advantaged peers. A less clear interaction pattern was identified in boys.

Conclusions

Based on theory and existing research we expected a typical social gradient in the strength of the association between mental disorder and academic achievement. However, we identified a U-shaped social gradient among girls. Analyses of the links between mental health and academic outcomes need to take both gender and social position into account. More research is needed to investigate these patterns further.

Association between poverty exposure during childhood and adolescence, and drug use disorders and drug-related crimes later in life

AIMS

To examine whether poverty exposure in childhood/adolescence increases the risk of later drug use disorder and drug crime conviction.

DESIGN, SETTING AND PARTICIPANTS

A national cohort study encompassing 634 284 individuals born between 1985 and 1990, residing in Sweden between 5 and 18 years of age, followed-up from January 2004 to December 2016, starting from the age of 19 years until the first visit to inpatient/outpatient care with a diagnosis of a drug use disorder or a drug crime offence.

MEASUREMENTS

The exposure variable was 'trajectories of poverty' based on household income, assessed through group-based trajectory analysis. Cox regression analysis was used to obtain hazard ratios for drug use disorders and drug crime convictions using age as the underlying time scale.

FINDINGS

We identified five trajectories of childhood/adolescence poverty: (1) 'moving out of poverty in childhood' (8.7%); (2) 'never poverty' (68.9%); (3) 'moving into poverty in adolescence' (11.0%); (4) 'moving out of poverty in adolescence' (5.4%); and (5) 'chronically poor' (5.9%). Compared with the 'never poor' group, almost all trajectory groups had higher risks for drug use problems. Young males 'moving into poverty in adolescence' had the highest risks of drug use disorder [hazard ratio (HR) = 1.48, 95% confidence interval (CI) = 1.40-1.57] and drug crime conviction (HR = 1.50, 95% CI = 1.38-1.62), after adjusting for calendar year, domicile, origin, psychiatric diagnosis and parental psychiatric diagnosis. The results were similar in females moving into poverty in adolescence (HR = 1.63, 95% CI = 1.52-1.76 and HR = 1.89, 95% CI = 1.74-2.05 for drug use disorders and drug crime, respectively).

CONCLUSION

In Sweden, poverty exposure early in life seems to increase the risk of drug use problems in adulthood. These associations are not explained fully by domicile, origin or other psychiatric disorders. Young males and females moving into poverty in adolescence are at highest risk.

Association between perinatal depression and risk of attention deficit hyperactivity disorder among children: a retrospective cohort study

PURPOSE

Perinatal depression has previously been identified as a risk factor for attention deficit hyperactivity disorder (ADHD) in the offspring. Population-based studies utilizing diagnosis data are needed to better understand the relationship between these two variables. The objective of this study was to examine the association between perinatal depression and the risk of ADHD among children born during a 5 or-more-year follow-up period.

METHODS

The sample was drawn from a population-based cohort of privately insured mother-child pairs within the state of Iowa. Hazard ratios for risk of ADHD by exposure to perinatal depression were estimated using adjusted Cox proportional-hazard models.

RESULTS

Among the 5,635 mother-child pairs, 484 mothers were diagnosed with depression during the perinatal period, and 269 children were diagnosed with ADHD. After adjustment for confounders, children born to mothers with perinatal depression were over three times more likely to be diagnosed with ADHD (HR 3.16 (95% CI 2.35, 4.23)).

CONCLUSIONS

Children born to mothers with perinatal depression were found to be at increased risk of ADHD. This finding suggests that ADHD and its adverse sequelae could be mitigated by increasing maternal depression intervention efforts as well as ADHD screening and treatment efforts targeted to this vulnerable population.

Short-run effects of poverty on asthma, ear infections and health service use: analysis of the Longitudinal Study of Australian Children

BACKGROUND

Many studies have reported an inferred causal association of income poverty with physical health among children; but making causal inference is challenging due to multiple potential sources of systematic error. We quantified the short-run effect of changes in household poverty status on children's health (asthma and ear infections) and service use (visits to the doctor and parent-reported hospital admissions), using a national longitudinal study of Australian children, with particular attention to potential residual confounding and selection bias due to study attrition.

METHODS

We use four modelling approaches differing in their capacity to reduce residual confounding (generalized linear, random effects (RE), hybrid and fixed effects (FE) regression modelling) to model the effect of income poverty (<60% of median income) on health for 10 090 children surveyed every 2nd year since 2004. For each method, we simulate the potential impact of selection bias arising due to attrition related to children's health status.

RESULTS

Of the 10 090 children included, 20% were in families in poverty at survey baseline (2004). Across subsequent years, ∼25% experienced intermittent and <2% persistent poverty. No substantial associations between poverty and child physical health and service use were observed in the FE models least prone to residual confounding [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.81-1.10 for wheeze], in contrast to RE models that were positive (consistent with previous studies). Selection bias causing null findings was unlikely.

CONCLUSIONS

While poverty has deleterious causal effects on children's socio-behavioural and educational outcomes, we find little evidence of a short-run causal effect of poverty on asthma, ear infections and health service use in Australia.

[The Role of the Socioeconomic Status in Mental Health Care Utilization by Children and Adolescents in Germany: Results of the BELLA Study]

OBJECTIVE

Children and adolescents with a low socioeconomic status (SES) are significantly more often affected by mental health problems than their peers with a high SES. So far, little is known about the association between family's SES and utilization of mental health care. This study examines the mental health care utilization by children and adolescents depending on their SES and symptoms of mental health problems as well as the impact of mental health problems.

METHODS

The analysis comprisesd data from the population-based BELLA-study, which investigates mental health in a representative subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Between 2014 and 2017, 1,580 participants aged 7 to 17 years were examined. SES was measured by the indicators of household income, parental educational attainment and parental occupation status. Symptoms and impairment of mental health problems were measured using the Strength and Difficulties Questionnaire (SDQ and SDQ-Impact). To investigate mental health care, the consultation of child and adolescent psychiatrists, medical and psychological psychotherapists and psychologists was considered. A hierarchic binary logistic regression model was calculated predicting mental health care use. In addition, effects of SES-indicators on associations between symptoms and impairment as well as mental health care utilization (moderator analysis) were investigated.

RESULTS

Children and adolescents with a low SES were more likely to utilize mental health care services than their peers with a high SES. Mental health care utilization was significantly predicted by symptoms of mental health problems (OR=1.15, p≤0.001) as well as by the impairment caused by these problems (OR=1.68, p≤0.001); we found no significant moderation effects for household income, parental education or parental occupation.

CONCLUSION

The probability of mental health care utilization by children and adolescents is significantly predicted by the symptoms and the impairments caused by mental health problems, but not by household income, parental education or parental occupation.

What Research Questions Should the Next Generation of Birth Cohort Studies Address? An International Delphi Study of Experts

OBJECTIVE

Birth cohort studies (BCS) have generated a wealth of invaluable basic scientific and policy-relevant information on a wide range of issues in child health and development. This study sought to explore what research questions are currently a priority for the next generation of BCS using a 3-round Delphi survey of interdisciplinary experts.

METHODS

Twenty-four (Round I, N = 17; Round II, N = 21; Round III, N = 18) experts across a wide range of fields (eg, psychology, public health, and maternal/child health) agreed to participate. In Round I, the expert panel was invited to freely respond to the question, "what are the key scientific questions future birth cohort studies should address?" Content analysis of answers was used to identify 47 questions for rating on perceived importance by the panel in Round II and consensus-achieving questions were identified. Questions that did not reach consensus in Round II were posed again for expert re-rating in Round III.

RESULTS

Twenty six of 47 questions reached consensus in Round II, with an additional 6 reaching consensus in Round III. Consensus-achieving questions rated highly on importance spanned a number of topics, including environmental effects on child development, intergenerational transmission of disadvantage, and designing BCS to inform intervention strategies.

CONCLUSION

Investigating the effects of family/environmental factors and social disadvantage on a child's development should be prioritized in designing future BCS. The panel also recommended that future BCS are designed to inform intervention strategies.

Household economic instability: Constructs, measurement, and implications

A growing body of research demonstrates the multiple dimensions and dynamism of family income and employment. The metrics of household economic instability and their associations with household characteristics and hardship require further examination in order to compare across studies, subgroups, and historical periods. This paper empirically examines and compares commonly used measures of income and employment instability, how these measures inter-relate, vary by household characteristics, and how they predict household hardship. Using longitudinal data from the 2008 panel of the Survey of Income and Program Participation (SIPP), and focusing on households with children, this study examined a range of descriptive measures of economic instability, including in income, earnings, public assistance benefits, and employment status, and how these measures related to each other. Results indicate that overall rates of income and employment instability were high, particularly among less-educated families, those with young children, and those who did not own a home. Economic instability, particularly decreases in employment, was associated with increased household hardship three months later. Findings also show that the source of income included in the instability measure affects the patterns identified and conclusions drawn, whereas the specific type of measure used matters less. Results highlight the instability of public assistance benefits and suggest that safety net programs must take economic instability into account when designing programs and benefits.

Association between socioeconomic status and the trajectory of insufficient sleep: Maternal emotional support as a moderator

OBJECTIVE

To examine the association between SES and the trajectory of insufficient sleep among children aged 0.5-8 years and to investigate whether these associations vary by age. The moderating role of maternal emotional support was further explored.

METHOD

Data were obtained from 20,874 children participating in the Taiwan Birth Cohort Study. Multilevel models were conducted to explore the association between SES and the trajectory of insufficient sleep. The moderating role of maternal emotional support was examined by testing the significance of the interaction between SES and emotional support.

RESULTS

Low parental education and poverty contributed to increased risk of insufficient sleep, and the observed associations varied by age. Specifically, the influences of parental education increased with age, and the effects of poverty were significant only among preschoolaged children. Poverty dynamics were also significantly associated with an elevated risk of insufficient sleep, but the association was mitigated by maternal emotional support.

CONCLUSIONS

Children with low SES exhibited increased risk of insufficient sleep. Furthermore, the relationship between SES and insufficient sleep differed by age, with varying patterns emerging for different SES indicators. However, the negative influences of low SES could be mitigated by increasing maternal emotional support. Interventions that reduce SES disparity or enhance maternal emotional support could decrease the risk of insufficient sleep among children living with an SES disadvantage.

Latent Class Analysis of Mental Health in Middle Childhood: Evidence for the Dual-Factor Model

Mental health is complex, comprising both mental distress and well-being. This study used latent class analysis to identify common combinations of mental distress and well-being (‘mental health classes’) among schoolchildren aged 8–9 years (N = 3340). Thirteen items, measuring a range of conduct problems, emotional symptoms, and subjective well-being, were included in the analysis. Four mental health classes were identified: (1) complete mental health (n = 1895, 57%), (2) vulnerable (n = 434, 13%), (3) emotional symptoms but content (n = 606, 18%), and (4) conduct problems but content (n = 404, 12%). The classes were reliably identified across different datasets, and for males and females. Differential relations with covariates indicated that mental health classes were distinct and externally valid. The results supported the dual-factor model of mental health, suggesting that mental distress and subjective well-being are separate continua. Three of the four possible combinations of high and low distress and subjective well-being posited by the dual-factor model were found using this inductive statistical method. Importantly, our analysis also revealed two ‘symptomatic but content’ groups, differentiated by symptom domain (internalising/externalising). The covariate analyses between mental health classes and sociodemographic factors, prior academic attainment, school connectedness, and peer support, indicated that there are nuanced relations between those variables and particular constellations of mental distress and well-being. As one of the few dual-factor studies to focus on middle childhood, the current study adds important new evidence that contributes to our understanding of the complexities of mental health among schoolchildren.

Household food insecurity and early childhood development: Longitudinal evidence from Ghana

The burden of food insecurity is large in Sub-Saharan Africa, yet the evidence-base on the relation between household food insecurity and early child development is extremely limited. Furthermore, available research mostly relies on cross-sectional data, limiting the quality of existing evidence. We use longitudinal data on preschool-aged children and their households in Ghana to investigate how being in a food insecure household was associated with early child development outcomes across three years. Household food insecurity was measured over three years using the Household Hunger Score. Households were first classified as "ever food insecure" if they were food insecure at any round. We also assessed persistence of household food insecurity by classifying households into three categories: (i) never food insecure; (ii) transitory food insecurity, if the household was food insecure only in one wave; and (iii) persistent food insecurity, if the household was food insecure in two or all waves. Child development was assessed across literacy, numeracy, social-emotional, short-term memory, and self-regulation domains. Controlling for baseline values of each respective outcome and child and household characteristics, children from ever food insecure households had lower literacy, numeracy and short-term memory. When we distinguished between transitory and persistent food insecurity, transitory spells of food insecurity predicted decreased numeracy (β = -0.176, 95% CI: -0.317; -0.035), short-term memory (β = -0.237, 95% CI: -0.382; -0.092), and self-regulation (β = -0.154, 95% CI: -0.326; 0.017) compared with children from never food insecure households. By contrast, children residing in persistently food insecure households had lower literacy scores (β = -0.243, 95% CI: -0.496; 0.009). No gender differences were detected. Results were broadly robust to the inclusion of additional controls. This novel evidence from a Sub-Saharan African country highlights the need for multi-sectoral approaches including social protection and nutrition to support early child development.

Cumulative social disadvantage and risk of attention deficit hyperactivity disorder: Results from a nationwide cohort study

Socioeconomic factors correlate with mental health and affect individual life chances. However, the influence of specific and cumulative social disadvantages on children's mental health problems has received little attention. Previous studies have primarily used global measures of mental health problems or aggregated indicators of socioeconomic status. We contribute to this research by including multiple indicators of parental social disadvantage to study independent and accumulative effects. The study focuses on the Attention Deficit/Hyperactivity Disorder (ADHD), which is known to affect children's educational and socioeconomic trajectories. ADHD is one of the most common child mental health problems and although heredity has been estimated to 76 percent, research suggests that a large social component remains in the prevalence. We exploit comprehensive high-quality registry data for the entire population of children born 1990-1999 in Denmark (N = 632,725). The ADHD prevalence is 3.68 percent. Estimates from linear probability models show that parental unemployment, relative income poverty, and low educational attainment increase children's risk of ADHD with 2.1 (95% CI 1.8-2.3), 2.3 (95% CI 2.1-2.5), and 3.5 percentage points (95% CI 3.3-3.7), respectively. Children who live with all three disadvantages face an increased risk of 4.9 percentage points.

Review on the role of socioeconomic status in child health and development

PURPOSE OF REVIEW

This review presents findings from recent studies investigating the role of socioeconomic status (SES) in child development. Studies on associations between SES and different parameters of physical and psychological health, on interventions and possible resilience factors are reviewed.

RECENT FINDINGS

Several cross-sectional and longitudinal studies demonstrate social disparities in child behavior and health. They underline the detrimental effects of low SES on child development. Some studies also highlight the potentially adverse effects of early diseases or vulnerabilities on later career and social position. Whereas most studies applied parent-based measures of SES, some studies emphasize the significance of child-based (e.g. perceived social position) and area-level indicators of SES (e.g. area deprivation). With respect to intervention, study findings suggest positive effects of programs aiming to improve specific neighborhood characteristics and psychosocial functioning of individuals.

SUMMARY

The relation between SES and health is bidirectional and stable, and the effects of interventions aiming at changing behaviors of children and families with low SES are small. There is a need for further center-based and area-level interventions and studies evaluating the effects of these interventions.