Abstract
This study investigates the sex, ethnic and socioeconomic inequalities in emotional difficulties over childhood and adolescence using longitudinal cohort studies in the UK and Australia. Estimating cross-national differences contributes to understanding of the consistency of inequalities in mental health across contexts. Data from 19,748 participants in two contemporary representative samples in Australia (Growing Up in Australia: The Longitudinal Study of Australian Children, n=4,975) and UK (Millennium Cohort Study, n=14,773) were used. Emotional difficulties were assessed using the parent-reported Strengths and Difficulties Questionnaire at ages 4/5, 6/7, 11/12 and 14/15years and the self-reported Short Moods and Feelings Questionnaire at age 14/15. Latent Growth Curve Modelling was used to examine mental health over time. There were significant increases in emotional difficulties in both countries over time. Emotional difficulties were higher in Australian children at all ages. The gender gap in self-reported depressive symptoms at age 14/15 was larger in the UK (8% of UK and 13% of Australian boys were above the depression cut-off, compared with 23% of girls). Ethnic minority children had higher emotional difficulties at age 4/5years in both countries, but over time this difference was no longer observed in Australia. In the UK, this reversed whereby at ages 11/12 and 14/15 ethnic minority children had lower symptoms than their White majority peers. Socioeconomic differences were more marked based on parent education and employment status in Australia and by parent income in the UK. UK children, children from White majority ethnicity and girls evidenced steeper worsening of symptoms from age 4/5 to 14/15 years. Even in two fairly similar countries (i.e. English-speaking, high-income, industrialised), the observed patterns of inequalities in mental health symptoms based on sociodemographics are not the same. Understanding country and context-specific drivers of different inequalities provides important insights to help reduce disparities in child and adolescent mental health.
Highlights
Mental ill-health is a leading cause of disease burden globally, and for many individuals, mental health difficulties are first experienced in childhood and adolescence (Kessler et al, 2005; Patel, Flisher, Hetrick, & McGorry, 2007)
While ethnic minority children in both countries exhibited higher symptoms at age 5, this difference disappeared in Australian children over time and reversed in UK children: by age 11 UK ethnic minority children experienced lower emotional symptoms than their White majority counterparts, and this remained the case through age 14
The extent of the sex, ethnic and SES inequalities in the UK and Australia differs across country, ages and reporter of mental health
Summary
Mental ill-health is a leading cause of disease burden globally, and for many individuals, mental health difficulties are first experienced in childhood and adolescence (Kessler et al, 2005; Patel, Flisher, Hetrick, & McGorry, 2007). Emotional difficulties tend to increase over time and are highly prevalent in adolescence and early adulthood, and differences between sexes can become more pronounced with age (Dekker et al, 2007; Kessler et al, 2007). Sex differences in internalising mental health are consistently observed from early adolescence, with. This study investigates the sex, ethnic and socioeconomic inequalities in emotional difficulties over childhood and adolescence using longitudinal cohort studies in the UK and Australia. Ethnic minority children had higher emotional difficulties at age 4/5 years in both countries, but over time this difference was no longer observed in Australia. Understanding country and context-specific drivers of different inequalities provides important insights to help reduce disparities in child and adolescent mental health.
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