Early‐life pathways to inequalities in child mental health: evidence from eight birth cohorts
Year: 2026
Type: article
Abstract: BACKGROUND: Socioeconomic inequalities in children's emotional and behavioural problems are already present at school entry. We examined associations between early-life socioeconomic conditions and children's externalising and internalising problems and assessed whether early-life risk factors mediated these associations. METHODS: We analysed harmonised individual participant data from eight birth cohorts within the EU Child Cohort Network. Maternal educational level during pregnancy was used as an indicator of early-life socioeconomic conditions (SECs). Scores of children's externalising and internalising problems around school entry age were used as the outcome variables. Inequalities were quantified using the Slope Index of Inequality which captures the difference in prevalence of problems between children from highest and lowest SECs. Mediation analysis was used to assess the mediating role of five early-life risk factors: maternal smoking during pregnancy, gestational age, small for gestational age, postpartum depression and breastfeeding. RESULTS: Inequalities in externalising and internalising problems by SECs were consistent across cohorts: Children of mothers with low educational level had on average a 12 and 11 percentage point increased prevalence of externalising and internalising problems respectively. Early-life factors explained around 8% (DNBC, Denmark) to 54% (INMA, Spain) of the inequality in externalising problems and 7% (ELFE, France) to 25% (ALSPAC, UK) in internalising problems. CONCLUSIONS: Children from lower SECs consistently had a higher prevalence of both externalising and internalising problems around school entry age. These inequalities were partly mediated by early-life factors. Public health interventions in pregnancy and the preschool period are critical to address the early emergence of inequalities in children's mental health.
DOI: 10.1111/jcpp.70207
Authors: Demetris Avraam, Gabriella Melis, Tim Cadman, Jennie Carson, Marie Aline Charles, Yu Wei Chua, Ahmed Elhakeem, Joaquín Escribano, Veit Grote, Dariusz Gruszfeld, Kathrin Guerlich, Rae‐Chi Huang, Jennifer R. Harris, Jesus Ibarluzea, Jordi Julvez, Berthold Koletzko, Ashleigh Lin, Unai Martin, Rosemary McEachan, Maria Melchior, Phillip Melton, Johanna Thorbjornsrud Nader, Angela Pinot de Moira, Maja Popovic, Simona Porru, Lorenzo Richiardi, Blanca Sarzo, Daniela Schlüter, Jordi Sunyer, Morris Swertz, Elvira Verduci, John Wright, Annick Xhonneux, Tiffany Yang, Daniela Zugna, Anne‐Marie Nybo Andersen, Katrine Strandberg‐Larsen, David Taylor‐Robinson
Institutions: University of Copenhagen, University of Liverpool, University Medical Center Groningen, University of Groningen, Barcelona Institute for Global Health, The University of Western Australia, Institut national d'études démographiques, Inserm, University of Bristol, MRC Integrative Epidemiology Unit, Institut de Recerca Biomèdica Catalunya Sud, Hospital Universitari Sant Joan de Reus, LMU Klinikum, Ludwig-Maximilians-Universität München, Children's Memorial Health Institute, Edith Cowan University, Norwegian Institute of Public Health, Instituto de Salud Carlos III, Biogipuzkoa Health Research Institute, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, La Trobe University, University of the Basque Country, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Institute for Health Research, Institut Pierre Louis d‘Épidémiologie et de Santé Publique, University of Tasmania, Menzies Institute for Medical Research, Imperial College London, University of Turin, Universitat Jaume I, Universitat de València, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Universitat Pompeu Fabra, Parc de Salut, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centre Hospitalier Chrétien
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $4,530
Funders: Danone, National Institute for Health and Care Research, Department of Health and Social Care, European Commission, Bundesministerium für Bildung und Forschung, HORIZON EUROPE Framework Programme, National Health and Medical Research Council, Instituto de Salud Carlos III, School for Public Health Research, NextGenerationEU
Awards: G3226459005, G416280049, G8531345561
OpenAlex ID: W7171521401