Childhood socio-economic status and the onset, persistence, and severity of DSM-IV mental disorders in a US national sample
Highlights
► Childhood financial hardship predicts first onset of DSM-IV mental disorders. ► Financial hardship predicts only child onsets after adjusting for other adversities. ► Parental education and occupation are unassociated with mental disorder onsets. ► Low parental education predicts greater severity of adult mental disorders. ► Low parental education predicts greater persistence of behavior disorders.
Introduction
Accumulating evidence suggests that childhood socio-economic status (SES) is an important marker of early-life environmental conditions that has lasting effects on health across the life-course (Davey Smith et al., 1997, Marmot et al., 2001, Power et al., 2007). Although much of the research on this topic has focused on physical health and mortality (Cohen et al., 2010, Galobardes et al., 2004), significant associations between childhood SES and adverse mental health outcomes in adulthood also have been reported in numerous studies (Fan and Eaton, 2001, Gilman et al., 2002, Gilman et al., 2003, Lundberg, 1993, Marmot et al., 2001, Power and Manor, 1992). However, knowledge of the relationship between childhood SES and adult mental health remains cursory due to several pervasive limitations in existing research. First, the specific dimensions of childhood SES that predict adult mental health remain to be identified due to a lack of studies that include a range of childhood SES indicators. Second, the extent to which childhood SES is associated with specific mental disorders or to other aspects of psychiatric morbidity such as disorder persistence and severity is unclear, as most studies have examined associations only with psychological distress. Third, because previous research has not had information on the age-of-onset of psychiatric outcomes, we know little about when in the life-course childhood SES first has effects on mental health. Finally, although the association between childhood SES and adult mental health may be accounted for by a wide range of other childhood adversities (CAs) that co-occur with low SES, existing research has largely failed to control for these important confounders. We address these gaps in the literature in the current report.
Section snippets
Dimensions of socioeconomic status
Childhood SES might contribute to the subsequent development of psychopathology through a number of pathways that are differentially related to aspects of childhood SES (Braveman et al., 2005, Galobardes et al., 2006, Krieger et al., 1997, Lynch and Kaplan, 2000). The three primary indicators of childhood SES are parental educational attainment, parental occupational status, and financial adversity. Low educational attainment reflects a persistent disadvantage in relative social position that
Dimensions of psychiatric morbidity
Most research on the long-term effects of childhood SES has examined its associations with psychological distress rather than with psychiatric disorders (Lahelma et al., 2006, Lundberg, 1993, Marmot et al., 2001, Power and Manor, 1992). Although some prior studies have examined mental disorders, many have focused exclusively on major depression (Fan and Eaton, 2001, Gilman et al., 2003, Ritsher et al., 2001, Stansfeld et al., 2008), precluding examination of differential effects of childhood
Other childhood adversities
Low childhood SES is associated with increased exposure to a range of other CAs such as parental psychopathology, maltreatment, and family violence (Tracy et al., 2008, Turner et al., 2006) that are associated with psychiatric disorders in adulthood (Green et al., 2010, Kessler et al., 1997, McLaughlin et al., 2010a, McLaughlin et al., 2010b). These CAs are likely confounders of the childhood SES-adult psychopathology association. Although several prior studies have examined this possibility,
Sample
The NCS-R was a face-to-face household survey of English-speaking respondents ages 18 and older carried out between February 2001 and April 2003 in a nationally-representative multi-stage clustered area probability sample of the US household population (Kessler & Merikangas, 2004). The response rate was 70.9%. The survey was administered in two parts. Part I included a core diagnostic assessment of mental disorders (n = 9282). Part II assessed risk factors, consequences, other correlates, and
Associations of childhood adversities with childhood SES and DSM-IV/CIDI disorders
We first conducted a series of analyses to determine whether CAs were associated with childhood SES and mental disorders and thus should be controlled in subsequent analysis. The 11 CAs were related both to childhood SES and to psychiatric disorders. Childhood SES indicators were examined as predictors of each of the 11 CAs in a series of logistic regression models, with controls for age, gender, and race/ethnicity. Financial hardship was associated with 10 of the 11 CAs, whereas parental
Discussion
This study provides useful new information about the associations of childhood SES with the onset, course, and severity of mental disorders. The reliance on retrospective reports is a potential limitation because of the possibility of recall bias (Simon & von Korff, 1995) which may persist despite the use of methods for prompting accurate recall of the onset and offset of disorders (Knauper et al., 1999). Although retrospective studies in representative samples such as this provide an
Acknowledgements
This project was supported by a National Institute of Mental Health grants (K01MH092526) to K. McLaughlin and (K01MH085710) to J. Green. The National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044780), and the John W. Alden Trust.
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