Parental income and mental disorders in children and adolescents: prospective register-based study.

Jonas Minet Kinge,Fartein Ask Torvik,Stein Emil Vollset,Ole Røgeberg,Siri Håberg,Miriam Evensen,Anders Skrondal,Simon Øverland,Martin Flatø,Maria Christine Magnus,Joseph Dieleman,Martin Tesli,Camilla Stoltenberg

doi:10.1093/ije/dyab066

Abstract

BackgroundChildren with low-income parents have a higher risk of mental disorders, although it is unclear whether other parental characteristics or genetic confounding explain these associations and whether it is true for all mental disorders.MethodsIn this registry-based study of all children in Norway (n = 1 354 393) aged 5–17 years from 2008 to 2016, we examined whether parental income was associated with childhood diagnoses of mental disorders identified through national registries from primary healthcare, hospitalizations and specialist outpatient services.ResultsThere were substantial differences in mental disorders by parental income, except for eating disorders in girls. In the bottom 1% of parental income, 16.9% [95% confidence interval (CI): 15.6, 18.3] of boys had a mental disorder compared with 4.1% (95% CI: 3.3, 4.8) in the top 1%. Among girls, there were 14.2% (95% CI: 12.9, 15.5) in the lowest, compared with 3.2% (95% CI: 2.5, 3.9) in the highest parental-income percentile. Differences were mainly attributable to attention-deficit hyperactivity disorder in boys and anxiety and depression in girls. There were more mental disorders in children whose parents had mental disorders or low education, or lived in separate households. Still, parental income remained associated with children’s mental disorders after accounting for parents’ mental disorders and other factors, and associations were also present among adopted children.ConclusionsMental disorders were 3- to 4-fold more prevalent in children with parents in the lowest compared with the highest income percentiles. Parents’ own mental disorders, other socio-demographic factors and genetic confounding did not fully explain these associations.

Highlights

Mental disorders were 3- to 4-fold more prevalent in children with parents in the lowest compared with the highest income percentiles
The parental-income gradient was largest for attention-deficit hyperactivity disorder, followed by anxiety and depression
Our study suggests that associations between lower parental income and children’s mental disorders were partly, but not fully, attributed to other socio-demographic factors, parents’ own mental disorders and genetic factors

Summary

Introduction

Survey data are commonly used to determine patterns of mental disorders in relation to income, the prevalence of mental disorders and parental income are not well measured in surveys.[7,8] Reporting and response biases affect the accuracy of both variables, leading to questionable validity and difficulties with comparisons between studies.[7,8,9,10] The use of national registry data in studies of parental income and offspring mental health has been limited, and can produce biased results, as access to mental healthcare is highly income-dependent in many countries.[11,12] Because of these challenges, there are several remaining questions. Parental income remained associated with children’s mental disorders after accounting for parents’ mental disorders and other factors, and associations were present among adopted children

Methods

Results

Discussion

Conclusion