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Primary schools and the amplification of social differences in child mental health: a population-based cohort study
  1. Louise Marryat1,
  2. Lucy Thompson2,3,
  3. Helen Minnis2,
  4. Philip Wilson3
  1. 1 Farr Institute, Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
  2. 2 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  3. 3 Centre for Rural Health, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Louise Marryat, Farr Institute, SCPHRP, University of Edinburgh, Edinburgh, EH8 9DX, UK; louise.marryat{at}


Background This paper examines socioeconomic inequalities in mental health at school entry and explores changes in these inequalities over the first 3 years of school.

Methods The study utilises routinely collected mental health data from education records and demographic data at ages 4 and 7 years, along with administrative school-level data. The study was set in preschool establishments and schools in Glasgow City, Scotland. Data were available on 4011 children (59.4%)at age 4 years, and 3166 of these children were followed at age 7 years (46.9% of the population). The main outcome measure was the teacher-rated Goodman’s Strengths and Difficulties Questionnaire (4–16 version) at age 7 years, which measures social, emotional and behavioural difficulties.

Results Children living in the most deprived area had higher levels of mental health difficulties at age 4 years, compared with their most affluent counterparts (7.3%vs4.1% with abnormal range scores). There was a more than threefold widening of this disparity over time, so that by the age of 7 years, children from the most deprived area quintile had rates of difficulties 3.5 times higher than their more affluent peers. Children’s demographic backgrounds strongly predicted their age 7 scores, although schools appeared to make a significant contribution to mental health trajectories.

Conclusions Additional support to help children from disadvantaged backgrounds at preschool and in early primary school may help narrow inequalities. Children from disadvantaged backgrounds started school with a higher prevalence of mental health difficulties, compared with their more advantaged peers, and this disparity widened markedly over the first 3 years of school.

  • psychology
  • psychiatry
  • mental health
  • child health
  • life course epidemiology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors LM cleaned the data and carried out the analysis. PW and LT designed the study. LM, PW, LT and HM were involved in discussions around interpretation of the results. LM, PW, LT and HM read various drafts and the final manuscript and all suggested edits prior to submission. LM, PW, LT and HM read and approved the final manuscript.

  • Funding The study was funded by the Scottish Government, Glasgow City Council and the Gillberg Neuropsychiatry Centre. LM is supported by the Farr Institute @ Scotland, which is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), (MRC Grant No: MR/K007017/1). LM sits in the Scottish Collaboration for Public Health Research and Policy, which is funded by MRC grant MR/K023209/1.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are owned by Glasgow City Council Education Services and are not currently publicly available.

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