How do early-life factors explain social inequalities in adolescent mental health? Findings from the UK Millennium Cohort Study

Social inequalities in child mental health trajectories: a longitudinal study using birth cohort data 12 countries

BACKGROUND

Social inequalities in child mental health are an important public health concern. Whilst previous studies have examined inequalities at a single time point, very few have used repeated measures outcome data to describe how these inequalities emerge. Our aims were to describe social inequalities in child internalising and externalising problems across multiple countries and to explore how these inequalities change as children age.

METHODS

We used longitudinal data from eight birth cohorts containing participants from twelve countries (Australia, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Poland, Norway, Spain and the United Kingdom). The number of included children in each cohort ranged from N = 584 (Greece) to N = 73,042 (Norway), with a total sample of N = 149,604. Child socio-economic circumstances (SEC) were measured using self-reported maternal education at birth. Child mental health outcomes were internalising and externalising problems measured using either the Strengths and Difficulties Questionnaire or the Child Behavior Checklist. The number of data collection waves in each cohort ranged from two to seven, with the mean child age ranging from two to eighteen years old. We modelled the slope index of inequality (SII) using sex-stratified multi-level models.

RESULTS

For almost all cohorts, at the earliest age of measurement children born into more deprived SECs had higher internalising and externalising scores than children born to less deprived SECs. For example, in Norway at age 2 years, boys born to mothers of lower education had an estimated 0.3 (95% CI 0.3, 0.4) standard deviation higher levels of internalising problems (SII) compared to children born to mothers with high education. The exceptions were for boys in Australia (age 2) and both sexes in Greece (age 6), where we observed minimal social inequalities. In UK, Denmark and Netherlands inequalities decreased as children aged, however for other countries (France, Norway, Australia and Crete) inequalities were heterogeneous depending on child sex and outcome. For all countries except France inequalities remained at the oldest point of measurement.

CONCLUSIONS

Social inequalities in internalising and externalising problems were evident across a range of EU countries, with inequalities emerging early and generally persisting throughout childhood.

Maternal parenting stress and social-emotional problems of Chinese preschoolers: The role of the mother-child relationship and maternal adverse childhood experiences

BACKGROUND

Previous research suggests that maternal parenting stress is a significant predictor of social-emotional problems in children. However, little is known regarding the mother-child relationship and the effect of maternal adverse childhood experiences (ACEs) on this association.

METHODS

Three waves of longitudinal panel data were collected from 2893 Chinese preschoolers with a follow-up interval of 6 months. The mothers of preschoolers were asked to complete anonymous questionnaires concerning demographic variables, maternal ACEs and parenting stress in Wave 1, mother-child relationships in Wave 2, and children's social-emotional problems in Wave 3. The parallel mediation model was conducted to analyze the mediating role of three dimensions of mother-child relationships, and the moderation model was conducted to examine the moderating role of maternal ACEs.

RESULTS

The results showed that maternal parenting stress predicted children's social-emotional problems directly or indirectly through the mother-child relationship, with an intimate mother-child relationship mediating this main effect negatively but a conflicted and dependent mother-child relationship mediating this main effect positively. In addition, moderating results indicated that the main effect of maternal parenting stress on children's social-emotional problems was more marked among participants with at least one maternal ACEs than those without maternal ACEs. Furthermore, the moderating effect was only detected in children whose mothers had a high school education or less.

LIMITATIONS

The subjectivity of mothers' reports may somewhat reduce the credibility due to the possible overestimation or underestimation of children's social-emotional problems.

CONCLUSION

These findings provide new evidence for the effects of maternal parenting stress on children's social-emotional development and highlight the need for more attention to children with mothers having ACE exposure, lower educational level and poor parent-child relationships.

Neighbourhood characteristics and socioeconomic inequalities in child mental health: Cross-sectional and longitudinal findings from the Growing Up in Ireland study

This study examined the role of neighbourhood characteristics in explaining socioeconomic inequalities in child mental health (the total difficulties score from the Strengths and Difficulties Questionnaire) using data from Cohort '08 of Growing Up in Ireland Waves 3 (age 5; baseline) and 5 (age 9; follow-up). Twenty neighbourhood items were grouped into neighbourhood safety, built environments, cohesion, interaction, and disorder. Data were analysed using regression, single and multiple mediation, and network psychometric analyses. We found that neighbourhood safety, cohesion, interaction, and disorder were associated with child mental health. These four domains separately (by up to 18 %) or in concert (by up to 23 %) partially explained socioeconomic inequalities in child mental health. Built environments may explain socioeconomic inequalities in mental health in urban children only. Findings from network analysis indicated that specific concerns over "people being drunk or taking drugs in public" and "this is a safe neighbourhood" had the strongest connections with child mental health. Improving neighbourhood characteristics may be important to reduce socioeconomic inequalities in child mental health in Ireland.

Changes in Early Childhood Irritability and Its Association With Depressive Symptoms and Self-Harm During Adolescence in a Nationally Representative United Kingdom Birth Cohort

OBJECTIVE

This study aimed to investigate longitudinal associations between changes in early childhood irritability, and depressive symptoms and self-harm at 14 years.

METHOD

We used data from 7,225 children in a UK-based general population birth cohort. Childhood irritability was measured at 3, 5, and 7 years using 4 items from 2 questionnaires (the Children's Social Behaviour Questionnaire [CSBQ] and the Strengths and Difficulties Questionnaire [SDQ]). Participants reported depressive symptoms via the short Mood and Feelings Questionnaire (sMFQ) and self-harm via a single-item question, at 14 years. We used multilevel models to calculate within-child change in irritability between 3 and 7 years and examined associations between irritability, and depressive symptoms and self-harm at 14 years using linear and logistic regression models, respectively. We adjusted for child and family sociodemographic/economic characteristics, mental health difficulties, and child cognitive development.

RESULTS

Irritability at ages 5 and 7 years was positively associated with depressive symptoms and self-harm at age 14 years. Irritability that remained high between 3 and 7 years was associated with depressive symptoms and self-harm at 14 years in unadjusted (depressive symptoms: β coefficient = 0.22, 95 % CI = 0.08-0.37, p = .003; self-harm: odds ratio = 1.09, 95 % CI = 1.01-1.16, p = .019) and adjusted models (depressive symptoms: β coefficient = 0.31, 95 % CI = 0.17-0.45, p < .001; self-harm: odds ratio = 1.12, 95 % CI = 1.0.4-1.19, p = .004). Results were similar in imputed samples.

CONCLUSION

Children with irritability that remains high between 3 and 7 years are more likely to report higher depressive symptoms and self-harm during adolescence. These findings support early intervention for children with high irritability and universal interventions in managing irritability for parents of preschool-aged children.

Parent-adolescent informant discrepancy on the Strengths and Difficulties Questionnaire in the UK Millennium Cohort Study

BACKGROUND

Developmental researchers often use a multi-informant approach to measure adolescent behaviour and adjustment, but informant discrepancies are common. In general population samples, it is often found that parents report more positive and less negative outcomes than adolescents themselves. This study aimed to investigate factors associated with informant discrepancy, including adolescent sex, and parental level of psychological distress and education.

METHODS

Informant discrepancy on the Strengths and Difficulties Questionnaire was investigated using a Latent Difference Score (LDS) approach, which estimates the true difference between parent and adolescent reports in a structural equation model. The sample were parent-adolescent dyads from the seventh wave of the UK Millennium Cohort Study (N = 6947, 49.3% female, aged 17 years).

RESULTS

Parents reported lower levels of difficulties (emotion symptoms, peer problems, conduct problems), and higher levels of pro-social behaviour than adolescents themselves. Conditional effects were found, as discrepancy was greater amongst parent-daughter dyads for emotion and peer problems, and greater amongst parent-son dyads for conduct problems and pro-social behaviour. Parent-adolescent discrepancy was also greater generally if parents had a lower level of psychological distress or a higher level of education.

CONCLUSIONS

In a large general population sample from the UK, it was found that adolescents tended to report more negative and less positive outcomes than parents reported about them. Conditional effects were found at the parent and adolescent level suggesting that specific informant biases are likely to impact the measurement of adolescent behaviour and adjustment across reporters.

The Different Roles of Structural and Cognitive Social Capital on Oral Health-Related Quality of Life among Adolescents

This study evaluated the relationship of structural and cognitive dimensions of social capital with oral health-related quality of life (OHRQoL) among adolescents. This was a cross-sectional study nested in a cohort of adolescents from southern Brazil. OHRQoL was evaluated using the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). Structural social capital was measured by attendance of religious meetings and social networks from friends and neighbours. Cognitive social capital was evaluated through trust in friends and neighbours, perception of relationships in the neighbourhood, and social support during hard times. Multilevel Poisson regression analysis was performed to estimate the association between social capital dimensions and overall CPQ11-14 scores; higher scores corresponded to worse OHRQoL. The sample comprised 429 adolescents with a mean age of 12 years. Adolescents who attended religious meetings less than once a month or never presented higher overall CPQ11-14 scores. Adolescents who did not trust their friends and neighbours, those who believe that their neighbours did not have good relationships, and those reporting no support during hard times also presented higher overall CPQ11-14 scores. OHRQoL was poorer in individuals who presented lower structural and cognitive social capital, with the greatest impact related to the cognitive dimension.

Inequalities in health complaints: 20-year trends among adolescents in Scotland, 1998-2018

This study examined trends in inequalities in health complaints among early adolescents in Scotland from 1998 to 2018. We analysed data from the Health Behaviour in School-aged Children (HBSC) survey conducted in Scotland in 1998, 2002, 2006, 2010, 2014 and 2018. A self-report questionnaire was administered in schools to a nationally representative sample of 11-, 13-, and 15-year-olds (n = 29,250). Health complaints were measured using a scale comprising four psychological symptoms (feeling low, feeling nervous, irritability and sleep difficulties) and four somatic symptoms (headache, backache, stomachache and dizziness). Socio-economic status was measured using the Family Affluence Scale. Between 1998 and 2018, there were significant increases in the proportion of girls and boys reporting feeling low, feeling nervous, sleep difficulties and backache. Prevalence of the eight individual health complaints was higher among girls and adolescents from lower affluence families. Socio-economic inequalities increased over time, such that declines in mental health were greatest among low affluence adolescents. The data show worsening trends in health complaints among Scottish adolescents between 1998 and 2018, particularly for girls and adolescents from low affluence families. Increasing inequalities in mental health highlight the need to address the underlying social and structural determinants of adolescent mental health.

Psychosocial health and quality of life in ICSI and naturally conceived adolescents: a cross-sectional comparison

PURPOSE

Psychosocial health (PH) and quality of life (QoL) are important health outcomes. We compared PH and QoL of adolescents conceived with intrazytoplasmatic sperm injection (ICSI) and of naturally conceived controls. The impact of disclosure of ICSI-conception on QoL and PH was quantified.

METHODS

The cross-sectional sample consisted of 545 ICSI-conceived adolescents and 427 unmatched singleton controls aged 14-18 years. Adolescents reported PH with the 'Strengths and Difficulties Questionnaire' (low values indicating high PH), and QoL with the KINDL questionnaire (high values indicating high QoL). Because of clustering of multiples within families, adjusted linear regressions with generalized estimating equations were used to compare ICSI- and naturally conceived adolescents. Missing values were treated by multiple imputation. Minimal importance was defined as half a standard deviation.

RESULTS

Both ICSI and control adolescents had high PH (low mean 'total difficulties' score: 9 of 40) and high QoL (mean 'total KINDL' score: 75 of 100). Differences were generally in favour of the ICSI group. Significant differences occurred for 'impact of behavioural problems' (p = 0.033), the 'total KINDL' score (p = 0.021) and the dimensions 'physical wellbeing' (p = 0.031) and 'school' (p = 0.005), but all differences were far below minimal importance. About 80% of ICSI adolescents were informed about their mode of conception. PH and QoL were slightly higher in informed adolescents; behavioural difficulties ('total behavioural problems' and 'conduct problems') were significantly lower (p = 0.013 and p = 0.003), behavioural strengths ('prosocial behaviour') and 'physical QoL' significantly higher (p = 0.004 and p = 0.018), but differences remained clearly below minimal importance.

CONCLUSIONS

Our results are reassuring for parents using ICSI and their children. Speaking openly about an ICSI conception in the family may be beneficial.

Social inequalities in child development: the role of differential exposure and susceptibility to stressful family conditions

BACKGROUND

Stressful family conditions may contribute to inequalities in child development because they are more common among disadvantaged groups (ie, differential exposure) and/or because their negative effects are stronger among disadvantaged groups (ie, differential impact/susceptibility). We used counterfactual mediation analysis to investigate to what extent stressful family conditions contribute to inequalities in child development via differential exposure and susceptibility.

METHODS

We used data from the Generation R Study, a population-based birth cohort in the Netherlands (n=6842). Mother's education was used as the exposure. Developmental outcomes, measured at age 13 years, were emotional and behavioural problems (Youth Self-Report), cognitive development (Wechsler Intelligence Scale for Children) and secondary education entry level. Financial and social stress at age 9 years were the putative mediators.

RESULTS

Differential exposure to financial stress caused a 0.07 (95% CI -0.12 to -0.01) SD worse emotional and behavioural problem -score, a 0.05 (95% CI -0.08 to -0.02) SD lower intelligence score and a 0.05 (95% CI -0.05 to -0.01) SD lower secondary educational level, respectively, among children of less-educated mothers compared with children of more-educated mothers. This corresponds to a relative contribution of 54%, 9% and 6% of the total effect of mother's education on these outcomes, respectively. Estimates for differential exposure to social stress, and differential susceptibility to financial or social stress, were much less pronounced.

CONCLUSION

Among children of less-educated mothers, higher exposure to financial stress in the family substantially contributes to inequalities in socioemotional development, but less so for cognitive development and educational attainment.

Socioeconomic position, bronchiolitis and asthma in children: counterfactual disparity measures from a national birth cohort study

BACKGROUND

The debated link between severe respiratory syncytial virus (RSV) infection in early life and asthma has yet to be investigated within a social inequity lens. We estimated the magnitude of socioeconomic disparity in childhood asthma which would remain if no child were admitted to hospital for bronchiolitis, commonly due to RSV, during infancy.

METHODS

The cohort, constructed from national administrative health datasets, comprised 83853 children born in Scotland between 1 January 2007 and 31 June 2008. Scottish Index for Multiple Deprivation (SIMD) was used to capture socioeconomic position. Emergency admissions for bronchiolitis before age 1 year were identified from hospital records. Yearly indicators of asthma/wheeze from ages 2 to 9 years were created using dispensing data and hospital admission records.

RESULTS

Using latent class growth analysis, we identified four trajectories of asthma/wheeze: early-transient (2.2% of the cohort), early-persistent (2.0%), intermediate-onset (1.8%) and no asthma/wheeze (94.0%). The estimated marginal risks of chronic asthma (combining early-persistent and intermediate-onset groups) varied by SIMD, with risk differences for the medium and high deprivation groups, relative to the low deprivation group, of 7.0% (95% confidence interval: 3.7-10.3) and 13.0% (9.6-16.4), respectively. Using counterfactual disparity measures, we estimated that the elimination of bronchiolitis requiring hospital admission could reduce these risk differences by 21.2% (4.9-37.5) and 17.9% (10.4-25.4), respectively.

CONCLUSIONS

The majority of disparity in chronic asthma prevalence by deprivation level remains unexplained. Our paper offers a guide to using causal inference methods to study other plausible pathways to inequities in asthma using complex, linked administrative data.

Influence of science education on mental health of adolescents based on virtual reality

This work is developed to explore the form of mental health education, strengthen scientific educational ideas, and improve the effect of psychological therapy. Virtual reality (VR) technology is innovatively applied in adolescent mental health treatment and education. Based on this, the mental health treatment and system design based on virtual reality technology are discussed, and the feasibility of applying VR technology to adolescent mental health education is explored. Second, the research concept of adolescent mental health is discussed. Based on the VR platform setup, questionnaire survey is implemented to analyze the factors influencing the mental health of primary and secondary school students in Xi’an, Shaanxi Province (the permission of the adolescent guardian is obtained during the interview), and five factors are obtained. Based on this, the adolescent mental health treatment system based on VR is designed, and the effectiveness of the system is tested and evaluated. The results show that the integrated delay of the VR equipment used is 29 ms, which can effectively provide service. There are significant differences in mental health status among adolescents of different genders, different ages, only children and non-only children, parents’ accompaniment during growing up, and urban and rural adolescents. Finally, after 3 months of psychological treatment, the mental health score of the experimental group of teenagers is 50–55 points. However, the mental health scores of the control group remain at 56–65 points, indicating that the mental health treatment system designed in this work can effectively help the adolescents to improve their mental health, thus proving the effectiveness of the system. To sum up, this work provides scientific reference for adolescent mental health education in schools. Psychological treatment system can help teenagers improve their psychological problems and promote the development of mental health education.

Disadvantage in early-life and persistent asthma in adolescents: a UK cohort study

OBJECTIVE

To determine how early-life risk factors explain socioeconomic inequalities in persistent asthma in adolescence.

METHODS

We did a causal mediation analysis using data from 7487 children and young people in the UK Millennium Cohort Study. Persistent asthma was defined as having a diagnosis reported at any two or more time points at 7, 11 or 14 years. The main exposure was maternal education, a measure of early-life socioeconomic circumstances (SECs), used to calculate the relative index of inequality. We assessed how blocks of perinatal (maternal health behaviours, infant characteristics and duration of breastfeeding, measured at 9 months) and environmental risk factors (family housing conditions; potential exposure to infections through childcare type and sibling number, and neighbourhood characteristics, measured at 3 years) mediated the total effect of childhood SECs on persistent asthma risk, calculating the proportion mediated and natural indirect effect (NIE) via blocks of mediators.

RESULTS

At age 14 the overall prevalence of persistent asthma was 15%. Children of mothers with lower educational qualifications were more likely to have persistent asthma, with a clear social gradient (degree plus: 12.8% vs no qualifications: 20.3%). The NIE gives the effect of SECs acting only via the mediators and shows a 31% increased odds of persistent asthma when SECs are fixed at the highest level, and mediators at the level which would naturally occur at the lowest SECs versus highest SECs (NIE OR 1.31, 95% CI 1.04 to 1.65). Overall, 58.9% (95% CI 52.9 to 63.7) of the total effect (OR 1.70, 95% CI 1.20 to 2.40) of SECs on risk of persistent asthma in adolescence was mediated by perinatal and environmental characteristics.

CONCLUSIONS

Perinatal characteristics and the home environment in early life are more important in explaining socioeconomic inequalities in persistent asthma in British adolescents than more distal environmental exposures outside the home.

Mediators of socioeconomic inequalities in preterm birth: a systematic review

BACKGROUND

Rates of preterm birth are substantial with significant inequalities. Understanding the role of risk factors on the pathway from maternal socioeconomic status (SES) to preterm birth can help inform interventions and policy. This study therefore aimed to identify mediators of the relationship between maternal SES and preterm birth, assess the strength of evidence, and evaluate the quality of methods used to assess mediation.

METHODS

Using Scopus, Medline OVID, "Medline In Process & Other Non-Indexed Citation", PsycINFO, and Social Science Citation Index (via Web of Science), search terms combined variations on mediation, socioeconomic status, and preterm birth. Citation and advanced Google searches supplemented this. Inclusion criteria guided screening and selection of observational studies Jan-2000 to July-2020. The metric extracted was the proportion of socioeconomic inequality in preterm birth explained by each mediator (e.g. 'proportion eliminated'). Included studies were narratively synthesised.

RESULTS

Of 22 studies included, over one-half used cohort design. Most studies had potential measurement bias for mediators, and only two studies fully adjusted for key confounders. Eighteen studies found significant socioeconomic inequalities in preterm birth. Studies assessed six groups of potential mediators: maternal smoking; maternal mental health; maternal physical health (including body mass index (BMI)); maternal lifestyle (including alcohol consumption); healthcare; and working and environmental conditions. There was high confidence of smoking during pregnancy (most frequently examined mediator) and maternal physical health mediating inequalities in preterm birth. Significant residual inequalities frequently remained. Difference-of-coefficients between models was the most common mediation analysis approach, only six studies assessed exposure-mediator interaction, and only two considered causal assumptions.

CONCLUSIONS

The substantial socioeconomic inequalities in preterm birth are only partly explained by six groups of mediators that have been studied, particularly maternal smoking in pregnancy. There is, however, a large residual direct effect of SES evident in most studies. Despite the mediation analysis approaches used limiting our ability to make causal inference, these findings highlight potential ways of intervening to reduce such inequalities. A focus on modifiable socioeconomic determinants, such as reducing poverty and educational inequality, is probably necessary to address inequalities in preterm birth, alongside action on mediating pathways.

Sense of coherence moderates the relationship between social capital and oral health‑related quality of life in schoolchildren: a 10-year cohort study

Background

This study aimed to evaluate the moderating effect of sense of coherence (SOC) on the relationship between social capital and oral health-related quality of life (OHRQoL) among schoolchildren.

Methods

A cohort study was conducted in the city of Santa Maria, Brazil, involving children aged 1–5 years at baseline who were reassessed after 10 years in adolescence (11–15 years-old). Social capital was assessed at baseline and follow-up through social networks and social trust. Sense of coherence scale (SOC-13) and the short form of the Child Perceptions Questionnaire 11–14 (CPQ11–14) were measured at 10-years follow-up. Demographic and socioeconomic characteristics, and dental caries were also evaluated. Moderating effect of SOC on the relationship between social capital and OHRQoL was tested using multilevel adjusted Poisson regression analysis and simple slope test.

Results

From the 639 subjects assessed at baseline, 429 were reassessed at follow-up (cohort retention rate 67.1%). Moderate and high levels of SOC demonstrated a moderating effect on the relationship between social capital and OHRQoL. Among individuals who presented low social capital at baseline and follow-up, those who had high SOC reported, respectively, an impact 63% and 70% lower on OHRQoL when compared to those with low SOC. The greatest margin effect was observed in individuals with low social capital and low SOC at follow-up (24.25; p < 0.05).

Conclusion

Our findings suggest that SOC moderates the negative impact of low social capital on poor OHRQoL in schoolchildren.

Poverty in adolescence and later drug use disorders: understanding the mediation and interaction effects of other psychiatric disorders

BACKGROUND

Poverty in adolescence is associated with later drug use. Few studies have evaluated the role of adolescent psychiatric disorders in this association.

AIMS

This study aimed to investigate mediation and interaction simultaneously, enabling the disentanglement of the role of adolescent psychiatric disorders in the association between poverty in adolescent and later drug use disorders.

METHOD

A national cohort study of 634 223 individuals born in 1985-1990, residing in Sweden between the ages of 13 and 18 years, was followed from age 19 years until the first in-patient or out-patient care visit with a diagnosis of drug use disorder. A four-way decomposition method was used to determine the total effect of the association with poverty and possible mediation by and/or interaction with diagnosis of adolescent psychiatric disorders.

RESULTS

The hazard ratios for drug use disorders among those experiencing poverty compared with those 'never in poverty' were 1.40 (95% CI, 1.32-1.63) in females and 1.43 (95% CI, 1.37-1.49) in males, after adjusting for domicile, origin and parental psychiatric disorders. Twenty-four per cent of this association in females, and 13% in males, was explained by interaction with and/or mediation by adolescent psychiatric disorders.

CONCLUSIONS

Part of the association between poverty in adolescence and later drug use disorders was due to mediation by and/or interaction with psychiatric disorders. Narrowing socioeconomic inequalities in adolescence might help to reduce the risks of later drug use disorders. Interventions aimed at adolescents with psychiatric disorders might be especially important.

Mediating effects of early health on the relationship between early poverty and long-term health outcomes of children: a birth cohort study

OBJECTIVE

This study analyses the mediating effects of early health prior to age 3 on the association between early poverty and the health outcomes of children at age 12.

DESIGN

Population-based longitudinal birth cohort study.

SETTING

Taiwan Birth Cohort Study (TBCS), 2005-2017.

PARTICIPANTS

16 847 TBCS children born in 2005 and followed up at 18 months, 3, 5, 8 and 12 years with available data on poverty and health status.

MAIN OUTCOME MEASURES

Child's general health, measured by the mothers' ratings of their child's health, and hospitalisation experience at 12 years of age.

RESULTS

Among the TBCS children, the prevalence of fair/poor health and hospitalisation was 20.8% and 2.5% at age 12. The ORs of experiencing fair/poor health and hospitalisation at age 12 were 1.33 (95% CI 1.21 to 1.45) and 1.35 (1.07 to 1.69) for early poverty, respectively. When early poor health was added in the multiple logistic regression models, the effects of early poverty were attenuated on poor general health and no longer significant on hospitalisation for children aged 12 years. Mediation analysis showed that 50%-87% of the total effect of early poverty on health at age 12 was mediated by early health status before age 3.

CONCLUSIONS

Our findings suggest that poor health in early life plays as a significant mediator in the relationship between early poverty and the long-term health outcomes of children. Universal health coverage thus should be achieved to prevent the adverse health effects of poverty throughout the life course, as one of the most important strategies for children growing up in poverty.

Early-life maternal attachment and risky health behaviours in adolescence: findings from the United Kingdom Millennium Cohort Study

Background

Early uptake of multiple risky behaviours during adolescence, such as substance use, antisocial and sexual behaviours, can lead to poor health outcomes without timely interventions. This study investigated how early-life maternal attachment, or emotional bonds between mothers and infants, influenced later risky behaviours in adolescence alongside other potential explanatory pathways using the United Kingdom Millennium Cohort Study.

Methods

Total maternal attachment scores measured at 9 months using the Condon (1998) Maternal Postnatal Attachment Scale compared higher and lower attachment, where mothers in the lowest 10th percentile represented lower attachment. Multiple risky behaviours, defined as two or more risky behaviours (including smoking cigarettes, vaping, alcohol consumption, illegal drug use, antisocial behaviour, criminal engagement, unsafe sex, and gambling), were scored from 0 to 8 at age 17. Five multivariate logistic regression models examined associations between maternal attachment and multiple risky behaviours among Millennium Cohort Study members (n = 7796). Mediation analysis sequentially adjusted for blocks of explanatory mechanisms, including low attachment mechanisms (multiple births, infant prematurity, sex, breastfeeding, unplanned pregnancy and maternal age at birth), maternal depression, and social inequalities (single-parent status, socioeconomic circumstance by maternal education and household income) at 9 months and poor adolescent mental health at 14 years.

Results

Children of mothers with lower maternal attachment at 9 months had 23% increased odds of multiple risky behaviours at 17 years (OR: 1.23, 95% CI: 1.00–1.50) in the unadjusted baseline model. All five explanatory blocks attenuated baseline odds. Low attachment mechanisms attenuated 13%, social inequalities 17%, and poor mental health 17%. Maternal depression attenuated the highest proportion (26%) after fully adjusting for all factors (30%).

Conclusions

Lower maternal attachment in early life predicted increased adolescent multiple risky behaviours. Almost a third of the excess risk was attributable to child, maternal and socioeconomic factors, with over a quarter explained by maternal depression. Recognising the influence of early-life risk factors on adolescent health could innovate current policies and interventions addressing multiple risky behaviour uptake affecting health inequalities across the life course.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12141-5.

Psychological distress in late adolescence: The role of inequalities in family affluence and municipal socioeconomic characteristics in Norway

The present study aims to explore, in the national context of Norway, how municipal socioeconomic indicators affect anxiety and depressive symptom scores among senior high school students and whether this potential municipal effect is dependent on the adolescents' family affluence levels. This cross-sectional study is based on questionnaire data collected in five waves (2014-2018) of the Ungdata survey. The study sample consisted of 97,460 adolescents aged 16-18 years attending high school in 156 municipalities in Norway. Measures of psychological distress, depression, and anxiety symptoms were based on the screening instrument, Hopkins Symptom Checklist-10. Two-level random intercept models were fitted to distinguish the individual and municipality sources of variation in adolescents' mental health. In general, the results indicate substantial psychological symptom load among the study sample. Inequalities in adolescents' psychological distress between family affluence groups were evident, with the lowest symptom loads in the most affluent families. The predicted depressive and anxiety symptoms among the students increased slightly along with the percentage of municipal residents with tertiary educations and with increasing income inequalities in their residential municipality. However, the interaction models suggest that the adverse effects of higher municipal education level and greater income inequality are, to a certain extent, steepest for adolescents with medium family affluence. This study highlights two key findings. Both municipality effects and family affluence account for a relatively small proportion of the total variance in the students' psychological symptoms loads; however, the mental health inequalities we explored between socioeconomic strata on both the individual and municipal levels are not insignificant in a public health perspective. Results are discussed in the context of psychosocial mechanisms related to social comparison and perceptions of social status that may be applicable in egalitarian welfare states such as Norway.

Pre-school childcare and inequalities in child development

Centre-based childcare may benefit pre-school children and alleviate inequalities in early childhood development, but evidence on socio-emotional and physical health outcomes is limited. Data were from the UK Millennium Cohort Study (n = 14,376). Inverse-probability weighting was used to estimate confounder-adjusted population-average effects of centre and non-centre-based childcare (compared to parental care only) between ages 26-31 months on (age 3): internalising and externalising symptoms, pro-social behaviour, independence, emotional dysregulation, vocabulary, school readiness, and body mass index. To assess impacts on inequalities, controlled direct effects of low parental education and lone parenthood on all outcomes were estimated under two hypothetical scenarios: 1) universal take-up of centre-based childcare; and 2) parental care only. On average, non-centre based childcare improved vocabulary and centre-based care improved school readiness, with little evidence of other benefits. However, socio-economic inequalities were observed for all outcomes and were attenuated in scenario 1 (universal take-up). For example, inequalities in externalising symptoms (according to low parental education) were reduced from a confounder-adjusted standard deviation difference of 7.8 (95% confidence intervals: 6.7-8.8), to 1.7 (0.6-2.7). Inequalities by parental education in scenario 2 (parental care only) were wider than in scenario 1 for externalising symptoms (at 3.4; 2.4-4.4), and for emotional dysregulation and school readiness. Inequalities by lone parenthood, which were smaller, fell in scenario 1, and fell further in scenario 2. Universal access to centre-based pre-school care may alleviate inequalities, while restricted access (e.g. during lockdown for a pandemic such as Covid-19) may widen some inequalities in socioemotional and cognitive development.

Modelling the potential for parenting skills interventions to reduce inequalities and population prevalence of children's mental health problems: Evidence from the Millennium Cohort Study

Parenting programmes can improve parenting quality and, in turn, children's mental health. If scaled-up, they have the potential to reduce population inequalities and prevalence in child mental health problems (MHP). However, this cannot be investigated with trials. Using data from the UK Millennium Cohort Study (18,000 children born 2000-2002), we simulated population impact of scale-up of seven parenting programmes. Predicted probabilities of child MHP (Strengths and Difficulties Questionnaire) by household income quintile (Risk ratios [RRs] and differences [RDs], 95% confidence intervals [CI]) were estimated from logistic marginal structural models, adjusting for parenting quality scores (Child-Parent Relationship Scale at 3 years) and confounders. The impact of scaling-up parenting programmes was simulated by re-estimating predicted probabilities of child MHP after increasing parenting scores according to intervention intensity, targeting mechanisms and programme uptake levels. Analyses included data from 14,399 children, with survey weights and multiple imputation addressing sampling design, attrition and item missingness. Prevalence of child MHP at 5 years was 11.3% (11.4% unadjusted), with relative and absolute income inequalities (RR = 4.8[95%CI:3.6-5.9]; RD = 15.8%[13.4-18.2]). In simulations, universal, non-intensive parenting programmes reduced prevalence (9.4%) and absolute inequalities (RR = 5.0[95%CI:3.8-6.2]; RD = 13.6%[11.5-15.7]). Intensive programmes, targeting a range of potential risk criteria (e.g. receipt of means-tested benefits), reduced inequalities (RR = 4.0[95%CI:3.0-4.9]; RD = 12.4%[10.3-14.6] and, to a lesser extent, prevalence (10.3%). By simulating implementation of parenting programmes, we show that universal non-intensive and targeted intensive approaches have the potential to reduce child MHP at population level, and to reduce but not eliminate inequalities, with important implications for future policy and practice.

Phenotypically independent profiles relevant to mental health are genetically correlated

Genome-wide association studies (GWAS) and family-based studies have revealed partly overlapping genetic architectures between various psychiatric disorders. Given clinical overlap between disorders, our knowledge of the genetic architectures underlying specific symptom profiles and risk factors is limited. Here, we aimed to derive distinct profiles relevant to mental health in healthy individuals and to study how these genetically relate to each other and to common psychiatric disorders. Using independent component analysis, we decomposed self-report mental health questionnaires from 136,678 healthy individuals of the UK Biobank, excluding data from individuals with a diagnosed neurological or psychiatric disorder, into 13 distinct profiles relevant to mental health, capturing different symptoms as well as social and risk factors underlying reduced mental health. Utilizing genotypes from 117,611 of those individuals with White British ancestry, we performed GWAS for each mental health profile and assessed genetic correlations between these profiles, and between the profiles and common psychiatric disorders and cognitive traits. We found that mental health profiles were genetically correlated with a wide range of psychiatric disorders and cognitive traits, with strongest effects typically observed between a given mental health profile and a disorder for which the profile is common (e.g. depression symptoms and major depressive disorder, or psychosis and schizophrenia). Strikingly, although the profiles were phenotypically uncorrelated, many of them were genetically correlated with each other. This study provides evidence that statistically independent mental health profiles partly share genetic underpinnings and show genetic overlap with psychiatric disorders, suggesting that shared genetics across psychiatric disorders cannot be exclusively attributed to the known overlapping symptomatology between the disorders.

COVID-19 pandemic reduces the negative perception of oral health-related quality of life in adolescents

Purpose

As people around the world are facing the Covid-19 outbreak, their perception of oral health problems could be changed. This study aimed to evaluate the immediate effects of the Covid-19 pandemic on oral health-related quality of life (OHRQoL) of adolescents.

Methods

A cohort study with schoolchildren from southern Brazil was conducted. Data on adolescents’ OHRQoL were collected from December 2019 to February 2020 (T1), before the Brazilian Covid-19 outbreak. Posteriorly, the data were collected again in June and July of 2020 (T2), under the Brazilian Covid-19 outbreak. The OHRQoL was assessed using the Brazilian short version of the CPQ11-14. Demographic and socioeconomic characteristics and the degree of social distancing were also assessed. Changes in OHRQoL between T1 and T2 were evaluated by adjusted Multilevel Poisson regression models for repeated measures.

Results

From 290 individuals evaluated at T1, 207 were reevaluated at T2 (response rate of 71.3%). The overall CPQ11-14 mean score was significantly lower during the pandemic, reducing from 10.8 at T1 to 7.7 at T2. This significant reduction was also observed for all CPQ domains, indicating a lower negative impact of oral conditions on adolescents' quality of life during the pandemic. Adolescents from families that had a middle or low degree of social distancing during the pandemic and whose parents were harmed in employment had higher CPQ11-14 scores.

Conclusion

Overall and specific-domains CPQ-14 scores were significantly lower during the Brazilian Covid-19 outbreak, indicating a decrease in the perception of oral health problems by adolescents over that period.

Socioeconomic Status, Health and Lifestyle Settings as Psychosocial Risk Factors for Road Crashes in Young People: Assessing the Colombian Case

The social determinants of health influence both psychosocial risks and protective factors, especially in high-demanding contexts, such as the mobility of drivers and non-drivers. Recent evidence suggests that exploring socioeconomic status (SES), health and lifestyle-related factors might contribute to a better understanding of road traffic crashes (RTCs). Thus, the aim of this study was to construct indices for the assessment of crash rates and mobility patterns among young Colombians who live in the central region of the country. The specific objectives were developing SES, health and lifestyle indices, and assessing the self-reported RTCs and mobility features depending on these indices. A sample of 561 subjects participated in this cross-sectional study. Through a reduction approach of Principal Component Analysis (PCA), three indices were constructed. Mean and frequency differences were contrasted for the self-reported mobility, crash rates, age, and gender. As a result, SES, health and lifestyle indices explained between 56.3–67.9% of the total variance. Drivers and pedestrians who suffered crashes had higher SES. A healthier lifestyle is associated with cycling, but also with suffering more bike crashes; drivers and those reporting traffic crashes have shown greater psychosocial and lifestyle-related risk factors. Regarding gender differences, men are more likely to engage in road activities, as well as to suffer more RTCs. On the other hand, women present lower healthy lifestyle-related indices and a less active implication in mobility. Protective factors such as a high SES and a healthier lifestyle are associated with RTCs suffered by young Colombian road users. Given the differences found in this regard, a gender perspective for understanding RTCs and mobility is highly suggestible, considering that socio-economic gaps seem to differentially affect mobility and crash-related patterns.

Socioeconomic disparities in suicide: Causation or confounding?

BACKGROUND

Despite an overall reduction in suicide, educational disparities in suicide have not decreased over the last decade. The mechanisms behind educational disparities in suicide, however, remain unclear: low educational status may increase the risk of suicide ("causation") or low educational status and suicide may share confounders. This paper assesses whether educational disparities in suicide (EDS) are more likely to be due to causation.

METHOD

The DEMETRIQ study collected and harmonized register-based data on mortality follow-up from forty population censuses from twelve European populations. More than 102,000 suicides were registered over 392 million person-years. Three analyses were carried out. First, we applied an instrumental variable approach that exploits changes in the legislation on compulsory educational age to instrument educational status. Second, we analyzed EDS by age under the hypothesis that increasing EDS over the life cycle supports causation. Finally, we compared EDS in men and women under the assumption that greater EDS in women would support causation.

FINDINGS

The instrumental variable analysis showed no evidence for causation between higher education and suicide, for men or women. The life-cycle analysis showed that the decrease of educational inequalities in suicide between the baseline 1991 period and the 2001 follow-up period was more pronounced and statistically significant in the first three younger age groups. The gender analysis indicated that EDS were systematic and greater in men than in women: the rate ratio of suicide for men with low level of education (RR = 2.51; 95%CI:2.44-2.58) was higher than the rate ratio in women (RR = 1.32; 95CI%:1.26-1.38).

INTERPRETATION

Overall, there was little support for the causation hypothesis, suggesting that the association between education and suicide is confounded. Educational inequalities in suicide should be addressed in early life by early targeting of groups who struggle to complete their education and display higher risk of mental disorder or of mental health vulnerabilities.

Effect of individual and neighborhood social capital on gingival bleeding in children: A 7-year cohort study

BACKGROUND

Social capital incorporates contextual and individual levels of interactions, which influence human health. The aim of this study was to evaluate the influence of individual and contextual social capital in early childhood on gingival bleeding in children after 7 years.

METHODS

This 7-year cohort study was conducted with a randomized sample of 639 children (1 to 5 years old) evaluated in 2010 (T1) in Santa Maria, southern Brazil. Gingival bleeding was recorded during follow-up (T2). Contextual (social class association and number of churches) and individual (religious practice, volunteer networks, and school involvement) social capital variables were collected at baseline, along with demographic, socioeconomic, and oral health variables. A multilevel Poisson regression model was used to investigate the influence of individual and contextual variables on mean gingival bleeding. The incidence rate ratio (IRR) and 95% confidence interval (95% CI) were calculated.

RESULTS

A total of 449 children were reassessed after 7 years (70.3% cohort retention rate). Children living in areas with a larger number of churches at baseline had lower mean gingival bleeding at follow-up. Regarding individual social capital, children whose parents did not attend school activities were more likely to have gingival bleeding. Additionally, low maternal education, poor parents' perception of oral health, non-use of dental services, and low frequency of tooth brushing were related to higher mean gingival bleeding at follow-up.

CONCLUSION

The presence of more churches in neighborhoods and parents' involvement in a child's school activities positively influenced children's oral health, and these individuals had lower mean gingival bleeding.

Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People

The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.

Trends in inequalities in Children Looked After in England between 2004 and 2019: a local area ecological analysis

OBJECTIVE

To assess trends in inequalities in Children Looked After (CLA) in England between 2004 and 2019, after controlling for unemployment, a marker of recession and risk factor for child maltreatment.

DESIGN

Longitudinal local area ecological analysis.

SETTING

150 English upper-tier local authorities.

PARTICIPANTS

Children under the age of 18 years.

PRIMARY OUTCOME MEASURE

The annual age-standardised rate of children starting to be looked after (CLA rate) across English local authorities, grouped into quintiles based on their level of income deprivation. Slope indices of inequality were estimated using longitudinal segmented mixed-effects models, controlling for unemployment.

RESULTS

Since 2008, there has been a precipitous rise in CLA rates and a marked widening of inequalities. Unemployment was associated with rising CLA rates: for each percentage point increase in unemployment rate, an estimated additional 9 children per 100 000 per year (95% CI 6 to 11) became looked after the following year. However, inequalities increased independently of the effect of unemployment. Between 2007 and 2019, after controlling for unemployment, the gap between the most and least deprived areas increased by 15 children per 100 000 per year (95% CI 4 to 26) relative to the 2004-2006 trend.

CONCLUSIONS

The dramatic increase in the rate of children starting to be looked after has been greater in poorer areas and in areas more deeply affected by recession. But trends in unemployment do not explain the decade-long rise in inequalities, suggesting that other socioeconomic factors, including rising child poverty and reduced spending on children's services, may be fuelling inequalities. Policies to safely reduce the CLA rate should urgently address the social determinants of child health and well-being.

Understanding pathways to inequalities in child mental health: a counterfactual mediation analysis in two national birth cohorts in the UK and Denmark

OBJECTIVES

We assessed social inequalities in child mental health problems (MHPs) and how they are mediated by perinatal factors, childhood illness and maternal mental health in two national birth cohorts.

DESIGN

Longitudinal cohort study SETTING: We used data from the UK Millennium Cohort Study and the Danish National Birth Cohort.

PRIMARY AND SECONDARY OUTCOME MEASURES

We applied causal mediation analysis to longitudinal cohort data. Socioeconomic conditions (SECs) at birth were measured by maternal education. Our outcome was child MHPs measured by the Strength and Difficulty Questionnaire at age 11. We estimated natural direct, indirect and total effects (TEs) of SECs on MHPs. We calculated the proportion mediated (PM) via three blocks of mediators-perinatal factors (smoking/alcohol use during pregnancy, birth weight and gestational age), childhood illness and maternal mental health.

RESULTS

At age 11 years, 9% of children in the UK and 3.8% in Denmark had MHPs. Compared with high SECs, children in low SECs had a higher risk of MHPs (relative risk (RR)=4.3, 95% CI 3.3 to 5.5 in the UK, n=13 112; and RR=6.2, 95% CI 4.9 to 7.8 in Denmark, n=35 764). In the UK, perinatal factors mediated 10.2% (95% CI 4.5 to 15.9) of the TE, and adding maternal mental health tripled the PM to 32.2% (95% CI 25.4 to 39.1). In Denmark, perinatal factors mediated 16.5% (95% CI 11.9 to 21.1) of the TE, and including maternal mental health increased the PM to 16.9% (95% CI 11.2 to 22.6). Adding childhood illness made little difference in either country.

CONCLUSION

Social inequalities in child mental health are partially explained by perinatal factors in the UK and Denmark. Maternal mental health partially explained inequalities in the UK but not in Denmark.

How do early-life adverse childhood experiences mediate the relationship between childhood socioeconomic conditions and adolescent health outcomes in the UK?

Background

Both adverse childhood experiences (ACEs) and adverse childhood socioeconomic conditions (SECs) in early life are associated with poor outcomes across the life course. However, the complex interrelationships between childhood SECs and ACEs are unclear, as are the consequences for health outcomes beyond childhood. We therefore assessed the extent to which early-life ACEs mediate the relationship between SECs and socioemotional behavioural problems, cognitive disability and overweight/obesity in adolescence.

Methods

We used longitudinal data from the UK Millennium Cohort Study (MSC). Outcomes assessed at age 14 were socioemotional behavioural problems, cognitive disability and overweight/obesity. SECs at birth were measured by maternal education. Potentially mediating ACEs measured up to 5 years were verbal and physical maltreatment, parental drug use, domestic violence, parental divorce, maternal mental illness and high frequency of parental alcohol use. We used counterfactual mediation analysis to assess the extent to which ACEs mediate the association between SECs at birth and behavioural, cognitive and physical outcomes at age 14, estimating total (TE), natural direct and indirect effects, and mediated proportions.

Results

Children with disadvantaged SECs were more likely to have socioemotional behavioural problems (relative risk (RR) 3.85, 95% CI 2.48 to 5.97), cognitive disability (RR 3.87, 95% CI 2.33 to 6.43) and overweight/obesity (RR 1.61, 95% CI 1.32 to 1.95), compared to those with more advantaged SECs. Overall, 18% of the TE of SECs on socioemotional behavioural problems was mediated through all ACEs investigated. For cognitive disability and overweight/obese, the proportions mediated were 13% and 19%, respectively.

Conclusion

ACEs measured up to age 5 years in the MCS explained about one-sixth of inequalities in adolescents behavioural, cognitive and physical outcomes.

Relationship between gingival bleeding and associated factors with reports of verbal bullying in adolescents

BACKGROUND

Dentofacial features are related to increased bullying episodes in young people. The aim of this study was to assess the association between gingival bleeding and reports of verbal bullying among adolescents.

METHODS

This is a cross-sectional study conducted with a representative sample of 608 12-year-old adolescents from southern Brazil. The occurrence of verbal bullying was verified through adolescents' self-report. Oral health measurements included the presence of gingival bleeding, dental fracture, dental fluorosis, and dental caries experience. Gingival bleeding was assessed through adolescent self-perception by the following question: "Did you notice any bleeding in your gums?" Demographic, socioeconomic, and psychosocial variables were also evaluated. Poisson regression models with robust variance were used to evaluate the influence of gingival bleeding on the occurrence of verbal bullying. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI).

RESULTS

Out of 608 adolescents evaluated, 577 answered bullying questions. The prevalence of self-reported verbal bullying was 12.8%. Adolescents who presented gingival bleeding had an 80% higher prevalence of verbal bullying than their counterparts (PR 1.80; 95% CI 1.01 -3.19). Dental shame, speech difficulties and influence of dental condition on studies also impacted the higher prevalence of bullying.

CONCLUSION

Our results suggest that the presence of gingival bleeding negatively impacts the social life of adolescents, causing more episodes of verbal bullying. These findings encourage public health policies aimed at reducing oral health inequities, thus reflecting on the well-being and quality of life of this target population.