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. 2024 Oct 22;24(1):2930.
doi: 10.1186/s12889-024-20291-5.

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

Tim Cadman  1 , Demetris Avraam  2 , Jennie Carson  3 , Ahmed Elhakeem  4 , Veit Grote  5 , Kathrin Guerlich  5 , Mònica Guxens  6   7   8   9 , Laura D Howe  4 , Rae-Chi Huang  10 , Jennifer R Harris  11 , Tanja A J Houweling  12 , Eleanor Hyde  13 , Vincent Jaddoe  14   15 , Pauline W Jansen  9   16 , Jordi Julvez  6   17 , Berthold Koletzko  5 , Ashleigh Lin  18 , Katerina Margetaki  19 , Maria Melchior  20 , Johanna Thorbjornsrud Nader  21 , Marie Pedersen  22 , Costanza Pizzi  23 , Theano Roumeliotaki  19 , Morris Swertz  13 , Muriel Tafflet  24 , David Taylor-Robinson  2 , Robyn E Wootton  25 , Katrine Strandberg-Larsen  22
Affiliations

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

Tim Cadman et al. BMC Public Health. .

Abstract

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.

Keywords: Child mental health; Externalising problems; Internalising problems; Social inequalities; Socio‐economic circumstances; Socio‐economic position; Trajectories.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The SII (slope index of inequality) is plotted against age for each outcome. All outcomes are standardised to have a mean of zero and a variance of one. The SII therefore represents the mean difference in SDs of the outcome between the highest and lowest maternal education. *CHOP study includes data from Germany, Belgium, Italy, Poland \& Spain
Fig. 2
Fig. 2
The SII (slope index of inequality) is plotted against age for each outcome. All outcomes are standardised to have a mean of zero and a variance of one. The SII therefore represents the mean difference in SDs of the outcome between the highest and lowest maternal education. *CHOP study includes data from Germany, Belgium, Italy, Poland \& Spain
See this image and copyright information in PMC

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