Growing up unequal? Socioeconomic disparities in mental disorders throughout childhood in Finland

How a Preschool Intervention Affected High School Outcomes: Longitudinal Pathways in a Randomized-Controlled Trial

This study examined the impact of the Head Start Research-based, Developmentally Informed (REDI) preschool intervention on high school outcomes and explored longitudinal mediation. 356 children (58% White, 25% Black, 17% Latinx; 54% female, 46% male; Mage = 4.49 years) were recruited from Head Start classrooms which were randomized to intervention (N = 192) or "usual practice" (N = 164). REDI effects emerged on high school emotional symptoms (teacher ratings, d = 0.41) and behavior problems (composite of teacher, parent, youth ratings, d = 0.27) with the latter benefits mediated by earlier intervention boosts to social-emotional learning, social adjustment, and parent involvement. REDI had no direct impact on GPA or on-time graduation but promoted these outcomes indirectly mediated by earlier intervention effects.

Effects of parental characteristics on the risk of psychopathology in offspring: a 4-year follow-up study

Offspring of patients diagnosed with schizophrenia (SZoff) or bipolar disorder (BDoff) have double the risk of developing a psychiatric disorder. Here we report the effects of some parental characteristics on the offspring risk of psychopathology at 4-year follow-up. At baseline, 90 BDoff, 41 SZoff and 107 Community Control offspring (CCoff) aged 6 to 17 were included. At 4-year follow-up, 71% of the sample was assessed. Parents' and offspring's psychiatric diagnoses as well as socio-economic status (SES) and global functioning were assessed in addition to parents' ages at childbirth and offspring subclinical psychotic/bipolar symptoms. Kaplan-Meier method and Cox regression analysis were used to assess between-group differences in the cumulative incidence of psychiatric disorders and subclinical psychotic/bipolar symptoms and the association of some offspring and parents' variables with risk of psychopathology and subclinical psychotic/bipolar symptoms. SZoff and BDoff had a higher risk of psychopathology than CCoff at 4-year follow-up. SZoff showed a higher risk for attention deficit hyperactivity disorder (ADHD), disruptive disorders and subclinical psychotic symptoms, whereas BDoff displayed a heightened risk for mood disorders, ADHD and subclinical bipolar symptoms when compared to CCoff. Higher parental psychosocial functioning and SES were associated with a lower prevalence of psychopathology. Both SZoff and BDoff samples have a higher risk for psychopathology but the pattern of this psychopathology seems to be group specific. Longer follow-up studies and larger sample sizes are needed to assess the capacity of psychopathological disorder and subclinical psychotic or bipolar symptoms to predict progression to fully-fledged disorders.

Educational differences in years lived with disability due to mental and substance use disorders: a cohort study using nationwide Norwegian and Danish registries

BACKGROUND

Findings from the Global Burden of Disease (GBD) study have shown that the burden of mental and substance use disorders is considerable, and unevenly distributed across demographic groups in the population. However, there is a lack of knowledge on how this burden differs by socioeconomic position. The aim of this study was to examine educational differences in years lived with disability (YLDs) from mental and substance use disorders among males and females in two high-income countries, taking comorbidity with other diseases into account.

METHODS

The study included all registered residents in Denmark and Norway from 2011 to 2021. Diagnostic information was retrieved from records in the Norwegian National Patient Registry (NPR) and the Danish Psychiatric Central Research Register (PCRR) and used as proxy measures for disorder prevalence. Demographical and educational information was taken from administrative registries. The YLD is a measure of the non-fatal health loss in the population and was calculated by multiplying the duration of a disorder with a disability weight (DW), scaled between 0 and 1. Information on remission and DWs were retrieved from the GBD study and other sources, and disorder specific DWs were averaged by severity levels and adjusted for comorbidity.

RESULTS

Educational gradients in YLD rates were found for mental and substance disorders overall, and for most of the specific disorders. The educational gradient was more pronounced for schizophrenia, intellectual disability and substance use disorders than for eating, anxiety, and affective disorders. Both higher YLD rates, and a larger attributed proportion of the total YLDs, were found for schizophrenia, intellectual disability, and substance use disorders in the groups with low versus high education. YLD rates for eating, anxiety, and affective disorders were more equal across educational levels, but constituted a smaller proportion of the total YLDs among the groups with low versus the groups with high educational level.

CONCLUSION

Most of the disease burden related to mental and substance use disorders falls on those with the fewest years of education. This should be taken into consideration when public health targets aimed at improving mental health and reducing social inequalities in health are developed and implemented.

Parental education and children's depression, anxiety, and ADHD traits, a within-family study in MoBa

Children born to parents with fewer years of education are more likely to have depression, anxiety, and attention-deficit hyperactivity disorder (ADHD), but it is unclear to what extent these associations are causal. We estimated the effect of parents' educational attainment on children's depressive, anxiety, and ADHD traits at age 8 years, in a sample of 40,879 Norwegian children born in 1998-2009 and their parents. We used within-family Mendelian randomization, which employs genetic variants as instrumental variables, and controlled for direct genetic effects by adjusting for children's polygenic indexes. We found little evidence that mothers' or fathers' educational attainment independently affected children's depressive, anxiety, or ADHD traits. However, children's own polygenic scores for educational attainment were independently and negatively associated with these traits. Results suggest that differences in these traits according to parents' education may reflect direct genetic effects more than genetic nurture. Consequences of social disadvantage for children's mental health may however be more visible in samples with more socioeconomic variation, or contexts with larger socioeconomic disparities than present-day Norway. Further research is required in populations with more educational and economic inequality and in other age groups.

Metabolic Profile and Long-Term Risk of Depression, Anxiety, and Stress-Related Disorders

Importance

Biomarkers of lipid, apolipoprotein, and carbohydrate metabolism have been previously suggested to be associated with the risk for depression, anxiety, and stress-related disorders, but results are inconsistent.

Objective

To examine whether the biomarkers of carbohydrate, lipid, and apolipoprotein metabolism are associated with the risk of depression, anxiety, and stress-related disorders.

Design, Setting, and Participants

This population-based cohort study with longitudinal data collection assessed 211 200 participants from the Apolipoprotein-Related Mortality Risk (AMORIS) cohort who underwent occupational health screening between January 1, 1985, and December 31, 1996, mainly in the Stockholm region in Sweden. Statistical analysis was performed during 2022 to 2023.

Exposures

Lipid, apolipoprotein, and carbohydrate biomarkers measured in blood.

Main Outcomes and Measures

The associations between biomarker levels and the risk of developing depression, anxiety, and stress-related disorders through the end of 2020 were examined using Cox proportional hazards regression models. In addition, nested case-control analyses were conducted within the cohort, including all incident cases of depression, anxiety, and stress-related disorders, and up to 10 control individuals per case who were individually matched to the case by year of birth, sex, and year of enrollment to the AMORIS cohort, using incidence density sampling. Population trajectories were used to illustrate the temporal trends in biomarker levels for cases and controls.

Results

A total of 211 200 individuals (mean [SD] age at first biomarker measurement, 42.1 [12.6] years; 122 535 [58.0%] male; 188 895 [89.4%] born in Sweden) participated in the study. During a mean (SD) follow-up of 21.0 (6.7) years, a total of 16 256 individuals were diagnosed with depression, anxiety, or stress-related disorders. High levels of glucose (hazard ratio [HR], 1.30; 95% CI, 1.20-1.41) and triglycerides (HR, 1.15; 95% CI, 1.10-1.20) were associated with an increased subsequent risk of all tested psychiatric disorders, whereas high levels of high-density lipoprotein (HR, 0.88; 95% CI, 0.80-0.97) were associated with a reduced risk. These results were similar for male and female participants as well as for all tested disorders. The nested case-control analyses demonstrated that patients with depression, anxiety, or stress-related disorders had higher levels of glucose, triglycerides, and total cholesterol during the 20 years preceding diagnosis, as well as higher levels of apolipoprotein A-I and apolipoprotein B during the 10 years preceding diagnosis, compared with control participants.

Conclusions and Relevance

In this cohort study of more than 200 000 participants, high levels of glucose and triglycerides and low levels of high-density lipoprotein were associated with future risk of depression, anxiety, and stress-related disorders. These findings may support closer follow-up of individuals with metabolic dysregulations for the prevention and diagnosis of psychiatric disorders.

Does social disadvantage persist over generations due to an uneven distribution of mental health diagnoses? A longitudinal investigation of Finnish register data

Social disadvantages persist over generations, while the mechanisms behind the intergenerational transmission are not well understood. To fill this gap, first, we examine to what degree being diagnosed with a mental health disorder in adolescence mediate the transmission of social disadvantage. Second, we investigate whether the role of mental health varies for different outcomes. Third, we examine differences between disorder groups and gender. We exploited register data on the full Finnish population including information on mental health diagnoses (MHD) based on ICD-10 classification recorded in public specialized health care. As socioeconomic outcomes, we used offspring's (N = 511,835) records for low educational attainment, unemployment, and social assistance dependency in early adulthood. In addition to linear probability models, the g-computation method was used to simulate the degree to which reducing mental health inequalities in adolescence could narrow the differences between children of different family backgrounds. Our results show that adolescents with MHD had a higher likelihood of experiencing social disadvantage as young adults even after accounting for parental socioeconomic status and alternative health pathways. The counterfactual analysis indicated that the proportion mediated by unevenly distributed MHD was with 7.5% highest for social assistance followed by 4.2% for education and 3.2% for unemployment. The effect of mental health was modified by gender yet direction and strength varied across methods and externalizing behaviors mattered more for the intergenerational persistence than internalizing behaviors. Hypothetically reducing MHD to the level of families with high socioeconomic status might indeed lower part of the intergenerational transmission of social assistance dependency but to lesser degree of unemployment and low educational attainment. We demonstrate the need of support and services for those with MHD, especially among socially disadvantaged groups. However, social disadvantage should not be overly medicalized as family background has an important independent effect on offspring's socioeconimic outcomes.