Abstract
The mechanisms by which childhood socioeconomic status (CSES) affects adult mental health, general health, and well-being are not clear. Moreover, the analytical assumptions employed when assessing mediation in social and psychiatric epidemiology are rarely explained. The aim of this paper was to explain the intermediate confounding assumption, and to quantify differential recall bias in the association between CSES, childhood abuse, and mental health (SCL-10), general health (EQ-5D), and subjective well-being (SWLS). Furthermore, we assessed the mediating role of psychological and physical abuse in the association between CSES and mental health, general health, and well-being; and the influence of differential recall bias in the estimation of total effects, direct effects, and proportion of mediated effects. The assumptions employed when assessing mediation are explained with reference to a causal diagram. Poisson regression models (relative risk, RR and 99% CIs) were used to assess the association between CSES and psychological and physical abuse in childhood. Mediation analysis (difference method) was used to assess the indirect effect of CSES (through psychological and physical abuse in childhood) on mental health, general health, and well-being. Exposure (CSES) was measured at two time points. Mediation was assessed with both cross-sectional and longitudinal data. Psychological abuse and physical abuse mediated the association between CSES and adult mental health, general health, and well-being (6–16% among men and 7–14% among women, p < 0.001). The results suggest that up to 27% of the association between CSES and childhood abuse, 23% of the association between childhood abuse, and adult mental health, general health, and well-being, and 44% of the association between CSES and adult mental health, general health, and well-being is driven by differential recall bias. Assessing mediation with cross-sectional data (exposure, mediator, and outcome measured at the same time) showed that the total effects and direct effects were vastly overestimated (biased upwards). Consequently, the proportion of mediated effects were underestimated (biased downwards). If there is a true (unobserved) direct or indirect effect, and the direction of the differential recall bias is predictable, then the results of cross-sectional analyses should be discussed in light of that.
Highlights
AND THEORETICAL CONSIDERATIONSSeveral psychoanalytic and cognitive theorists have proposed that the risk of psychopathology in adulthood may have roots in adverse childhood experiences (Beck, 1976; Arieti and Bemporad, 1980; Brewin, 1989; Safran, 1990; Blatt and Homann, 1992)
The results suggest that up to 27% of the association between childhood socioeconomic status (CSES) and childhood abuse, 23% of the association between childhood abuse, and adult mental health, general health, and well-being, and 44% of the association between CSES and adult mental health, general health, and wellbeing is driven by differential recall bias
Since different adversities may be correlated and co-occur in the same individuals, we aim to address the question of whether there is an independent and unique effect of CSES, psychological abuse, and physical abuse in childhood on mental health, general health, and well-being in adulthood, a question which has been rarely addressed in previous studies (Sheikh et al, 2016a)
Summary
AND THEORETICAL CONSIDERATIONSSeveral psychoanalytic and cognitive theorists have proposed that the risk of psychopathology in adulthood may have roots in adverse childhood experiences (Beck, 1976; Arieti and Bemporad, 1980; Brewin, 1989; Safran, 1990; Blatt and Homann, 1992). The “stress diathesis” model proposes that if genetic dispositions and stress from life experiences exceed a certain threshold, mental disorders are likely to develop (Brietzke et al, 2012). The complex interplay between genetic dispositions and social factors in early childhood can shape one’s susceptibility, and can contribute to the development of disorders. Exposure to severe stress caused by low socioeconomic status (such as malnutrition, interaction with stressed-out parents, etc.) in early childhood can make an individual more susceptible, both biologically and psychologically, to subsequent stress (such as abuse). Some studies have suggested that childhood abuse may not occur at random, as children with behavioral problems and poor social conformity may have a tendency to put themselves in situations with a high probability of stressful events (Plomin et al, 1990; Lyons et al, 1993)
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