Impact of moving into poverty on maternal and child mental health: longitudinal analysis of the Millennium Cohort Study

BackgroundThe UK Government has recently questioned whether relative measures of income poverty effectively reflect children's life chances. Although relative poverty is associated with poor maternal and child mental health, few studies have assessed the impact of moving into poverty on mental health outcomes. To inform this debate, we explored the association between transitions into poverty and mental health among children and their mothers using a nationally representative sample of children in the UK followed up between 2000 and 2012.MethodsOur analysis of the UK Millennium Cohort Study was based on 5877 singletons who participated in sweeps of the study at ages 9 months to 11 years and were not in relative poverty nor had maternal and child mental health problems when these measures were first recorded at 3 years old. The main outcomes were maternal psychological distress (Kessler Psychological Distress scale, K6) and child socioemotional behavioural problems (Strengths and Difficulties Questionnaire) at ages 5, 7, and 11 years. The main exposure of interest was moving into relative poverty, defined as household equivalised income less than 60% of median household income, according to the Organisation for Economic Co-operation and Development equivalence scale. Using discrete time-hazard models, we estimated odds ratios for subsequent maternal and child mental health of new transitions into poverty, while adjusting for baseline confounding. We further assessed how maternal mental health mediated any impact on child mental health.FindingsOverall 904 families (15·4%) experienced a new transition into poverty. After adjustment for confounders, transition into relative poverty increased the odds of maternal psychological distress (odds ratio 1·86, 95% CI 1·51–2·29) and socioemotional behaviour problems in children (1·37, 1·02–1·85). Controlling for maternal psychological distress reduced the odds of socioemotional behavioural problems in children, and rendered the association non significant (adjusted odds ratio 1·26, 95% CI 0·92–1·72).InterpretationIn this UK cohort, transitions into relative poverty, by use of the currently contested income-based definition, were associated with an increase in the risk of child and maternal mental health problems. Maternal mental health appeared to mediate the association between poverty transitions and child mental health. Actions to address child poverty are needed to tackle the mental health crisis in children in the UK.FundingSW, BB, and DT-R are funded by the Wellcome Trust.     

Simulating the impact of poverty reduction on social inequalities in adolescent mental health in the UK: a causal mediation analysis using the UK Millennium Cohort Study

Background

Adolescent mental health is poor in the UK, with higher prevalence of poor mental health in adolescents living in poverty. However, little experimental evidence exists to understand the potential impact of poverty reduction on inequalities in mental health in the UK population. We aimed to fill this gap by assessing the effect of poverty reduction with a hypothetical intervention on adolescent mental health.

Understanding social inequalities in childhood hospital admissions: longitudinal analysis of the UK Millennium Cohort Study

BackgroundChildhood hospital admission rates are increasing annually and are socially patterned. To inform policies to reduce hospital admissions in children, we aimed to assess risk factors for hospital admissions and the extent to which any socioeconomic inequality in admissions could be attenuated after accounting for risk factors.MethodsThis analysis used a sample of 11 085 children, across five sweeps from ages 9 months to 11 years, from the UK Millennium Cohort Study. The Millennium Cohort Study oversamples children living in disadvantaged areas and ethnic minority groups by means of a stratified clustered sampling design, and includes sampling weights to address attrition. The primary outcome for the present analysis was parental report of a child “ever being admitted to a hospital ward” (ever admitted) by age 11 years. Parents' educational attainment at the child's birth was the main exposure. Primary outcome data were analysed with Poisson regression, according to parental education, adjusted for covariates including perinatal risk factors, maternal and child health status, and environmental risk factors.Findings4615 parents (45·6%) reported that their child had been admitted to hospital by age 11 years. Children of parents with no educational qualifications were more likely than those of parents with degree level or higher qualifications to have been admitted (risk ratio 1·49, 95% CI 1·20–1·85), and there was evidence of a dose-response association. Controlling for risk factors attenuated the increased risk of admissions in children from households with the lowest educational attainment (adjusted risk ratio 1·09, 95% CI 0·93–1·29). In the fully adjusted analysis, low birthweight (1·24, 1·06–1·45) and longstanding illnesses (1·21, 1·18–1·24) were associated with an increased risk of being ever admitted, and female sex was protective (0·81, 0·75–0·88). Repeating the analysis with the main exposure as income produced similar results.InterpretationIn a contemporary representative sample of children in the UK, nearly half were admitted to hospital by age 11 years. Children of parents with no qualifications had around 50% greater risk of admission, largely explained by differences in childhood longstanding illness and low birthweight. Policies to reduce inequalities in these factors might also reduce inequalities in hospital admissions. Study limitations include the potential for differential self-reporting of hospital admission from households with different educational attainment, and not being able to explore service model differences.FundingNone.     

Maternal depression in the 5 years after childbirth among women with and without perinatal depression: a population-based cohort study

BackgroundMany studies estimate the burden of perinatal depression, yet few have assessed continuing patterns of maternal depression in the initial years after childbirth. Since numerous child outcomes are related to perinatal depression, understanding ongoing childhood exposure has potentially important implications for families and clinical practice. We aimed to describe episodes of maternal depression during the first 5 years of children's lives in relation to the presence of maternal antenatal depression, postnatal depression, or both.MethodsWe used a population-based cohort of mother–child pairs from England who had linked primary care and hospital admission data from, respectively, the Clinical Practice Research Datalink and Hospital Episode Statistics for 1997–2014. Incidence of maternal depression was estimated per 100 person-years from 6 months after childbirth to the child's fifth birthday, stratified by whether the mother had antenatal depression, postnatal depression, or both. Incidence rate ratios (IRRs), adjusting for maternal age at delivery, socioeconomic status, and number of children aged 0–4 years in the household, were estimated with Poisson regression. Clinical diagnoses, antidepressant treatment, and admissions to hospital were used to identify episodes of depression. The study was approved by the Independent Scientific Advisory Committee for the Medicines and Healthcare products Regulatory Agency in February, 2014.FindingsOf the 209 418 mothers in the cohort, 5091 (2·4%) had antenatal depression, 13 526 (6·5%) postnatal depression, and 6663 (3·2%) both. Incidence rates of maternal depression when the child was aged 6 months to 4 years were 22·5/100 person-years (95% CI 21·7–23·3) after antenatal depression, 16·0 (15·6–16·4) after postnatal depression, and 14·5 (14·0–15·1) after both, compared with 6·4 (6·3–6·5) for women without perinatal depression. After adjustment, depression rates remained more than twice as high among women with perinatal depression as those without (adjusted IRR 3·28 [3·16–3·39] after antenatal depression, 2·32 [2·26–2·39] after postnatal depression, and 2·18 [2·08–2·27] after both).InterpretationWomen with perinatal depression have an increased risk of subsequent depressive episodes during the first 5 years of their child's life. Studies assessing perinatal depression as a risk factor for child outcomes need also to consider the effect of recurrent maternal depressive episodes occurring in the child's early years. This study only captured depressive episodes where medical attention was sought, and was unable to assess the effect of marital status and social support on risk of depression.FundingRB is funded by the National Institute for Health Research (NIHR) School for Primary Care Research and the University of Nottingham.     

Maternal depression and risk of injuries in children aged 0–4 years: a population-based cohort study

BackgroundThe association between maternal depression and childhood injuries is underexplored, with existing studies relying on maternal reporting of injury occurrences. We aimed to assess the association between the incidence of three common childhood injuries and exposure to maternal antenatal depression, postnatal depression, or both.MethodsUsing a cohort of 209 418 mother–child pairs who had linked data from the Clinical Practice Research Datalink and Hospital Episode Statistics for 1997–2014, we estimated incidence of poisonings, fractures, and burns per 10 000 person-years from birth to the child's fifth birthday, stratified by whether the mother had antenatal depression, postnatal depression, or both. One child was randomly selected per mother to prevent clustering. Using Poisson regression, we estimated incidence rate ratios (IRRs), adjusted for maternal age at delivery, socioeconomic status, number of older siblings, and number of children aged 0–4 years in the household. The study was approved by the Independent Scientific Advisory Committee for the Medicines and Healthcare products Regulatory Agency in February, 2014.FindingsCrude injury rates were higher for each injury type among children whose mothers had antenatal depression, postnatal depression, or both. Poisoning incidence per 10 000 person-years was 59·6 (95% CI 48·7–72·8) for children of mothers with antenatal depression, 64·4 (57·4–72·2) for children of mothers with postnatal depression, and 74·2 (63·2–87·1) for children of mothers with both, compared with 36·3 (34·8–37·8) for those unexposed to either antenatal or postnatal depression. Similar patterns were seen for fractures and burns. After adjustment, IRRs remained significant for poisonings and burns, with the greatest risk for children whose mothers had both antenatal and postnatal depression (poisonings 1·94, 95% CI 1·63–2·32; burns 1·32, 1·13–1·55). However, there was no significant association between fractures and perinatal depression.InterpretationAntenatal and postnatal depression were associated with a higher risk of child poisonings and burns, suggesting that maternal depression could be a modifiable risk factor for these types of injury. By using routinely collected health data we only identified women who sought medical attention for depression, and were unable to adjust for other variables such as child behaviour. Differences in the ascertainment of injury events between mothers with and without perinatal depression could lead to an overestimation of injury risk. Further work could include assessing certain injuries (eg, long-bone fractures) for which ascertainment is likely to be almost complete.FundingRB is funded by the National Institute for Health Research (NIHR) School for Primary Care Research and the University of Nottingham.     

Socioeconomic inequalities in childhood mortality from congenital heart defects: need for internal comparison cohort

BackgroundAn increasing proportion of children with congenital heart defects survive into childhood. Since study populations typically do not contain children without such defects, how survival compares with the general population is unknown. Whereas socioeconomic inequalities in child mortality persist in the general population, such inequalities have not been investigated in children with congenital heart defects. We estimated postneonatal mortality in children with congenital heart defects by socioeconomic status and assessed whether inequalities differed from those in children without major congenital anomalies.MethodsA population-based cohort of 264 247 children born 1990–09 was constructed from the Health Improvement Network, a UK database of prospectively collected primary care records. Diagnoses of major congenital anomalies were classified with the European Surveillance of Congenital Anomalies criteria. Socioeconomic status was measured by quintiles of the Townsend Index of Deprivation, a nationally standardised ranking of area-level material deprivation. Mortality rates (age 1 month to 5 years) were calculated per 1000 person-years for children with congenital heart defects and for those without major congenital anomalies, stratified by socioeconomic status quintile; mortality rate ratios (MRRs) were used to compare risk between each population by quintile. The stratified log-rank test was used to test whether MRRs differed by socioeconomic status.FindingsAmong 2012 children with congenital heart defects, mortality was 6·4 per 1000 person-years (95% CI 4·9–8·6). Rates were lowest in the least deprived quintile (4·26/1000, 2·13–8·51) and rose with each quintile to 12·33/1000 (7·00–21·7) in the most deprived quintile. Risk of death in children with congenital heart defects was 20 times higher than in those without major congenital anomalies (MRR 20·0, 95% CI 14·8–27·2). However, the effect of socioeconomic status on mortality was similar between children with congenital heart defects and those without major congenital anomalies (stratified log-rank test p=0·891). This non-statistically significant result might have resulted from insufficient sample size to generate precise mortality risk ratios.InterpretationDeprivation was associated with an increased risk of death in children with congenital heart defects and without major congenital anomalies, but no evidence was found to suggest that the association with socioeconomic status was different between the two populations. These findings highlight the need to target health inequalities in children with congenital heart defects as well as in the general population.FundingRS is supported by a post-graduate scholarship from the Economic and Social Research Council.     

Visual health inequalities: findings from UK Biobank

BackgroundLittle is known about inequalities in eye health. Between 2009 and 2010, 117 908 UK Biobank participants (aged 40–69 years) undertook an ophthalmic assessment, which included distance visual acuity. UK Biobank was not designed to be a fully representative population sample so prevalence estimation is precluded. However, the size and diversity of the sample provide a unique opportunity for investigation of socioeconomic influences on visual health in UK adults.MethodsHabitual (usual optical correction) distance acuity was measured with a standardised computer-based system. 112 314 participants were reliably assigned, on the basis of acuity in the better eye, into one of six categories spanning the spectrum of vision from bilateral normal vision (log of minimum angle of resolution [logMAR] 0·2 or better) to low-vision–blind (≤0·5, WHO taxonomy). Socioeconomic information included educational qualifications and Townsend Index. Multinomial and ordinal regression analyses were undertaken.FindingsThe frequency of normal bilateral vision decreased with age (age 40–49 years, 86% [21 934/25 645]; 50–59 years, 77% [27 482/35 786]; and 60–70 years, 72% [36 461/50 883]). Overall, risk of visual impairment across severity categories was associated with an increasing gradient of key demographic and socioeconomic variables, indicating deprivation. These patterns of visual health inequalities were not explained by risk of underlying eye disease. For example, compared with normal vision, socially significant visual impairment (SSVI), a mid-range category of visual impairment, was associated with increasing age (risk ratio 1·05, 95% CI 1·046–1·06), being female (1·09, 1·01–1·16), no educational qualifications (1·7, 1·4–1·9), a higher deprivation score (1·08, 1·07–1·09), and being part of any minority ethnic group (eg, Asian 2·5, 2·1–2·9). Participants unable to work or unemployed were at least 30% more likely to be in the SSVI category than were those with normal vision and, if employed, at least 9% more likely to have a lower status job.InterpretationThere are consistent patterns of associations between visual impairment across the full spectrum including, importantly, people with mild impairment, and known health determinants as well as key social outcomes. To our knowledge, our study provides evidence for the first time that policies tackling health inequalities as well as initiatives to address inequalities in ophthalmological clinical settings have the potential to improve visual health outcomes.FundingThis work was funded by the National Eye Research Centre. PMC is funded by the Ulverscroft Foundation and JSR receives part funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology. The study was undertaken at University College London Institute of Child Health, which receives a proportion of its funding from the Department of Health's NIHR Biomedical Research Centres funding scheme.     

Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood: associations and potential explanations

BackgroundEvidence of the association between childhood maltreatment and risk of adult cardiometabolic disease is sparse. We investigated associations of different forms of child maltreatment with adult cardiometabolic markers and potential explanations.MethodsIn the 1958 British birth cohort, we tested associations of childhood neglect (ascertained at age 7 years and 11 years) and abuse (physical, sexual, psychological, self-reported at 45 years) with adult (45 years) cardiometabolic markers (blood pressure, lipids, glycated haemoglobin [HbA_1c]) using linear and logistic regressions. Models were adjusted, first for factors affecting measurements (eg, room temperature, postal delay of blood sample, and for women oral contraception and hormone replacement therapy) and early life factors (eg, birthweight, socioeconomic status) and second for explanatory factors (change in body-mass index from childhood to adulthood, adult socioeconomic status, lifestyles, mental health). We applied multiple imputation to missing data on neglect and covariates, and restricted analyses to individuals with observed cardiometabolic data.FindingsAmong 9349 participants (4650 men, 4699 women), 12% (1143) reported any form of abuse. Prevalence for sexual abuse was 1·6% (149), physical abuse 6·0% (565), and psychological abuse 10·0% (926), and 1627 (17·4%) had two or more indicators of childhood neglect. Childhood neglect was associated in adulthood with raised triglycerides by 3·9% (95% CI 0·4–7·4) and HbA_1c by 1·2% (0·4–2·0), and for women lower HDL by 0·05 mmol/L (0·01–0·08), after adjusting for early life covariates. Physical abuse was associated with increased risk of high LDL (odds ratio [OR] 1·24, 95% CI 1·00–1·55) and raised HbA_1c in men by 2·4% (0·6–4·2), and lower HDL in women by 0·06 mmol/L (0·01–0·12). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. Psychological abuse was associated with increased risk of high triglycerides (OR 1·23, 1·03–1·46) and low HDL by 0·04 mmol/L (0·01–0·07). Maltreatment was not associated with raised blood pressure. All associations disappeared after further adjustment: adult lifestyle was a key explanatory factor for most associations, adult socioeconomic status was important for associations with neglect but not abuse, body-mass index was important for neglect and physical abuse, and mental health was important for psychological abuse.InterpretationChildhood maltreatments were associated with poor lipid and HbA_1c profiles decades later in adulthood in this population cohort. Explanations for associations varied by form of maltreatment. Further work is needed on the role of life-course explanatory factors and on effective strategies to reduce or prevent long-term health consequences of maltreatment.FundingThis work was funded by the Department of Health Policy Research Programme through the Public Health Research Consortium and supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health. Data collection for participants at age 45 years was funded by the Medical Research Council (grant G0000934).     

Child maltreatment and living standards in adulthood: findings from a prospective birth cohort

BackgroundChild maltreatment (abuse and neglect) has well-established effects on mental health, but less is known about its influence on adult life economic circumstances. We aimed to establish associations of child maltreatment with such outcomes in mid-life.MethodsWe used data from the 1958 British birth cohort (n=8076) on child neglect and abuse (physical, sexual, psychological, and witnessing abuse) and adult (at age 50 years) long-term sickness absence, not in employment, education, or training (NEET), lacking assets, income-related support, poor educational qualifications, financial insecurity, manual social class, and social mobility. Logistic regression was used to assess associations with maltreatment separately and combined as a score (0, 1, ≥2) with and without adjustment for potential confounding factors (maternal age, birthweight, birth order, social class at birth, parental education, household amenities, crowding, and tenure at age 7 years). Missing values were imputed with multiple imputation chained equations.FindingsAbuse prevalence varied from 1% (n=115) for sexual abuse to 10% (776) for psychological abuse; 1208 (16%) were defined as neglected. 1506 (19%) of the population experienced one type of maltreatment, and 585 (7%) experienced two or more. All maltreatments were associated with most outcomes (eg, for physical abuse, adjusted odds ratio [OR] of long-term sickness absence was 2·33, 95% CI 1·62–3·35). There was a trend across multiple types of maltreatment and unfavourable outcomes—eg, adjusted OR for NEET increased for one and two or more maltreatments compared with no maltreatment (1·30 [1·02–1·65] and 1·72 [1·28–2·33], respectively; p_trend<0·0001). Likewise, adjusted OR for three or more unfavourable adult outcomes increased with more maltreatment compared with none (1·94 [1·59–2·37] for one and 2·23 (1·75–2·84] for two or more; p_trend<0·0001). Children who were sexually abused or neglected were less likely than those not sexually abused or neglected, respectively, to be upwardly mobile from birth to mid-adulthood (unadjusted OR 0·49 [0·30–0·81] and 0·45 [0·39–0·53]).InterpretationChild abuse was reported retrospectively in adulthood, although child neglect and potential confounding factors were ascertained prospectively and we examined a wide range of adult socioeconomic outcomes that are important because of their costs to individuals and society. That childhood maltreatments were associated with most unfavourable outcomes in mid-adulthood, has implications for the broader field of health equity. The increasing risk of poor adult outcome associated with multiple types of maltreatment suggests that they have an accumulating burden.FundingThis work was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health.     

Trends in mental health and wellbeing among children and young people in the UK: a repeated cross-sectional study, 2000–14

BackgroundIncreasing concerns have been raised by professionals in education, health, and other sectors that mental health and wellbeing among children and young people in the UK might be deteriorating, but few nationally representative studies have tested this hypothesis. The objective of this study was to investigate trends in mental health and wellbeing among participants aged 4–24 years in UK national health surveys, 2000–14.MethodsWe used data from national health surveys of four UK countries: England (15 surveys, n=67 386, unweighted), Scotland (8, 16 862), Wales (8, 17 677), and Northern Ireland (1, 339). Trends were evaluated for children aged 4–12 years with the Strengths and Difficulties Questionnaires (SDQ) (parent or carer report) and for young people aged 16–24 years with the General Health Questionnaire (GHQ12) and Warwick Edinburgh Mental Health and Wellbeing Scores (WEMWBS) (self-report for both instruments). We assessed changes over time within countries using weighted t tests of the earliest and latest data for each country and linear regression models using all data.FindingsThere were no significant changes in SDQ scores in England, Wales, or Scotland. The proportion of Scottish parents reporting emotional problems was lower in 2014 than in 2003 (weighted proportions 43/908, 4·7% [95% CI 3·3–6·1] vs 175/1819, 9·6 [8·3–11·0]; p<0·001), but no significant overall trend in any country was seen. According to the GHQ scores, prevalence of mental health problems was higher in Scotland in 2014 than in 2003 (103/570, 18·1% [14·9–22·1] vs 117/931, 12·6 [10·4–14·7]; p=0·004), but unchanged in England. Regression analyses showed no significant trend. Wellbeing scores in England measured by WEMWBS were unchanged but were lower in Scotland in 2014 than in 2008 (49·5 [48·9–50·2] vs 50·5 [50·0–51·0], p=0·04). There was no significant overall trend.InterpretationPrevalence of mental health problems among children and young people has been largely stable in England and Wales over the past 14 years. In Scotland, no significant linear trends were identified, but the most recent data show fewer emotional problems in younger children along with more mental health problems, and decreased wellbeing among young adults.FundingNone.     

Associations between measures of child poverty,health-care use,and health outcomes: observational study of nationally representative English data

BackgroundThe UK Government has recently proposed the abolition of income-based measures of child poverty in favour of environmental, educational, and employment measures of deprivation. We aimed to study how strongly these proposed measures are associated with health outcomes among children and young people compared with a relative income measure.MethodsWith data from Hospital Episode Statistics for 2013–14 (n=16·4 million), we compared inequalities in inpatient admissions of children and young people aged 0–24 years per thousand (total and chronic conditions) using five deprivation measures (deciles of area-based measures: index of multiple deprivation [IMD], income, index of income deprivation affecting children [IDACI], education, living environment). With data from Health Survey for England for 2014 (n=3085), we compared inequalities in general health and long-standing illness reported by an individual, parent, or carer using equivalised household income quintiles, IMD quintiles, and whether the household reference person was employed (n=2417, 78·3%); not working (397, 12·9%); or retired, long-term sick, or other (274, 8·9%). The ratios of hospital admission rates and weighted prevalence of poor self-reported health were compared between the most and least deprived groups within each measure.FindingsTotal admission rates were higher among the most versus least deprived IMD deciles (ratio 1·60, 95% CI 1·59–1·61). The ratio was greater when income deciles were compared (1·69, 1·68–1·71) and smaller when analysis was by education (1·59, 1·58–1·60), IDACI (1·52, 1·51–1·53), and living environment (1·01, 1·00–1·02). The ratio was lower for admissions for chronic conditions (IMD 1·18, 1·16–1·20). Inequalities were largest when analysis was by income decile (1·25, 1·22–1·27). In the household-level analyses, inequalities in fair or poor, self or parent-reported health were seen when comparing lowest versus highest income quintiles (12·2% vs 3·9; ratio 3·12, 1·99–5·87), not working versus being employed (14·1 vs 6·1; 2·30, 1·68–3·03), and most versus least deprived IMD quintiles (9·8 vs 6·5; 1·49, 1·05–2·21). For long-standing illness, the equivalent data were: income (22·0 vs 11·0; 1·99, 1·50–2·77), employment (23·6 vs 15·8; 1·50, 1·21–1·81), and IMD (18·9 vs 17·2; 1·10, 0·88–1·39).InterpretationAlthough some important aspects of health such as use of primary care and community services are not included, this study shows that child poverty measures differ significantly in their association with key indicators of population health and health-care use. Of the deprivation measures studied here, hospital admissions were most strongly associated with income inequality. Self-reported health outcomes were also more strongly linked to household income than area-level IMD.FundingNone.     

Social cohesion,neighbourhood resilience,and health: evidence from New Deal for Communities programme

BackgroundThe contribution of socioeconomic determinants to health is well established, whereas the role of contextual and environmental factors, such as social community cohesion and control, remains understudied. These factors could possibly be the drivers of neighbourhood resilience, and hence help to explain variation in health among residents of communities situated in similarly disadvantaged neighbourhoods. This study aimed to assess the effects of different dimensions of social cohesion on resilience and health in disadvantaged neighbourhoods in the UK.MethodsTo explore which elements of social cohesion are associated with self-assessed health and mental health of residents living in communities in disadvantaged neighbourhoods, we conducted secondary data analysis using four waves (2002–08) of biannual repeat cross-sectional surveys collected for the New Deal for Communities programme (about 17 710 individuals per wave). Ten items depicting community social cohesion were subjected to principal axis factor analysis with varimax rotation. Two-level logit models accounted for the clustering of residents (level 1) within 39 areas (level 2), and were used to estimate the likelihood of reporting good self-assessed health and good mental health. To check robustness, analyses were repeated on pooled data after excluding duplications.FindingsThree social cohesion factors explained 54·4% of the total variance (Kaiser-Meyer-Olkin 0·784; χ²=36890·26, df=45, p<0·0001) and were classified as trust in local organisations, social network and neighbourliness, and control and participation. After adjustment for baseline and sociodemographic characteristics, two social cohesion factors (trust in local organisations, and social network and neighbourliness) were associated with good self-assessed health (odds ratio 1·29 [95% CI 1·22–1·35] and 1·09 [1·04–1·15], respectively). Associations with control and participation were not significant. Findings for mental health showed a similar pattern.InterpretationOur preliminary results illustrate the importance of social cohesion, particularly of trust in local organisations and social network and neighbourliness for self-assessed and mental health among residents of disadvantaged neighbourhoods. These findings support recent public health strategies that emphasise the importance of community cohesion and control to promote neighbourhood resilience and initiatives aimed at reduction of health and social inequalities.FundingThis work was supported by the National Institute for Health Research (NIHR) School for Public Health Research.     

Estimated effects of health conditions and risk factors on social and socioeconomic outcomes: mendelian randomisation of UK Biobank data

BackgroundA person's health might influence their ability to attend and concentrate at school, obtain, maintain, and be productive in employment, and maintain wellbeing and an active social life. We aimed to better understand the causal effects of health on social and socioeconomic outcomes, to help establish the broader benefits of investing in effective health policy, thereby strengthening the case for cross-governmental action to improve health and its wider determinants at the population level.MethodsWe used a mendelian randomisation approach to analyse data from the UK Biobank to estimate the effect of eight health conditions (asthma, breast cancer, coronary heart disease, depression, diabetes, eczema, migraine, osteoarthritis) and five risk factors (alcohol intake, body-mass index [BMI], cholesterol, systolic blood pressure, smoking) with known genetic determinants on 19 socioeconomic outcomes in men and women of white British ancestry, aged between 39 and 72 years. The main outcome measures were annual household income, deprivation (measured using the Townsend deprivation index [TDI]), degree-level education, satisfaction with health, and self-reported happiness and loneliness. UK Biobank received ethical approval from the Research Ethics Committee (11/NW/0382).FindingsOur cohort consisted of 337 009 men and women. Of the five risk factors, our results showed that higher BMI, smoking, and alcohol use affected socioeconomic outcomes. Smoking was estimated to reduce household income (mean difference –£24 394 [95% CI –£33 403 to –£15 384]), the chance of owning accommodation (absolute percentage change [APC] –21·5% [95% CI –29·3 to –13·6), being satisfied with health (APC –32·4% [–48·9 to –15·8), and of receiving a university degree (APC –73·8% [–90·7 to –56·9), and increased deprivation (mean difference in TDI 1·89 [1·13 to 2·64]). Of the eight health conditions, asthma decreased household income (mean difference –£13 519 [–£18 794 to –£8 243]), the chance of having a university degree (APC –17·0% [–25·3 to –8·7), and the chance of cohabiting (APC –11·0% [–18·0 to –4·0]), and migraine reduced the chance of having a weekly leisure or social activity (APC –43·7% [–66·0 to –21·3]), especially in men. No other associations were found.InterpretationHigher BMI, smoking, and alcohol use were all estimated to negatively affect multiple social and socioeconomic outcomes. Associations were not detected between health conditions and socioeconomic outcomes with the exceptions of depression, asthma, and migraine. Our findings might reflect true null associations, or be a result of selection bias (given the relative good health and older age of participants in UK Biobank compared with the eligible UK population), or a lack of power to detect effects.FundingThe Health Foundation.     

Premature mortality in adult survivors of child abuse and neglect: a nationwide birth cohort study

BackgroundChild neglect and abuse are not uncommon. Both are associated with deleterious outcomes in adulthood, but there is sparse evidence on the association between such trauma and premature adult mortality. We aimed to establish whether different types of child maltreatments were associated with all-cause mortality in mid-adulthood and examined potential intermediaries of this association.MethodsUsing the 1958 British birth cohort (n=9310), we examined associations between child neglect (prospectively recorded at years 7 and 11 of age) and abuse (physical, psychological, witnessing and sexual; self-reported at years 44–45 of age) with all-cause mortality, using Cox proportional hazard models adjusted for early-life covariates and other maltreatment types. We tested interactions between each maltreatment type and sex; there was little evidence of effect modification (p_interaction>0·001), hence models also adjust for sex. Mortality follow-up was between 2002–03 and December 2016 (participants aged 44–45 to 58 years). Death was ascertained from the National Health Service Central Register (n=296) or from survey updates (n=16). Potential intermediaries included: adult social factors, health behaviours, adiposity, mental health, cardiometabolic markers, and growth (height) at years 7 to 45 of age. Missing data were imputed via multiple imputation.FindingsChild maltreatment prevalence varied from 1·6% (n=149; sexual abuse) to 11% (n=1000; physiological abuse); 77% (n=6536) reported no maltreatment. Neglect and abuse (physical and sexual) were associated with increased risk of premature death, independent of covariates and other maltreatment types; adjusted hazard ratios (HRs) were 1·47 (95% CI 1·05–2·05) for neglect, 1·73 (1·10–2 ·71) for physical abuse, and 2·60 (1·49–4·52) for sexual abuse. Associations for neglect and physical abuse disappeared after adjustment for adult health behaviours, and, for neglect only, social factors; other intermediaries had little effect on these associations. Sexual abuse associations were largely unexplained by examined intermediaries. Risk of all-cause mortality increased with the number of maltreatments (versus none): adjusted HRs were 1·44 (1·07–1·93) for one maltreatment and 2·04 (1·45–2·87) for at least two maltreatments.InterpretationChild neglect and physical and sexual abuse are associated with increased risk of premature mortality in mid-adulthood. Our findings highlight the importance of preventing specific child maltreatments and of supporting survivors to potentially mitigate differences in premature mortality. Child abuse was reported retrospectively and estimated associations for sexual abuse might be imprecise due to low prevalence. However, child neglect, potential confounders, and mediators were ascertained prospectively.FundingUS National Institute on Aging, the UK Economic and Social Research Council, the UK Biotechnology and Biological Sciences Research Council, and the UK National Institute for Health Research Biomedical Research Centre.     

Childhood adversities and mid-late depressive symptoms over the life course: evidence from a retrospective cohort study in China

Background

The cumulative effect of childhood adversities on depressive symptoms in later life is well documented in many countries. However, there is a dearth of accurate information about this effect in the Chinese population. We aimed to examine the cumulative effect of childhood adversities on depressive symptoms in mid-to-late life, using data from the Chinese population.

Maternal adversity and variation in the rate of children entering local authority care during infancy in England: a longitudinal ecological study

BackgroundEngland has seen unsustainable increases in the number of children entering care in recent years. One in five children entering care are infants, although rate of infant entry to care varies considerably by local authority. Understanding this variation and its drivers could inform upstream strategies to improve outcomes for children at risk of, or receiving, care. Parental ill health or risk behaviour from pregnancy onwards could trigger state involvement in infants’ care. Therefore, we explored whether adversity indicated within women's hospitalisation history, pre-delivery, could help to explain local authority variation in rates of infant entry to care.MethodsWe combined data on hospitalisations (hospital episode statistics) and entries to care (children looked after return) with publicly available data on local authority characteristics (2011 Census, Office for National Statistics Population Estimates, and Public Health England Fingertips) for 131 English local authorities. Our primary outcome was annual (April–March) local authority rate of infant entry to care (per 10 000 infants in the local authority population) between April 1, 2006, and March 31, 2014. We used linear mixed-effects models to analyse the relationship between the outcome and local authority-specific proportion of livebirths with maternal history of adversity-related hospital admissions (ie, substance misuse, mental health problems, or violence-related admissions in the 3 years before delivery), adjusted for seven other predictors for entry to care (including local authority-specific prevalence of maternal deprivation, births to teenage mothers, and community violence).FindingsRate of infant entry to care (mean 85·16 per 10 000 [SD 41·07, range 0·00–318·51) and proportion of livebirths with maternal history of adversity-related hospital admissions (mean 4·62% [2·44, 0·52–16·19]) varied greatly by local authority. Prevalence of maternal adversity accounted for 24% (95% CI 14–35%) of variation in rate of entry. After adjustment, a percentage point increase in prevalence of maternal adversity (both within and between local authorities) was associated with an additional 2·56 infants (95% CI 1·31–3·82) per 10 000 entering care.InterpretationPrevalence of maternal adversity before birth helps explain differing rates of infant entry to care among English local authorities. This study also highlights the need for linked parent–child data on health and child protection to inform policy interventions to improve maternal wellbeing and potentially reduce entries to care.FundingNational Institute for Health Research—Great Ormond Street Hospital Biomedical Research Centre.     

Socioeconomic inequalities in risk of small for gestational age birth in primiparous and multiparous women: analysis of a population-based cohort in the south of England

Background

Small for gestational age (SGA) babies have increased risk of later morbidity. Birth of the first child is a life-changing event that affects biology, behaviour, and social circumstances. We aimed to examine socioeconomic inequalities in SGA risk, and explore potential mediators and effect modification by parity.