Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
Department of Public Administration and Sociology, Erasmus University, Rotterdam, Netherlands.
J Epidemiol Community Health. 2023 Feb;77(2):74-80. doi: 10.1136/jech-2022-219548. Epub 2022 Nov 25.
Stressful family conditions may contribute to inequalities in child development because they are more common among disadvantaged groups (ie, differential exposure) and/or because their negative effects are stronger among disadvantaged groups (ie, differential impact/susceptibility). We used counterfactual mediation analysis to investigate to what extent stressful family conditions contribute to inequalities in child development via differential exposure and susceptibility.
We used data from the Generation R Study, a population-based birth cohort in the Netherlands (n=6842). Mother's education was used as the exposure. Developmental outcomes, measured at age 13 years, were emotional and behavioural problems (Youth Self-Report), cognitive development (Wechsler Intelligence Scale for Children) and secondary education entry level. Financial and social stress at age 9 years were the putative mediators.
Differential exposure to financial stress caused a 0.07 (95% CI -0.12 to -0.01) SD worse emotional and behavioural problem -score, a 0.05 (95% CI -0.08 to -0.02) SD lower intelligence score and a 0.05 (95% CI -0.05 to -0.01) SD lower secondary educational level, respectively, among children of less-educated mothers compared with children of more-educated mothers. This corresponds to a relative contribution of 54%, 9% and 6% of the total effect of mother's education on these outcomes, respectively. Estimates for differential exposure to social stress, and differential susceptibility to financial or social stress, were much less pronounced.
Among children of less-educated mothers, higher exposure to financial stress in the family substantially contributes to inequalities in socioemotional development, but less so for cognitive development and educational attainment.
紧张的家庭环境可能导致儿童发展不平等，因为它们在弱势群体中更为普遍（即差异暴露），或者因为它们对弱势群体的负面影响更强（即差异影响/易感性）。我们使用反事实中介分析来研究紧张的家庭环境通过差异暴露和易感性对儿童发展不平等的影响程度。
我们使用了荷兰基于人群的出生队列 Generation R 研究的数据（n=6842）。母亲的教育程度被用作暴露因素。在 13 岁时测量的发展结果是情绪和行为问题（青少年自我报告）、认知发展（儿童韦氏智力量表）和中学入学水平。9 岁时的经济和社会压力是假设的中介因素。
经济压力的差异暴露导致受教育程度较低的母亲的孩子的情绪和行为问题评分降低 0.07（95%置信区间-0.12 至-0.01）标准差，智力评分降低 0.05（95%置信区间-0.08 至-0.02）标准差，中学教育水平降低 0.05（95%置信区间-0.05 至-0.01）标准差，与受教育程度较高的母亲的孩子相比。这分别对应于母亲教育对这些结果的总效应的 54%、9%和 6%的相对贡献。对社会压力的差异暴露和对经济或社会压力的差异易感性的估计则不那么明显。
在受教育程度较低的母亲的孩子中，家庭中较高的经济压力暴露程度大大加剧了社会情感发展的不平等，但对认知发展和教育程度的影响则较小。
