Income disparity in school readiness and the mediating role of perinatal maternal mental health: a longitudinal birth cohort study

Abstract

Aims There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness. Methods Prospective data from 505 mother–child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models. Results Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034). Conclusions Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.

A Golden Thread approach to transforming Maternal and Child Health in Singapore

“…The development of the MCH system in Singapore between 1907 and 1957, 1958-1984 and 1985-2020. MCH, maternal and child health to one in 10 women experience depression during preconception, which continues into the pregnancy and postpartum periods [18,19]. Emerging evidence shows that the children of mothers with depressive symptoms during pregnancy are at risk of altered structural brain development, as well as poor school-readiness and performance in early childhood [19,20].…”

Associations Between Infant Screen Use, Electroencephalography Markers, and Cognitive Outcomes

“…Monthly household income was stratified into 4 groups: less than SGD 2000 (US $1478), SGD 2000 to 3999 (US $1478-$2955), SGD 4000 to 5999 (US $2956-$4433), and SGD 6000 or greater (≥US $4434). The group with monthly income less than SGD 2000 represented those who likely received governmental financial subsidy based on absolute criterion in 2010 . In Singapore, economic deprivation and psychological ill effects are often reported in families receiving subsidies, with estimates of 14% to 31% endorsing severe to extremely severe scores on the Depression, Anxiety and Stress Scale (DASS-21) .…”

“…The group with monthly income less than SGD 2000 represented those who likely received governmental financial subsidy based on absolute criterion in 2010. In Singapore, economic deprivation and psychological ill effects are often reported in families receiving subsidies, with estimates of 14% to 31% endorsing severe to extremely severe scores on the Depression, Anxiety and Stress Scale (DASS-21). When their child was aged 12 months, parents were asked to report the amount of time on average that the child spent on screens per day on weekdays, Saturdays, and Sundays in the past 1 month.…”

“…Covariates in the model, including household income, birth weight, smoking exposure during pregnancy, child sex, and negative maternal mental health during pregnancy, were all associated with executive functioning in prior literature. 29,39,40 We examined whether neural changes in the frequency bands responded in a dose-response manner based on the amount of screen time at age 12 months. We then tested for correlations between screen time duration and 18-month absolute and relative EEG power measures at the frontocentral and parietal regions.…”

Transdisciplinary research and clinical priorities for better health

“…Preconception parental environmental factors (diet, fitness, and metabolic and mental health) affect children's chronic disease risk and influence epigenetic heritage [15]. A high proportion of women experience emotional distress in pregnancy, which seems to be associated with deficits in children's neurodevelopment [16]. The first 1,000 days of life shaped by maternal diet also influence fetal development, newborn well-being, and health trajectory for the entire life span [17].…”