Social Inequality and Children's Mental Health

描述（由申请人提供）：儿童心理健康的社会梯度是有充分记录的。不太清楚的是，社会不平等如何影响儿童的发展。我们建议从三个层面来分析这个问题。在社区层面，我们将评估儿童居住的当地区域的生态计量特征，并测试社区层面的社会过程（如集体效能）是否介导了社区贫困对儿童心理健康的影响。在家庭层面，我们将追踪社会经济剥夺对近端家庭过程（暴露于暴力、粮食不安全）的影响，并测试早期生活压力事件如何成为生物学上的内在因素。在个人层面上，我们将使用遗传信息纵向设计来检验儿童对其社会地位的看法可以帮助解释为什么一些在贫困中长大的儿童会出现健康问题，而不是出现健康问题。方法：我们将使用来自环境风险（E-Risk）研究的数据进行本研究。E-Risk是一项纵向研究（从出生到12岁），研究对象是1994-1995年在英格兰和威尔士出生的具有全国代表性的双胞胎样本（N=2232），这些样本选自英国国家统计局（ONS）创建的登记处。我们对这些孩子进行了12年的跟踪调查，监测他们的发展和环境暴露情况，包括多种形式的社会不平等。我们收集了儿童及其家庭在6个时间点（出生、2岁、5岁、7岁、10岁和12岁）的数据。我们还对儿童成长的社区进行了两次独立的生态计量评估，使我们能够在社区和家庭层面上研究儿童生活中的不平等现象。创新与意义：提出的研究对理解和减少健康不平等都有意义。在每个分析层次上，我们采用过程方法来检验社会不平等如何影响儿童的发展。在社区层面，我们将确定社区层面干预的可塑因素，这可能比个人层面的干预更具成本效益和实用性。在家庭层面，我们将测试家庭社会经济条件对儿童发展的直接和间接贡献，并确定具体的干预目标，以减少儿童心理健康方面的社会不平等。在个人层面上，如果我们发现儿童的主观社会地位与其健康之间的环境中介效应，其含义将指出儿童对社会地位的看法是可塑的干预目标，并为赋予儿童权力开辟了干预可能性的领域。公共卫生相关性：在儿童心理健康问题的人口差异中，约有一半是由环境因素造成的，而社会不平等是人生头十年健康的最突出决定因素。然而，预防早期出现的心理健康问题的希望需要进行研究，以确定不平等影响健康的潜在机制。我们提出的研究测试了社会不平等如何影响儿童健康，旨在确定社区、家庭和个人层面的可塑干预目标。

DESCRIPTION (provided by applicant): The social gradient in children's mental health is well documented. What is less clear is how social inequalities influence children's development. We propose to examine this question at three levels of analysis. At the neighborhood level, we will assess ecometric properties of the local areas in which children reside and test whether neighborhood-level social processes, such as collective efficacy, mediate the effects of neighborhood poverty on children's mental health. At the family level, we will trace the effects of socioeconomic deprivation on proximal family processes (exposure to violence, food insecurity) and test how stressful early life events may become biologically embedded. At the individual level, we will use a genetically-informative longitudinal design to test the hypothesis that children's perceptions of their social position can help to explain why some children growing up in poverty do versus do not develop health problems. METHOD: We will conduct this research using data from the Environmental Risk (E-Risk) Study. E-Risk is a longitudinal study (from birth to age 12) of a nationally-representative sample of twins born in England and Wales in 1994-1995 (N=2232), selected from a registry created with the UK Office of National Statistics (ONS). We have tracked the children over the first 12 years of their lives, monitoring their development and their environmental exposures, including multiple forms of social inequality. We have gathered data about the children and their families at 6 time points (birth, ages 2, 5, 7, 10, and 12 years). We have also conducted two independent ecometric assessments of the neighborhoods in which the children are growing up, enabling us to study inequalities in children's lives at both the community and family level. INNOVATION AND SIGNIFICANCE: The proposed research has implications both for understanding and reducing health inequalities. At each level of analysis, we adopt a process approach to test how social inequalities influence children's development. At the neighborhood level, we will identify malleable factors for community-level interventions which may be more cost effective and pragmatic than individual-level interventions. At the family level, we will test the direct and indirect contributions of family socio-economic conditions to children's development and identify specific intervention targets for reducing social inequalities in children's mental health. At the individual level, if we discover environmentally-mediated effects between children's subjective social status and their health, the implications would point to children's perceptions of social status as malleable intervention targets and open up a realm of intervention possibilities for empowering children. PUBLIC HEALTH RELEVANCE: About half of the population variation in children's mental health problems is accounted for by environmental factors, and social inequalities stand out as the most prominent determinants of health in the first decade of life. However, the hope of preventing early- emerging mental health problems requires research to identify the underlying mechanisms by which inequalities affect health. Our proposed research tests how social inequalities affect children's health, aiming to identify malleable intervention targets at the community, family, and individual levels.