No causal associations between childhood family income and subsequent psychiatric disorders, substance misuse and violent crime arrests: a nationwide Finnish study of >650 000 individuals and their siblings

Abstract

Background: Childhood family income has been shown to be associated with later psychiatric disorders, substance misuse and violent crime, but the consistency, strength and causal nature of these associations remain unclear.

Methods: We conducted a nationwide cohort and co-sibling study of 650 680 individuals (426 886 siblings) born in Finland between 1986 and 1996 to re-examine these associations by accounting for unmeasured confounders shared between siblings. The participants were followed up from their 15th birthday until they either migrated, died, met criteria for the outcome of interest or reached the end of the study period (31 December 2017 or 31 December 2018 for substance misuse). The associations were adjusted for sex, birth year and birth order, and expressed as adjusted hazard ratios (aHRs). The outcomes included a diagnosis of a severe mental illness (schizophrenia-spectrum disorders or bipolar disorder), depression and anxiety. Substance misuse (e.g. medication prescription, hospitalization or death due to a substance use disorder or arrest for drug-related crime) and violent crime arrests were also examined. Stratified Cox regression models accounted for unmeasured confounders shared between differentially exposed siblings.

Results: For each $15 000 increase in family income at age 15 years, the risks of the outcomes were reduced by between 9% in severe mental illness (aHR = 0.91; 95% confidence interval: 0.90-0.92) and 23% in violent crime arrests (aHR = 0.77; 0.76-0.78). These associations were fully attenuated in the sibling-comparison models (aHR range: 0.99-1.00). Sensitivity analyses confirmed the latter findings.

Conclusions: Associations between childhood family income and subsequent risks for psychiatric disorders, substance misuse and violent crime arrest were not consistent with a causal interpretation.

Keywords: Socio-economic status; anxiety; bipolar disorder; depression; family income; public health; quasi-experimental research designs; schizophrenia; substance-use disorders; violence.

Figure 1.

Associations between family income at age 15 years (in units of $15 000) and subsequent psychiatric disorders, substance misuse and violent-crime arrest among individuals born in Finland in 1986–1996 and followed up until 31 December 2017 (31 December 2018 for substance misuse). All models were adjusted for sex, birth year and birth order. The adjusted-for-measured-confounders models were adjusted for immigrant background, urbanicity, single-parent household, parental educational attainment, psychiatric disorders, substance misuse and violent-crime arrest.

Figure 2.

Associations between family income measured across ages 1–15 years (in units of $15 000) and subsequent psychiatric disorders, substance misuse and violent-crime arrest among individuals born in Finland in 1986–1996 and followed up until 31 December 2017 (31 December 2018 for substance misuse). All models were adjusted for sex, birth year and birth order. The average family-income measure was calculated using four measurement points (e.g. ages 1, 5, 10 and 15 years).