. 2023 Jul 23:23:101472.

doi: 10.1016/j.ssmph.2023.101472. eCollection 2023 Sep.

Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic: An intersectional analysis

Elsa Lorthe^{1

2}, Viviane Richard^{1

3}, Roxane Dumont^{1

3}, Andrea Loizeau¹, Javier Perez-Saez^{1

4}, Hélène Baysson¹, Maria-Eugenia Zaballa¹, Julien Lamour¹, Nick Pullen¹, Stephanie Schrempft¹, Rémy P Barbe⁵, Klara M Posfay-Barbe^{6

7}, Idris Guessous^{3

8}, Silvia Stringhini^{1

3

9}; SEROCoV-KIDS study group

Collaborators, Affiliations

Collaborators

SEROCoV-KIDS study group:
Deborah Amrein, Isabelle Arm-Vernez, Andrew S Azman, Antoine Bal, Michael Balavoine, Rémy P Barbe, Hélène Baysson, Julie Berthelot, Patrick Bleich, Livia Boehm, Aminata R Bouchet, Gaëlle Bryand, Viola Bucolli, Prune Collombet, Alain Cudet, Vladimir Davidovic, Carlos de Mestral, Paola D'Ippolito, Richard Dubos, Roxane Dumont, Isabella Eckerle, Nacira El Merjani, Marion Favier, Natalie Francioli, Clément Graindorge, Idris Guessous, Munire Hagose, Séverine Harnal, Samia Hurst, Laurent Kaiser, Omar Kherad, Julien Lamour, Pierre Lescuyer, Arnaud G L'Huillier, Andrea Loizeau, Elsa Lorthe, Chantal Martinez, Stéphanie Mermet, Mayssam Nehme, Natacha Noël, Francesco Pennacchio, Javier Perez-Saez, Anne Perrin, Didier Pittet, Klara M Posfay-Barbe, Jane Portier, Géraldine Poulain, Caroline Pugin, Nick Pullen, Viviane Richard, Frederic Rinaldi, Deborah Rochat, Cyril Sahyoun, Irine Sakvarelidze, Khadija Samir, Hugo Alejandro Santa Ramirez, Jessica Rizzo, Stephanie Schrempft, Claire Semaani, Silvia Stringhini, Stéphanie Testini, Yvain Tisserand, Deborah Urrutia Rivas, Charlotte Verolet, Jennifer Villers, Guillemette Violot, Nicolas Vuilleumier, Sabine Yerly, María-Eugenia Zaballa, Christina Zavlanou, Silvia Stringhini

Affiliations

¹ Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
² Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France.
³ Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
⁵ Division of Child and Adolescent Psychiatry, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁶ Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁷ Department of Pediatrics, Gynecology & Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁸ Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁹ University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland.

PMID: 37560087
PMCID: PMC10407575
DOI: 10.1016/j.ssmph.2023.101472

Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic: An intersectional analysis

Elsa Lorthe et al. SSM Popul Health. 2023.

. 2023 Jul 23:23:101472.

doi: 10.1016/j.ssmph.2023.101472. eCollection 2023 Sep.

Authors

Collaborators

SEROCoV-KIDS study group:
Deborah Amrein, Isabelle Arm-Vernez, Andrew S Azman, Antoine Bal, Michael Balavoine, Rémy P Barbe, Hélène Baysson, Julie Berthelot, Patrick Bleich, Livia Boehm, Aminata R Bouchet, Gaëlle Bryand, Viola Bucolli, Prune Collombet, Alain Cudet, Vladimir Davidovic, Carlos de Mestral, Paola D'Ippolito, Richard Dubos, Roxane Dumont, Isabella Eckerle, Nacira El Merjani, Marion Favier, Natalie Francioli, Clément Graindorge, Idris Guessous, Munire Hagose, Séverine Harnal, Samia Hurst, Laurent Kaiser, Omar Kherad, Julien Lamour, Pierre Lescuyer, Arnaud G L'Huillier, Andrea Loizeau, Elsa Lorthe, Chantal Martinez, Stéphanie Mermet, Mayssam Nehme, Natacha Noël, Francesco Pennacchio, Javier Perez-Saez, Anne Perrin, Didier Pittet, Klara M Posfay-Barbe, Jane Portier, Géraldine Poulain, Caroline Pugin, Nick Pullen, Viviane Richard, Frederic Rinaldi, Deborah Rochat, Cyril Sahyoun, Irine Sakvarelidze, Khadija Samir, Hugo Alejandro Santa Ramirez, Jessica Rizzo, Stephanie Schrempft, Claire Semaani, Silvia Stringhini, Stéphanie Testini, Yvain Tisserand, Deborah Urrutia Rivas, Charlotte Verolet, Jennifer Villers, Guillemette Violot, Nicolas Vuilleumier, Sabine Yerly, María-Eugenia Zaballa, Christina Zavlanou, Silvia Stringhini

Affiliations

¹ Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
² Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France.
³ Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
⁵ Division of Child and Adolescent Psychiatry, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁶ Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁷ Department of Pediatrics, Gynecology & Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁸ Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁹ University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland.

PMID: 37560087
PMCID: PMC10407575
DOI: 10.1016/j.ssmph.2023.101472

Abstract

Background: Children and adolescents are highly vulnerable to the impact of sustained stressors during developmentally sensitive times. We investigated how demographic characteristics intersect with socioeconomic dimensions to shape the social patterning of quality of life and mental health in children and adolescents, two years into the COVID-19 pandemic.

Methods: We used data from the prospective SEROCoV-KIDS cohort study of children and adolescents living in Geneva (Switzerland, 2022). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 48 social strata defined by intersecting sex, age, immigrant background, parental education and financial hardship in Bayesian multilevel logistic models for poor health-related quality of life (HRQoL, measured with PedsQL) and mental health difficulties (measured with the Strengths and Difficulties Questionnaire).

Results: Among participants aged 2-17 years, 240/2096 (11.5%, 95%CI 10.1-12.9) had poor HRQoL and 105/2135 (4.9%, 95%CI 4.0-5.9) had mental health difficulties. The predicted proportion of poor HRQoL ranged from 3.4% for 6-11 years old Swiss girls with highly educated parents and no financial hardship to 34.6% for 12-17 years old non-Swiss girls with highly educated parents and financial hardship. Intersectional strata involving adolescents and financial hardship showed substantially worse HRQoL than their counterparts. Between-stratum variations in the predicted frequency of mental health difficulties were limited (range 4.4%-6.5%).

Conclusions: We found considerable differences in adverse outcomes across social strata. Our results suggest that, post-pandemic, interventions to address social inequities in HRQoL should focus on specific intersectional strata involving adolescents and families experiencing financial hardship, while those aiming to improve mental health should target all children and adolescents.

Keywords: Adolescents; Health equity; MAIHDA; Socioeconomic disparities; Youth.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: KMPB is a member of the Advisory Boards for pneumococcal vaccine and varicella vaccine at MSD. All other authors declare that they have no competing interests.

Figures

**Fig. 1**
Flow Chart Legend: PedsQL: Pediatric quality of life inventory, SDQ: Strengths and difficulties questionnaire.

**Fig. 2**
Social stratum-specific predicted proportions of health-related quality of life (left), parent-reported poor mental health (center) and mental health difficulties (right) Interpretation: This figure shows the stratum-specific predicted probability of each outcome obtained from the corresponding simple intersectional models.

**Fig. 3**
Estimated intersectional effects (stratum-level residuals) Interpretation: We present here strata-level residuals (attributable to intersectional interaction) and their corresponding 95% credible intervals for each stratum ranked from lowest to highest. Strata with significant intersectional effect (i.e., their 95% credible intervals do not overlap with 0) are highlighted in grey.

**Fig. 4**
Social stratum-specific predicted proportions of physical and psychosocial health-related quality of life (top panel) and estimated intersectional effects (stratum residuals - bottom panel).

**Fig. 5**
Social stratum-specific predicted proportions of externalizing problems, internalizing problems and prosocial behaviors (top panel) and estimated intersectional effects (stratum residuals - bottom panel).

See this image and copyright information in PMC

References

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Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic: An intersectional analysis

Collaborators

Affiliations

Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic: An intersectional analysis

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources