Finnish Institute for Health and Welfare (THL) Mannerheimintie 166 00271 Helsinki - Finland.
Soc Sci Med. 2023 Aug;330:116037. doi: 10.1016/j.socscimed.2023.116037. Epub 2023 Jun 26.
Social disadvantages persist over generations, while the mechanisms behind the intergenerational transmission are not well understood. To fill this gap, first, we examine to what degree being diagnosed with a mental health disorder in adolescence mediate the transmission of social disadvantage. Second, we investigate whether the role of mental health varies for different outcomes. Third, we examine differences between disorder groups and gender. We exploited register data on the full Finnish population including information on mental health diagnoses (MHD) based on ICD-10 classification recorded in public specialized health care. As socioeconomic outcomes, we used offspring's (N = 511,835) records for low educational attainment, unemployment, and social assistance dependency in early adulthood. In addition to linear probability models, the g-computation method was used to simulate the degree to which reducing mental health inequalities in adolescence could narrow the differences between children of different family backgrounds. Our results show that adolescents with MHD had a higher likelihood of experiencing social disadvantage as young adults even after accounting for parental socioeconomic status and alternative health pathways. The counterfactual analysis indicated that the proportion mediated by unevenly distributed MHD was with 7.5% highest for social assistance followed by 4.2% for education and 3.2% for unemployment. The effect of mental health was modified by gender yet direction and strength varied across methods and externalizing behaviors mattered more for the intergenerational persistence than internalizing behaviors. Hypothetically reducing MHD to the level of families with high socioeconomic status might indeed lower part of the intergenerational transmission of social assistance dependency but to lesser degree of unemployment and low educational attainment. We demonstrate the need of support and services for those with MHD, especially among socially disadvantaged groups. However, social disadvantage should not be overly medicalized as family background has an important independent effect on offspring's socioeconimic outcomes.
社会劣势代代相传，但其背后的代际传递机制尚不清楚。为了填补这一空白，首先，我们研究了在青少年时期被诊断出患有精神健康障碍在多大程度上介导了社会劣势的传递。其次，我们调查了精神健康的作用是否因不同的结果而有所不同。第三，我们研究了不同障碍群体和性别的差异。我们利用了包含基于 ICD-10 分类的公共专门医疗保健记录的心理健康诊断 (MHD) 信息的全芬兰人口登记数据。作为社会经济结果，我们使用了后代（N=511835）在成年早期低教育程度、失业和社会援助依赖的记录。除了线性概率模型外，还使用 g 计算方法模拟了在青少年时期减少精神健康不平等程度可以缩小不同家庭背景的孩子之间差异的程度。我们的结果表明，即使考虑到父母的社会经济地位和替代健康途径，患有 MHD 的青少年在成年早期更有可能经历社会劣势。反事实分析表明，通过不均匀分布的 MHD 介导的比例，社会援助最高，为 7.5%，其次是教育，为 4.2%，失业为 3.2%。心理健康的影响受到性别的影响，但方向和强度因方法而异，且外向行为比内向行为对代际持续性的影响更大。假设将 MHD 降低到高社会经济地位家庭的水平，实际上可能会降低社会援助依赖的代际传递的一部分，但对失业和低教育程度的影响程度较小。我们证明了需要为患有 MHD 的人提供支持和服务，特别是在社会劣势群体中。然而，社会劣势不应该被过度医学化，因为家庭背景对后代的社会经济结果有重要的独立影响。
