School composition, family poverty and child behaviour

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

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.

School socioeconomic status and psychological complaints among adolescents in 44 countries: The mediating role of schoolwork pressure and classmate support and the moderating role of family SES and country-level income inequality

Previous research has reported both positive and negative associations between school socioeconomic status (SES) and internalizing problems among adolescents. Little is known about cross-national differences in this association, as well as potential mediators and moderators. Therefore, this study investigated this association using representative cross-national samples of adolescents whilst exploring the mediating role of schoolwork pressure and classmate support, and the moderating role of family SES and country-level income inequality. Using data from adolescents aged 11-15 from 44 countries, participating in the 2017/2018 Health Behaviour in School-aged Children (HBSC) study (N = 202,202), we employed multilevel regression models with cross-level interactions. School SES was operationalized as the average family affluence of adolescents within a school and psychological complaints (e.g., feeling low/depressed) were used as an indication of internalizing problems. On average across countries, adolescents in higher SES schools reported more psychological complaints, with a large effect size. However, differences in this association were observed across countries, with a positive association in 19 out of 44 countries, a negative association in one country, and nonsignificant associations in the remaining countries. Schoolwork pressure partially mediated the average association between school SES and psychological complaints, as school SES was positively associated with schoolwork pressure which was associated with more psychological complaints. Our results did not support the mediating role of classmate support. Also, we found a moderating effect of family SES, indicating a stronger positive association between school SES and psychological complaints for those with a below average family SES compared to those with an average and above average family SES. No moderating effect was observed for country-level income inequality. These findings suggest that adolescents with low family SES attending higher SES schools are especially at risk for psychological complaints, and may therefore require tailored support. A promising strategy to reduce psychological complaints entails addressing schoolwork pressure.

The Role of Primary School Composition in the Trajectories of Internalising and Externalising Problems across Childhood and Adolescence

There is little research on the role of school and its composition in explaining individual children’s psychological outcomes. This study examined for the first time the role of several primary-school compositional characteristics, and their interactions with individual level characteristics, in the development of two such outcomes, internalising and externalising problems, at ages 7, 11 and 14 years in 4794 children in England participating in the Millennium Cohort Study. Using hierarchical (multilevel) linear models, we found that, even after adjusting for individual and family characteristics, children in schools with higher proportions of pupils eligible for free school meals had more externalising problems. In general, children with special educational needs, lower academic performance, more distressed mothers, and those in non-intact families had more internalising and externalising problems. Our results underline the importance of targeting schools with less affluent overall intakes, but also highlight the key role of individual and family characteristics in the development of their pupils’ psychological functioning.

A Study of Depression, Externalizing, and Internalizing Behaviors among Adolescents Living in Institutional Homes

Background:

Adolescence, a psychologically vulnerable stage of life, when coupled with stressful environment such as institutional homes, may result in high psychiatric morbidity. These psychiatric disorders including depression are detrimental to the psychological development in adolescents.

Aims and Objectives:

The objectives of the study were to describe and study the extent of depression in adolescent boys and girls living in institutional homes and to study the association between depression and externalizing and Internalizing behaviors among adolescents in institutional homes.

Materials and Methods:

This cross-sectional descriptive study was done on 150 adolescents staying in institutional homes in Visakhapatnam city. A semi-structured questionnaire was used to collect sociodemographic data. Patient Health Questionnaire was used to screen for Depression. Strengths and Difficulties Questionnaire was used to score for externalizing and internalizing behaviors. Statistical analysis was done using descriptive statistics and tests of association. P < 0.05 was taken as significant.

Results:

Clinical Depression was found in 19 (12.7%) out of 150 adolescents. Subclinical mild depression was found in 19.3% of the sample. Depression was found to be significantly associated with gender and academic performance. Externalizing and internalizing behaviors were positively correlated with depression while prosocial behavior was negatively correlated with depression.

Conclusion:

Depression has high prevalence in institutionalized adolescents. Those adolescents who show signs of externalizing or internalizing behaviors should be especially screened for depression. Further research should be done to collect more data in this regard and to focus on designing interventions for its prevention, screening, and treatment.

School poverty effects on trajectories of child behaviour: Do they depend on gender and ethnicity?

This study examined English school poverty effects on trajectories of child behaviour across ages 3, 5, 7 and 11, and the moderating roles of ethnicity and gender. School poverty predicted internalising and externalising problems concurrently, and internalising problems longitudinally. In poor schools, girls had a steeper incline in internalising problems, but made greater reductions in externalising problems. Ethnic differences were also found in the association between school poverty and child adjustment. Gender and ethnic background may influence how a child responds emotionally and behaviourally to the composition of peers at school.