Abstract
This paper investigates the role that socioeconomic inequality in postnatal depression might play in intergenerational transmission of inequality. Infants’ development is thought to be particularly sensitive to mothers’ mental health at this time, suggesting that greater early-life exposure to maternal depression among disadvantaged groups might be a root of later socioeconomic inequalities. Heightened contact with health services during this period presents opportunities for intervention, but higher unmet need for treatment of postnatal depression among the disadvantaged might be widening inequalities. The aim of this study is to quantify the potential contribution of postnatal depression to socioeconomic inequalities in adverse childhood health and development outcomes. Regression-based decomposition of the concentration index is used to explore the association between income inequality in postnatal depressive symptoms and income inequality in children’s outcomes. Four problems of early adolescence are explored: emotional and conduct problems, special educational needs, and low self-assessed health. Data are taken from the UK Millennium Cohort Study, with a sample of 4359 mothers and children with complete data on outcomes and covariates, and a second sample of 5441 when missing covariates are filled using multiple imputation. The key finding is that socioeconomic inequality in maternal postnatal depression is a significant contributor to inequalities in special educational needs, emotional problems, and low self-assessed health for children at age 11 years, even after accounting for a range of other factors that might explain such associations. These findings highlight the importance of understanding the impact of postnatal depression interventions on inequalities, and the downstream influence on children’s outcomes. Addressing inequalities in mothers’ postnatal depression might be an avenue for reducing early-life disadvantage for children.
Similar content being viewed by others
References
Reiss, F.: Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc. Sci. Med. 90, 24–31 (2013). https://doi.org/10.1016/j.socscimed.2013.04.026
Case, A., Lubotsky, D., Paxson, C.: Economic status and health in childhood: the origins of the gradient. Am. Econ. Rev. 92(5), 1308–1334 (2002)
Fleurbaey, M., Schokkaert, E.: Unfair health inequality. In: Culyer, A.J. (ed.) Encyclopedia of Health Economics. Academic Press, Amsterdam (2014)
Marmot, M., Bell, R.: Fair society, healthy lives. Public. Health. 126(Suppl 1), S4–S10 (2012). https://doi.org/10.1016/j.puhe.2012.05.014
Haas, S.: Trajectories of functional health: the ‘long arm’ of childhood health and socioeconomic factors. Soc. Sci. Med. 66(4), 849–861 (2008). https://doi.org/10.1016/j.socscimed.2007.11.004
Goodman, A., Joyce, R., Smith, J.P.: The long shadow cast by childhood physical and mental problems on adult life. Proc. Natl. Acad. Sci. 108, 6032–6037 (2011)
Crombie, I.K., Irvine, L., Elliott, L., Wallace, H.: Closing the health inequalities gap: an intenational perspective. World Health Organization Europe, Copenhagen (2005)
Elgar, F.J., Pförtner, T.-K., Moor, I., De Clercq, B., Stevens, G.W., Currie, C.: Socioeconomic inequalities in adolescent health 2002–2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study. Lancet. 385(9982), 2088–2095 (2015)
Gavin, N.I., Gaynes, B.N., Lohr, K.N., Meltzer-Brody, S., Gartlehner, G., Swinson, T.: Perinatal depression: a systematic review of prevalence and incidence. Obstet. Gynecol. 106(5 Pt 1), 1071–1083 (2005). https://doi.org/10.1097/01.AOG.0000183597.31630.db
Roberts, J., Donkin, A., Marmot, M.: Opportunities for reducing socioeconomic inequalities in the mental health of children and young people—reducing adversity and increasing resilience. J. Public. Mental. Health. 15(1), 4–18 (2016)
Matijasevich, A., Golding, J., Smith, G.D., Santos, I.S., Barros, A.J., Victora, C.G.: Differentials and income-related inequalities in maternal depression during the first two years after childbirth: birth cohort studies from Brazil and the UK. Clin. Pract. Epidemiol. Mental. Health. 5, 12 (2009). https://doi.org/10.1186/1745-0179-5-12
Seguin, L., Potvin, L., St-Denis, M., Loiselle, J.: Socio-environmental factors and postnatal depressive symptomatology: a longitudinal study. Women. Health. 29(1), 57–72 (1999)
Ban, L., Gibson, J.E., West, J., Fiaschi, L., Oates, M.R., Tata, L.J.: Impact of socioeconomic deprivation on maternal perinatal mental illnesses presenting to UK general practice. Brit. J. Gen. Pract. 62(603), e671–e678 (2012). https://doi.org/10.3399/bjgp12x656801
Goyal, D., Gay, C., Lee, K.A.: How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers? Women’s. Health. Issues. 20(2), 96–104 (2010)
Mayberry, L.J., Horowitz, J.A., Declercq, E.: Depression symptom prevalence and demographic risk factors among US women during the first 2 years postpartum. J. Obstet. Gynecol. Neonatal. Nurs. 36(6), 542–549 (2007). https://doi.org/10.1111/j.1552-6909.2007.00191.x
O’Hara, M.W., McCabe, J.E.: Postpartum depression: current status and future directions. Annu. Rev. Clin. Psychol. 9, 379–407 (2013)
Hahn-Holbrook, J., Cornwell-Hinrichs, T., Anaya, I.: Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front. Psychiatry. 8, 248 (2018)
Stein, A., Pearson, R.M., Goodman, S.H., Rapa, E., Rahman, A., McCallum, M., Howard, L.M., Pariante, C.M.: Effects of perinatal mental disorders on the fetus and child. Lancet. 384(9956), 1800–1819 (2014)
Goodman, S.H., Rouse, M.H., Connell, A.M., Broth, M.R., Hall, C.M., Heyward, D.: Maternal depression and child psychopathology: a meta-analytic review. Clin. Child. Fam. Psychol. Rev. 14(1), 1–27 (2011)
Ahun, M.N., Côté, S.M.: Maternal depressive symptoms and early childhood cognitive development: a review of putative environmental mediators. Arch. Women’s. Mental. Health. 22(1), 15–24 (2019). https://doi.org/10.1007/s00737-018-0870-x
Goodman, J.H.: Postpartum depression beyond the early postpartum period. J. Obstet. Gynecol. Neonatal. Nurs. 33(4), 410–420 (2004). https://doi.org/10.1177/0884217504266915
Philipps, L.H.C., O’Hara, M.W.: Prospective-study of postpartum depression—41/2-year follow-up of women and children. J. Abnorm. Psychol. 100(2), 151–155 (1991). https://doi.org/10.1037/0021-843x.100.2.151
Turney, K.: Prevalence and correlates of stability and change in maternal depression: evidence from the fragile families and child wellbeing study. PLoS. One. 7(9), e45709 (2012). https://doi.org/10.1371/journal.pone.0045709
Netsi, E., Pearson, R.M., Murray, L., Cooper, P., Craske, M.G., Stein, A.: Association of persistent and severe postnatal depression with child outcomes. JAMA. Psychiatry. 75(3), 247–253 (2018)
Stein, A., Pearson, R.M., Goodman, S.H., Rapa, E., Rahman, A., McCallum, M., Howard, L.M., Pariante, C.M.: Effects of perinatal mental disorders on the fetus and child. Lancet. 384(9956), 1800–1819 (2014). https://doi.org/10.1016/S0140-6736(14)61277-0
Tsivos, Z.-L., Calam, R., Sanders, M.R., Wittkowski, A.: Interventions for postnatal depression assessing the mother–infant relationship and child developmental outcomes: a systematic review. Int. J. Women’s. Health. 7, 429 (2015)
Stein, A., Netsi, E., Lawrence, P.J., Granger, C., Kempton, C., Craske, M.G., Nickless, A., Mollison, J., Stewart, D.A., Rapa, E., West, V., Scerif, G., Cooper, P.J., Murray, L.: Mitigating the effect of persistent postnatal depression on child outcomes through an intervention to treat depression and improve parenting: a randomised controlled trial. Lancet. Psychiatry. 5(2), 134–144 (2018). https://doi.org/10.1016/S2215-0366(18)30006-3
Newton, J.: Preventing Mental Ill-Health: Informing Public Health Planning and Mental Health Practice. Taylor and Francis, Routledge (2013)
Murray, L., Woolgar, M., Murray, J., Cooper, P.: Self-exclusion from health care in women at high risk for postpartum depression. J. Public. Health. Med. 25(2), 131–137 (2003). https://doi.org/10.1093/pubmed/fdg028
Goyal, N.K., Hall, E.S., Jones, D.E., Meinzen-Derr, J.K., Short, J.A., Ammerman, R.T., Van Ginkel, J.B.: Association of maternal and community factors with enrollment in home visiting among at-risk, first-time mothers. Am. J. Public. Health. 104(S1), S144–S151 (2014)
O’Mahen, H.A., Richards, D.A., Woodford, J., Wilkinson, E., McGinley, J., Taylor, R.S., Warren, F.C.: Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol. Med. 44(8), 1675–1689 (2014). https://doi.org/10.1017/S0033291713002092
Bate, A., Parkin, E., Mackley, A.: Perinatal mental illness: debate pack. London House of Commons Library, vol. CDP-2018-0178 (2018). https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CDP-2018-0178
Jackson, M.I., Kiernan, K., McLanahan, S.: Maternal education, changing family circumstances, and children’s skill development in the United States and UK. Ann. Am. Acad. Political. Soc. Sci. 674(1), 59–84 (2017)
Ban, L., Gibson, J.E., West, J., Tata, L.J.: Association between perinatal depression in mothers and the risk of childhood infections in offspring: a population-based cohort study. BMC. Public. Health. 10, 799 (2010). https://doi.org/10.1186/1471-2458-10-799
Turney, K.: Maternal depression and childhood health inequalities. J. Health. Soc. Behav. 52(3), 314–332 (2011). https://doi.org/10.1177/0022146511408096
Sanger, C., Iles, J.E., Andrew, C.S., Ramchandani, P.G.: Associations between postnatal maternal depression and psychological outcomes in adolescent offspring: a systematic review. Arch. Women. Mental. Health. 18(2), 147–162 (2015). https://doi.org/10.1007/s00737-014-0463-2
Wagstaff, A., Paci, P., van Doorslaer, E.: On the measurement of inequalities in health. Soc. Sci. Med. 33(5), 545–557 (1991)
Wagstaff, A., van Doorslaer, E., Watanabe, N.: On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J. Econom. 112(1), 207–223 (2003). https://doi.org/10.1016/s0304-4076(02)00161-6. (Pii S0304-4076(02)00161-6)
Connelly, R., Platt, L.: Cohort profile: UK millennium cohort study (MCS). Int. J. Epidemiol. 43(6), 1719–1725 (2014). https://doi.org/10.1093/ije/dyu001
Dex, S., Joshi, H.: Children of the 21st century: from birth to nine months. Policy Press, Bristol (2005)
Gjerdingen, D., Crow, S., McGovern, P., Miner, M., Center, B.: Postpartum depression screening at well-child visits: validity of a 2-question screen and the PHQ-9. Ann. Fam. Med. 7(1), 63–70 (2009)
Tonei, V.: Mother’s mental health after childbirth: does the delivery method matter? J. Health. Econ. 63, 182–196 (2019). https://doi.org/10.1016/j.jhealeco.2018.11.006
Centre for longitudinal studies: measuring signs of psychological distress or depression in teenagers and adults: the malaise inventory. http://doc.ukdataservice.ac.uk/doc/5805/mrdoc/pdf/MalaiseQuestions.pdf. Accessed 17 Aug 2015
Boyle, D., Burton, E.: Making Sense of SEN: Special Educational Needs, a Guide for Donors and Grant-Makers. New Philanthropy Capital, London (2004)
Goodman, R.: The strengths and difficulties questionnaire: a research note. J. Child. Psychol. Psychiatry. 38(5), 581–586 (1997)
Goodman, R., Ford, T., Simmons, H., Gatward, R., Meltzer, H.: Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br. J. Psychiatry. 177(6), 534–539 (2000)
Goodman, A., Lamping, D.L., Ploubidis, G.B.: When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the strengths and difficulties questionnaire (SDQ): data from British parents, teachers and children. J. Abnorm. Child. Psychol. 38(8), 1179–1191 (2010)
Shaw, M., Lawlor, D.A., Najman, J.M.: Teenage children of teenage mothers: psychological, behavioural and health outcomes from an Australian prospective longitudinal study. Soc. Sci. Med. 62(10), 2526–2539 (2006)
Riley, A.W.: Evidence that school-age children can self-report on their health. Ambul. Pediatr. 4(4), 371–376 (2004)
Hansen, K., Johnson, J., Calderwood, L., Mostafa, T., Platt, L., Rosenberg, R., Smith, K.: Millennium cohort study: a guide to the datasets. First, second, third, fourth and fifth surveys. In: Hansen, K. (ed.) Centre for Longitudinal Studies. University of London, London (2014)
Noble, M., Wright, G., Smith, G., Dibben, C.: Measuring multiple deprivation at the small-area level. Environ. Plann. A. 38(1), 169–185 (2006)
Anders, Y., Sammons, P., Taggart, B., Sylva, K., Melhuish, E., Siraj-Blatchford, I.: The influence of child, family, home factors and pre-school education on the identification of special educational needs at age 10. Br. Edu. Res. J. 37(3), 421–441 (2011)
Plewis, I., Calderwood, L., Hawkes, D., Hughes, G., Joshi, H.: Millennium Cohort Study: Technical Report on Sampling. Centre for Longitudinal Studies, London (2007)
O’Donnell, O.A., Wagstaff, A.: Analyzing health equity using household survey data: a guide to techniques and their implementation. World Bank Publications, Washington (2008)
Kjellsson, G., Gerdtham, U.G.: On correcting the concentration index for binary variables. J. Health. Econ. 32(3), 659–670 (2013). https://doi.org/10.1016/j.jhealeco.2012.10.012
Erreygers, G.: Correcting the concentration index. J. Health. Econ. 28, 569 (2009). https://doi.org/10.1016/j.jhealeco.2008.02.003
van Doorslaer, E., Koolman, X., Jones, A.M.: Explaining income-related inequalities in doctor utilisation in Europe. Health. Econ. 13(7), 629–647 (2004). https://doi.org/10.1002/Hec.919
Wilson, G.: The effects of season of birth, sex and cognitive abilities on the assessment of special educational needs. Educ. Psychol. 20(2), 153–166 (2000)
Dearden, L., Sibieta, L., Sylva, K.: The socio-economic gradient in early child outcomes: evidence from the Millennium Cohort Study. Longitud. Life. Course. Stud. 2(1), 19–40 (2011)
Kelly, Y., Sacker, A., del Bono, E., Francesconi, M., Marmot, M.: What role for the home learning environment and parenting in reducing the socioeconomic gradient in child development? Findings from the Millennium Cohort Study. Arch. Dis. Child. 96, 832–837 (2011)
Zilanawala, A., Sacker, A., Nazroo, J., Kelly, Y.: Ethnic differences in children’s socioemotional difficulties: findings from the Millennium Cohort Study. Soc. Sci. Med. 134, 95–106 (2015). https://doi.org/10.1016/j.socscimed.2015.04.012
Sabates, R., Dex, S.: The impact of multiple risk factors on young children’s cognitive and behavioural development. Child. Soc. 29(2), 95–108 (2015). https://doi.org/10.1111/chso.12024
Jo, H., Schieve, L.A., Sharma, A.J., Hinkle, S.N., Li, R., Lind, J.N.: Maternal prepregnancy body mass index and child psychosocial development at 6 years of age. Pediatrics. 135, 2014–3058 (2015)
Washbrook, E., Gregg, P., Propper, C.: A decomposition analysis of the relationship between parental income and multiple child outcomes. J. R. Stat. Soc. Stat. 177(4), 757–782 (2014). https://doi.org/10.1111/rssa.12074
Gledhill, J., Ford, T., Goodman, R.: Does season of birth matter?: the relationship between age within the school year (season of birth) and educational difficulties among a representative general population sample of children and adolescents (aged 5–15) in Great Britain. Res. Educ. 68(1), 41–47 (2002)
Rubin, D.B.: Multiple Imputation for Nonresponse in Surveys, vol. 81. Wiley, New York (2004)
Erreygers, G., Kessels, R.: Regression-based decompositions of rank-dependent indicators of socioeconomic inequality of health. In: Rosa Dias, P., O’Donnell, O. (eds.) Health and Inequality (Research on Economic Inequality, Volume 21, Chapter 9). Emerald Group Publishing Limited, London (2013)
Hay, D.F., Pawlby, S., Sharp, D., Asten, P., Mills, A., Kumar, R.: Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. J. Child. Psychol. Psychiatry. 42(7), 871–889 (2001)
Zhang, C., Zhao, C., Liu, X., Wei, Q., Luo, S., Guo, S., Zhang, J., Wang, X., Scherpbier, R.W.: Inequality in early childhood neurodevelopment in six poor rural counties of China: a decomposition analysis. Int. J. Equity. Health. 16(1), 212 (2017)
Straatmann, V., Campbell, M., Rutherford, C., Wickham, S., Taylor-Robinson, D.: OP61 understanding social inequalities in child mental health: findings from the uk millennium cohort study. J. Epidemiol. Commun. H. 71(Suppl 1), A31 (2017). https://doi.org/10.1136/jech-2017-SSMAbstracts.60
Sahrakorpi, N., Koivusalo, S.B., Eriksson, J.G., Kautiainen, H., Stach-Lempinen, B., Roine, R.P.: Perceived financial satisfaction, health related quality of life and depressive symptoms in early pregnancy. Matern. Child. Health. J. 21(7), 1493–1499 (2017)
Petrou, S., Kupek, E., Gray, R.: Income inequalities and self-reported maternal health status: cross-sectional national survey. BJOG Int. J. Obstet. Gynecol. 114(8), 1018–1022 (2007). https://doi.org/10.1111/j.1471-0528.2007.01413.x
Halligan, S.L., Murray, L., Martins, C., Cooper, P.J.: Maternal depression and psychiatric outcomes in adolescent offspring: a 13-year longitudinal study. J. Affect. Disord. 97(1–3), 145–154 (2007). https://doi.org/10.1016/j.jad.2006.06.010
Hay, D.F., Pawlby, S., Waters, C.S., Sharp, D.: Antepartum and postpartum exposure to maternal depression: different effects on different adolescent outcomes. J. Child. Psychol. Psychiatry. 49(10), 1079–1088 (2008). https://doi.org/10.1111/j.1469-7610.2008.01959.x
Pearson, R.M., Evans, J., Kounali, D., Lewis, G., Heron, J., Ramchandani, P.G., O’Connor, T.G., Stein, A.: Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA. Psychiatry. 70(12), 1312–1319 (2013). https://doi.org/10.1001/jamapsychiatry.2013.2163
Boardman, J.D.: Self-rated health among US adolescents. J. Adolesc. Health. 38(4), 401–408 (2006). https://doi.org/10.1016/j.jadohealth.2005.01.006
Bauldry, S., Shanahan, M.J., Boardman, J.D., Miech, R.A., Macmillan, R.: A life course model of self-rated health through adolescence and young adulthood. Soc. Sci. Med. 75(7), 1311–1320 (2012). https://doi.org/10.1016/j.socscimed.2012.05.017
De Los Reyes, A., Kazdin, A.E.: Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychol. Bull. 131(4), 483 (2005)
Najman, J.M., Williams, G.M., Nikles, J., Spence, S., Bor, W., O’callaghan M, M., Brocque, R.L., Andersen, M.J.: Mothers’ mental illness and child behavior problems: cause-effect association or observation bias? J. Am. Acad. Child. Adolesc. Psychiatry. 39(5), 592–602 (2000)
Bradley, R.H., Corwyn, R.F.: Socioeconomic status and child development. Annu. Rev. Psychol. 53(1), 371–399 (2002)
Brockington, I.: Postpartum psychiatric disorders. Lancet. 363(9405), 303–310 (2004). https://doi.org/10.1016/S0140-6736(03)15390-1
Dickerson, A., Popli, G.K.: Persistent poverty and children’s cognitive development: evidence from the UK Millennium Cohort Study. J. R. Stat. Soc. Stat. 179(2), 535–558 (2016). https://doi.org/10.1111/rssa.12128
Gawlik, S., Muller, M., Hoffmann, L., Dienes, A., Wallwiener, M., Sohn, C., Schlehe, B., Reck, C.: Prevalence of paternal perinatal depressiveness and its link to partnership satisfaction and birth concerns. Arch. Women. Mental. Health. 17(1), 49–56 (2014). https://doi.org/10.1007/s00737-013-0377-4
Edoka, I.P., Petrou, S., Ramchandani, P.G.: Healthcare costs of paternal depression in the postnatal period. J. Affect. Disord. 133(1–2), 356–360 (2011). https://doi.org/10.1016/j.jad.2011.04.005
Schumacher, M., Zubaran, C., White, G.: Bringing birth-related paternal depression to the fore. Women. Birth. 21(2), 65–70 (2008). https://doi.org/10.1016/j.wombi.2008.03.008
Woodward, A., Kawachi, I.: Why reduce health inequalities? J. Epidemiol. Commun. H. 54(12), 923–929 (2000)
Asaria, M., Griffin, S., Cookson, R., Whyte, S., Tappenden, P.: Distributional cost-effectiveness analysis of health care programmes–a methodological case study of the UK bowel cancer screening programme. Health. Econ. 24(6), 742–754 (2015). https://doi.org/10.1002/hec.3058
Armstrong, K., Morris, J.: Promoting secure attachment, maternal mood and child health in a vulnerable population: a randomized controlled trial. J. Paediatr. Child. H. 36(6), 555–562 (2000)
Zlotnick, C., Tzilos, G., Miller, I., Seifer, R., Stout, R.: Randomized controlled trial to prevent postpartum depression in mothers on public assistance. J. Affect. Disord. 189, 263–268 (2016). https://doi.org/10.1016/j.jad.2015.09.059
Cowley, S., Whittaker, K., Malone, M., Donetto, S., Grigulis, A., Maben, J.: Why health visiting? Examining the potential public health benefits from health visiting practice within a universal service: a narrative review of the literature. Int. J. Nurs. Stud. 52(1), 465–480 (2015). https://doi.org/10.1016/j.ijnurstu.2014.07.013
Brugha, T.S., Morrell, C.J., Slade, P., Walters, S.J.: Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care. Psychol. Med. 41(4), 739–748 (2011). https://doi.org/10.1017/S0033291710001467
Whitehead, M., Dahlgren, G.: Levelling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health. World Health Organization, Copenhagen (2006)
Kessels, R., Erreygers, G.: Structural equation modeling for decomposing rank-dependent indicators of socioeconomic inequality of health: an empirical study. Health. Econ. Rev. 6(1), 56 (2016)
Acknowledgements
I am very grateful to Guido Erreygers, Stavros Petrou, Dennis Petrie, and Emily Lancsar for their helpful advice and comments on earlier versions of this paper.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ride, J. Is socioeconomic inequality in postnatal depression an early-life root of disadvantage for children?. Eur J Health Econ 20, 1013–1027 (2019). https://doi.org/10.1007/s10198-019-01073-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10198-019-01073-y
Keywords
- UK
- Socioeconomic inequality
- Postnatal depression
- Childhood difficulties
- Decomposition of the concentration index