How do early-life factors explain social inequalities in adolescent mental health? Findings from the UK Millennium Cohort Study

Straatmann, Viviane S.; Lai, Eric; Lange, Theis; Campbell, Melisa; Wickham, Sophie; Andersen, Anne‐Marie Nybo; Strandberg‐Larsen, Katrine; Taylor-Robinson, David

doi:10.1136/jech-2019-212367

Cited by 38 publications

(37 citation statements)

References 39 publications

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“…17 Using this framework, we previously showed the importance of early years mediators in the UK, particularly perinatal factors, such as birth weight and gestational age, and family factors such as maternal MHPs. 10 Building on these findings, we aimed to compare causal pathways to inequalities in child MHPs in the UK and Denmark. We hypothesised that children growing up in more disadvantaged SECs are at increased risk of MHPs due to increased exposure to perinatal, maternal and child level risk factors.…”

Section: Open Accessmentioning

confidence: 99%

“…In our previous study, we identified a range of childhood risk factors that potentially explain the social inequalities in adolescent mental health. 10 We mapped these potential mediators to those available at similar time points across both cohorts. These are shown in table 1, grouped into three categories: perinatal factors, childhood illness and maternal mental health.…”

Section: Potential Mediatorsmentioning

confidence: 99%

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Understanding pathways to inequalities in child mental health: a counterfactual mediation analysis in two national birth cohorts in the UK and Denmark

et al. 2020

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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 studySettingWe used data from the UK Millennium Cohort Study and the Danish National Birth Cohort.Primary and secondary outcome measuresWe 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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Section: Open Accessmentioning

confidence: 99%

Section: Potential Mediatorsmentioning

confidence: 99%

Understanding pathways to inequalities in child mental health: a counterfactual mediation analysis in two national birth cohorts in the UK and Denmark

et al. 2020

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“…6–8 Our recent study, for example, has shown that socioeconomic inequalities in an adolescent mental health outcome can be partially explained by perinatal, individual child, family, peer relation and neighbourhood-level factors up to age 3. 9 Some of these early-life risk factors (e.g. parental mental health and alcohol misuse, and bullied children) may be framed as ACEs, 9 and reinforce the importance of these detrimental experiences in the early years 7 and their potential role in mediating socioeconomic inequalities in health outcomes in adolescence.…”

Section: Introductionmentioning

confidence: 99%

“…9 Some of these early-life risk factors (e.g. parental mental health and alcohol misuse, and bullied children) may be framed as ACEs, 9 and reinforce the importance of these detrimental experiences in the early years 7 and their potential role in mediating socioeconomic inequalities in health outcomes in adolescence.…”

Section: Introductionmentioning

confidence: 99%

“…For example, as outlined in our logic model in figure 1, previous studies show that children living in disadvantaged SECs are more likely to be exposed to ‘toxic stress’ such as parental mental health problems, parental drug and alcohol misuse, and other family dysfunctions, which may lead to subsequent adverse health outcomes later in life. 9 11 14…”

Section: Introductionmentioning

confidence: 99%

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How do early-life adverse childhood experiences mediate the relationship between childhood socioeconomic conditions and adolescent health outcomes in the UK?

Straatmann

Lai

Law

et al. 2020

J Epidemiol Community Health

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BackgroundBoth adverse childhood experiences (ACEs) and adverse childhood socioeconomic conditions (SECs) in early life are associated with poor outcomes across the life course. However, the complex interrelationships between childhood SECs and ACEs are unclear, as are the consequences for health outcomes beyond childhood. We therefore assessed the extent to which early-life ACEs mediate the relationship between SECs and socioemotional behavioural problems, cognitive disability and overweight/obesity in adolescence.MethodsWe used longitudinal data from the UK Millennium Cohort Study (MSC). Outcomes assessed at age 14 were socioemotional behavioural problems, cognitive disability and overweight/obesity. SECs at birth were measured by maternal education. Potentially mediating ACEs measured up to 5 years were verbal and physical maltreatment, parental drug use, domestic violence, parental divorce, maternal mental illness and high frequency of parental alcohol use. We used counterfactual mediation analysis to assess the extent to which ACEs mediate the association between SECs at birth and behavioural, cognitive and physical outcomes at age 14, estimating total (TE), natural direct and indirect effects, and mediated proportions.ResultsChildren with disadvantaged SECs were more likely to have socioemotional behavioural problems (relative risk (RR) 3.85, 95% CI 2.48 to 5.97), cognitive disability (RR 3.87, 95% CI 2.33 to 6.43) and overweight/obesity (RR 1.61, 95% CI 1.32 to 1.95), compared to those with more advantaged SECs. Overall, 18% of the TE of SECs on socioemotional behavioural problems was mediated through all ACEs investigated. For cognitive disability and overweight/obese, the proportions mediated were 13% and 19%, respectively.ConclusionACEs measured up to age 5 years in the MCS explained about one-sixth of inequalities in adolescents behavioural, cognitive and physical outcomes.

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Relationship between gingival bleeding and associated factors with reports of verbal bullying in adolescents

Moraes

Knorst

Brondani

et al. 2020

Journal of Periodontology

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Background Dentofacial features are related to increased bullying episodes in young people. The aim of this study was to assess the association between gingival bleeding and reports of verbal bullying among adolescents. Methods This is a cross‐sectional study conducted with a representative sample of 608 12‐year‐old adolescents from southern Brazil. The occurrence of verbal bullying was verified through adolescents' self‐report. Oral health measurements included the presence of gingival bleeding, dental fracture, dental fluorosis, and dental caries experience. Gingival bleeding was assessed through adolescent self‐perception by the following question: “Did you notice any bleeding in your gums?” Demographic, socioeconomic, and psychosocial variables were also evaluated. Poisson regression models with robust variance were used to evaluate the influence of gingival bleeding on the occurrence of verbal bullying. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI). Results Out of 608 adolescents evaluated, 577 answered bullying questions. The prevalence of self‐reported verbal bullying was 12.8%. Adolescents who presented gingival bleeding had an 80% higher prevalence of verbal bullying than their counterparts (PR 1.80; 95% CI 1.01 ‐3.19). Dental shame, speech difficulties and influence of dental condition on studies also impacted the higher prevalence of bullying. Conclusion Our results suggest that the presence of gingival bleeding negatively impacts the social life of adolescents, causing more episodes of verbal bullying. These findings encourage public health policies aimed at reducing oral health inequities, thus reflecting on the well‐being and quality of life of this target population.

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How do early-life factors explain social inequalities in adolescent mental health? Findings from the UK Millennium Cohort Study

Cited by 38 publications

References 39 publications

Understanding pathways to inequalities in child mental health: a counterfactual mediation analysis in two national birth cohorts in the UK and Denmark

Understanding pathways to inequalities in child mental health: a counterfactual mediation analysis in two national birth cohorts in the UK and Denmark

How do early-life adverse childhood experiences mediate the relationship between childhood socioeconomic conditions and adolescent health outcomes in the UK?

Relationship between gingival bleeding and associated factors with reports of verbal bullying in adolescents

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