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Review
. 2019 Nov;73(11):1049-1060.
doi: 10.1136/jech-2019-212367. Epub 2019 Sep 6.

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

Viviane S Straatmann  1 , Eric Lai  2 , Theis Lange  3   4 , Melisa Claire Campbell  2 , Sophie Wickham  2 , Anne-Marie Nybo Andersen  5 , Katrine Strandberg-Larsen  5 , David Taylor-Robinson  2
Affiliations
Review

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

Viviane S Straatmann et al. J Epidemiol Community Health. 2019 Nov.

Abstract

Background: Reducing inequalities in adolescent mental health is a public health priority, yet the pathways that link social conditions to mental health outcomes in the early years are unclear. We aimed to evaluate the extent to which early years risk factors explain social inequalities in adolescent mental health in the UK.

Methods: We analysed data from 6509 children captured in the UK Millennium Cohort Study. Mental health was assessed through the socioemotional behavioural problems at age 14 (Strengths and Difficulties Questionnaire). The main exposure was maternal education at birth, used as a measure of childhood socioeconomic conditions (SECs), and used to calculate the relative index of inequality. Using causal mediation analysis, we assessed how perinatal, individual child, family, peer relation and neighbourhood-level factors measured up to age 3-mediated the total effect (TE) of SECs on adolescent socioemotional behavioural problems, estimating the proportion mediated and natural indirect effect (NIE) via each block of mediators, and all mediators together.

Results: Children of mothers with no qualification were almost four times as likely to have socioemotional behavioural problems compared with degree plus level (relative risk (RR) 3.82, 95% CI 2.48 to 5.88). Overall, 63.9% (95% CI 50.2% to 77.6%) (NIE RR 1.97, 95% CI 1.63 to 2.37) of the TE (RR 4.40, 95% CI 3.18 to 6.07) of social inequalities on risk of adolescent socioemotional behavioural problems was mediated by early-life factors.

Conclusions: About two-thirds of the social inequality in adolescent mental health was explained by early risk factors measured by age 3, highlighting the importance of public health interventions in this period.

Keywords: EPIDEMIOLOGY; Lifecourse / Childhood Circumstances; MENTAL HEALTH; SOCIAL INEQUALITIES.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Logical model of block of perinatal and early-life (age 3 years) mediators of SECs and maternal report of mental health problems at age 14 years. SEC, socioeconomic condition.
Figure 2
Figure 2
Prevalence (%) and CIs (95% CI) of adolescents’ mental health problems in the UK at age 14 by maternal education at birth (N=6509). GCSE, General Certificate of Secondary Education.
Figure 3
Figure 3
Mediation analysis with a conterfactual approach by block of risk factors (perinatal, child individual, family, peer relations and neighbourhood) in the association between socioeconomic condition and adolescents’ mental health at age 14 (relative risk and CIs (95% CI)) (N=6509).
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