Social Inequality and Children's Mental Health

描述(由申请者提供)：儿童心理健康的社会梯度被很好地记录下来。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分析这个问题。在社区层面，我们将评估儿童所在地区的生态计量特性，并测试社区层面的社会过程，如集体效能，是否中介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亲家庭过程(暴露于暴力、食物不安全)的影响，并测试压力较大的早期生活事件可能如何在生物上嵌入。在个人层面上，我们将使用遗传信息的纵向设计来检验这样一个假设，即儿童对其社会地位的感知有助于解释为什么一些在贫困中长大的儿童会出现健康问题，而不是没有。方法：我们将使用环境风险(E-RISK)研究中的数据进行这项研究。E-Risk是对1994-1995年间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)进行的纵向研究(从出生到12岁)，从英国国家统计局(ONS)创建的登记中挑选出来。我们对儿童出生后的头12年进行了跟踪，监测他们的发育和他们在环境中的暴露，包括多种形式的社会不平等。我们收集了6个时间点(出生、2岁、5岁、7岁、10岁和12岁)儿童及其家人的数据。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。创新和意义：这项拟议的研究对理解和减少健康不平等具有重要意义。在每个分析层面上，我们采用过程方法来测试社会不平等如何影响儿童的发展。在邻里层面，我们将为社区层面的干预确定可塑性因素，这些因素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状况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和他们的健康之间存在环境中介效应，其影响将指向儿童将社会地位视为可延展的干预目标的看法，并为赋予儿童权力开辟了干预可能性的领域。与公共健康相关：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，社会不平等是生命头十年健康的最显著决定因素。然而，预防早期出现的精神健康问题的希望需要研究来确定不平等影响健康的潜在机制。我们建议的研究测试社会不平等如何影响儿童的健康，旨在确定社区、家庭和个人层面的可塑性干预目标。

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.