ArticleBMJ open2020
Understanding pathways to inequalities in child mental health: a counterfactual mediation analysis in two national birth cohorts in the UK and Denmark.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 10 citations in OpenAlex.
- A Within-Person Examination of the Family Stress Model: Family Income, Parental Distress, and Child Mental Health.Research on child and adolescent psychopathology · 2026Article
- Household income and children's mental health outcomes: the mediating role of maternal wellbeing and parent-child relationship quality.European child & adolescent psychiatry · 2025Article
- Impact of Telemedicine Adoption on Hemiplegia in Patients With Stroke in Florida: Longitudinal Observational Study.Journal of medical Internet research · 2025Observational
- Does cumulative adverse socioeconomic exposure mediate the association of maternal mental ill health at birth and adolescent mental ill health at age 17? An analysis of the Millennium Cohort Study.Journal of epidemiology and community health · 2023Article
- Multifaceted determinants of social-emotional problems in preschool children in Sweden: An ecological systems theory approach.SSM - population health · 2023Article
- Social isolation, socioeconomic status, and development of functional impairments in Chinese older adults aged 70 years and over: a cohort study.Aging clinical and experimental research · 2023Article
- Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study.The Lancet regional health. Europe · 2022Article
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Authors and funding
7 authors at 2 institutions in 4 countries.
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Abstract
objectivesWe assessed social inequalities in child mental health problems (MHPs) and how they are mediated by perinatal factors, childhood illness and maternal mental health in two national birth cohorts.
designLongitudinal cohort study
settingWe used data from the UK Millennium Cohort Study and the Danish National Birth Cohort. PRIMARY AND SECONDARY OUTCOME MEASURES: We applied causal mediation analysis to longitudinal cohort data. Socioeconomic conditions (SECs) at birth were measured by maternal education. Our outcome was child MHPs measured by the Strength and Difficulty Questionnaire at age 11. We estimated natural direct, indirect and total effects (TEs) of SECs on MHPs. We calculated the proportion mediated (PM) via three blocks of mediators-perinatal factors (smoking/alcohol use during pregnancy, birth weight and gestational age), childhood illness and maternal mental health.
resultsAt age 11 years, 9% of children in the UK and 3.8% in Denmark had MHPs. Compared with high SECs, children in low SECs had a higher risk of MHPs (relative risk (RR)=4.3, 95% CI 3.3 to 5.5 in the UK, n=13 112; and RR=6.2, 95% CI 4.9 to 7.8 in Denmark, n=35 764). In the UK, perinatal factors mediated 10.2% (95% CI 4.5 to 15.9) of the TE, and adding maternal mental health tripled the PM to 32.2% (95% CI 25.4 to 39.1). In Denmark, perinatal factors mediated 16.5% (95% CI 11.9 to 21.1) of the TE, and including maternal mental health increased the PM to 16.9% (95% CI 11.2 to 22.6). Adding childhood illness made little difference in either country.
conclusionSocial inequalities in child mental health are partially explained by perinatal factors in the UK and Denmark. Maternal mental health partially explained inequalities in the UK but not in Denmark.
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