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

Abstract

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.

Keywords: child health; health inequalities; life course epidemiology.

Figure 1

Conceptual model of the proposed processes of differential exposure and differential impact/susceptibility to stressful family conditions, leading to inequalities in child outcomes by mother’s education. Confounders are not included in the conceptual model.

Figure 2

Contributions of differential exposure and susceptibility to financial stress (A) and social stress (B) to the effect of mother’s educational level (high vs low) on child development. Estimates for total effects, differential exposure and differential susceptibility were derived from four-way decomposition analyses. Estimates are expressed in number of SD. For example, differential exposure to financial stress caused a 0.07 lower SD socioemotional development score among children from less-educated mothers compared with children from more-educated mothers. Minor differences in total effect estimates occurred due to bootstrapping.