Associations between Family Income and Child Development: Mediation by Antenatal Maternal Mental Health

Abstract

Background: Socioeconomic gradients in numerous measures of child health and development exist. Programs to promote equity for children require a clear understanding of pathways underlying the associations between socioeconomic status and child outcomes. Methods: We used a prospective birth cohort study consisting of 1247 mother-child dyads and assessed maternal mood symptoms at four time points during antenatal and postnatal visits. Child outcomes from ages 2 to 6 included socio-emotional health, school readiness, intelligence, and executive function. We performed latent growth curve analysis to examine the maternal mood trajectory formed by repeated measures, then we conducted structural equation models (SEM) to determine outcome prediction by family income and the mood trajectory. Findings: Family income was a robust predictor of maternal mood and child developmental skills. Between children from the bottom and top family income quartiles, school readiness and IQ differed by a standard deviation of 0·78 (95% CI 0·65-1·07) to 1·18 (95% CI 0·96-1·40). There was a high occurrence (38·2%) of suboptimal maternal mental health. Children of mothers with little or no symptoms were significantly better in many areas of development compared to those of mothers with either clinical or sub-clinical levels of symptoms. While antenatal mood and its mood trajectory to 24-months postpartum are strong correlates of child outcomes, only antenatal mood exerted broad-ranging mediating effects on the associations of family income and all measured child outcomes, accounting for 13·3-56·5% of the total effects. Interpretations: Perinatal maternal symptoms of depression and anxiety are modifiable risks and are thus potential leverage points for intervention to alleviate socioeconomic gradients in child development. Funding Statement: Singapore National Medical Research Council Translational and Clinical Research Flagship Programme (NMRC/TCR/004-NUS/2008, 012-NUHS/2014), Health Services Research Grant (HSR-NIG 011/2015), and the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR). Declaration of Interests: Professor C.Y.S. is part of the Epigen Academic Consortium that has received academic research funding from Abbot Nutrition, Nestec, and Danone outside of this submitted work. All other co-authors do not have any conflict of interest. Ethics Approval Statement: Ethics were approved by the Singapore National Healthcare Group and SingHealth Institutional Review Boards. All mothers gave informed consent before taking part in this study.