Early‐life pathways to inequalities in child mental health: evidence from eight birth cohorts

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.

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Journal
Journal of Child Psychology and Psychiatry
Published
2026-07-28
DOI
https://doi.org/10.1111/jcpp.70207
Primary Topic
Maternal Mental Health During Pregnancy and Postpartum
Type
article
Field-Weighted Citation Impact
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article

Early‐life pathways to inequalities in child mental health: evidence from eight birth cohorts

Angela Pinot de Moira, Ashleigh Lin, Gabriella Melis, Anne‐Marie Nybo Andersen et al.
Journal of Child Psychology and Psychiatry
Maternal Mental Health During Pregnancy and Postpartum
article

Early‐life pathways to inequalities in child mental health: evidence from eight birth cohorts

Angela Pinot de Moira, Ashleigh Lin, Gabriella Melis, Anne‐Marie Nybo Andersen, Dariusz Gruszfeld, Katrine Strandberg‐Larsen, Maria Melchior, Yu Wei Chua, Daniela Zugna, Tim Cadman, Annick Xhonneux, Joaquín Escribano, Blanca Sarzo, Rae‐Chi Huang, Demetris Avraam, Simona Porru, Elvira Verduci, Jordi Júlvez, Veit Grote, Kathrin Guerlich, Jennifer R. Harris, Johanna Thorbjornsrud Nader, Marie Aline Charles, Maja Popovic, Tiffany Yang, Rosemary McEachan, Jennie Carson, Phillip Melton, Morris Swertz, Ahmed Elhakeem, Berthold Koletzko, David Taylor‐Robinson, John Wright, Jesus Ibarluzea, Lorenzo Richiardi, Unai Martin, Jordi Sunyer, Daniela Schlüter
article en

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.

Journal of Child Psychology and Psychiatry
Universitat Jaume I (ES), Edith Cowan University (AU), University of Copenhagen (DK), University of Tasmania (AU), Norwegian Institute of Public Health (NO), University Medical Center Groningen (NL), University of Liverpool (GB), Inserm (FR), University of the Basque Country (ES), Universitat Pompeu Fabra (ES), The University of Western Australia (AU), La Trobe University (AU), Instituto de Salud Carlos III (ES), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), University of Bristol (GB), German Center for Pediatric and Adolescent Rheumatology (DE), Centre Hospitalier Chrétien (BE), Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (ES), Biogipuzkoa Health Research Institute (ES), Institut de Recerca Biomèdica Catalunya Sud (ES), National Institute for Demographic Studies (FR), Children's Memorial Health Institute (PL), University Children's Hospital Tübingen (DE), Parc de Salut (ES), Institut Pierre Louis d‘Épidémiologie et de Santé Publique (FR), Onkologikoa (ES), Barcelona Institute for Global Health (ES), Hospital Universitari Sant Joan de Reus (ES), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), Bradford Teaching Hospitals NHS Foundation Trust (GB), Imperial College London (GB), University of Turin (IT), Ludwig-Maximilians-Universität München (DE)
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Maternal Mental Health During Pregnancy and Postpartum
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