Structural and Intermediary Social Determinants of Health and the Emotional and Behavioral Health of US Children

Children grow up in homes where varying environmental and socioeconomic contexts have a bearing on their emotional and behavioral health (EBH). This study used data from a representative sample of the child supplement of the US National Health Information Survey (NHIS) and applied the social determinants of health (SDoH) framework to explore factors associated with child EBH. We conducted a path analysis of the child’s EBH measured by the strengths and difficulties questionnaire (SDQ) from their macro and socioeconomic contexts, e.g., policy, household, and other health system risk factors. For children in the sample, aged 4 to 17 years old (n = 9205), most path relationships to child SDQ scores were statistically significant. The total effects from a child’s visit to a mental health specialist (0.28) and child’s age (0.22) had the highest coefficients to child SDQ scores. A modified model showed a better fit with X2 (4) = 22.124, RMSEA = 0.021, and 90% CI [0.013–0.03], CFI = 0.98. Findings indicate that child factors such as being older, the use of mental healthcare services, and family socioeconomic status were significantly associated with EBH, calling attention to the need for more responsive policy and behavioral health interventions that address household/familial and child-level factors, critical determinants of child wellbeing.

[1]  Katherine L. Chen,et al.  Association of Promoting Housing Affordability and Stability With Improved Health Outcomes , 2022, JAMA network open.

[2]  A. Reeves,et al.  The Impact of Monetary Poverty Alleviation Programs on Children's and Adolescents' Mental Health: A Systematic Review and Meta-Analysis Across Low-, Middle-, and High-Income Countries. , 2022, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[3]  M. Kogan,et al.  Five-Year Trends in US Children’s Health and Well-being, 2016-2020 , 2022, JAMA pediatrics.

[4]  D. Brody,et al.  Mental Health Surveillance Among Children — United States, 2013–2019 , 2022, MMWR supplements.

[5]  Youngmi Kim,et al.  Patterns of adverse childhood experiences and depressive symptoms: self-esteem as a mediating mechanism , 2021, Social Psychiatry and Psychiatric Epidemiology.

[6]  M. Santana,et al.  Working with parents of children with complex mental health issues to improve care: A qualitative inquiry , 2021, Journal of child health care : for professionals working with children in the hospital and community.

[7]  J. Edbrooke‐Childs,et al.  Associations between child mental health, carer worry and help-seeking , 2021, Journal of child health care : for professionals working with children in the hospital and community.

[8]  A. Matijasevich,et al.  The impact of cash transfers on mental health in children and young people in low-income and middle-income countries: a systematic review and meta-analysis , 2020, BMJ Global Health.

[9]  C. Kerr,et al.  Substance Abuse and Mental Health Services Administration , 2020, Definitions.

[10]  Joe Feinglass,et al.  Adverse childhood experiences and the onset of chronic disease in young adulthood. , 2019, Preventive medicine.

[11]  Maite Garaigordobil,et al.  Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments , 2019, Front. Psychol..

[12]  M. Kenney,et al.  Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders and Poverty Among Children Aged 2–8 Years — United States, 2016 , 2018, MMWR. Morbidity and Mortality Weekly Report.

[13]  R. Catalano,et al.  The Future of CTC and Community-Based Prevention* , 2018, Oxford Scholarship Online.

[14]  M. Alegría,et al.  Social Determinants of Mental Health: Where We Are and Where We Need to Go , 2018, Current Psychiatry Reports.

[15]  N. Marlow,et al.  Trajectories of behavior, attention, social and emotional problems from childhood to early adulthood following extremely preterm birth: a prospective cohort study , 2018, European Child & Adolescent Psychiatry.

[16]  Michelle C. Kondo,et al.  Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear , 2018, Proceedings of the National Academy of Sciences.

[17]  M. Ogundele Behavioural and emotional disorders in childhood: A brief overview for paediatricians , 2018, World journal of clinical pediatrics.

[18]  S. Hodgkinson,et al.  Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting , 2017, Pediatrics.

[19]  Michelle A. Williams,et al.  Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. , 2016, The lancet. Psychiatry.

[20]  Gillian Thompson Meeting the needs of adolescent parents and their children. , 2016, Paediatrics & child health.

[21]  Yi Yang,et al.  Clinical and Economic Burden of Mental Disorders Among Children With Chronic Physical Conditions, United States, 2008–2013 , 2016, Preventing chronic disease.

[22]  D. Boomsma,et al.  Analysis of Behavioral and Emotional Problems in Children Highlights the Role of Genotype × Environment Interaction. , 2015, Child development.

[23]  J. Baio,et al.  Mental health surveillance among children--United States, 2005-2011. , 2013, MMWR supplements.

[24]  R. Reading Characteristics of the strengths and difficulties questionnaire in preschool children , 2013 .

[25]  W. Eaton,et al.  Public Mental Health , 2013 .

[26]  M. D. de Wolff,et al.  Characteristics of the Strengths and Difficulties Questionnaire in Preschool Children , 2013, Pediatrics.

[27]  M. Georgieff,et al.  Research review: maternal prenatal distress and poor nutrition - mutually influencing risk factors affecting infant neurocognitive development. , 2013, Journal of child psychology and psychiatry, and allied disciplines.

[28]  P. Zandi,et al.  Genes as a Source of Risk for Mental Disorders , 2012, Public Mental Health.

[29]  A. Hofman,et al.  Economic Disadvantage and Young Children’s Emotional and Behavioral Problems: Mechanisms of Risk , 2012, Journal of abnormal child psychology.

[30]  Michael Marmot,et al.  Adolescence and the social determinants of health , 2012, The Lancet.

[31]  David R Williams,et al.  The social determinants of health: coming of age. , 2011, Annual review of public health.

[32]  P. Braveman,et al.  Health Disparities Beginning in Childhood: A Life-Course Perspective , 2009, Pediatrics.

[33]  W. Sribney,et al.  Perceived Discrimination and Self-Reported Quality of Care Among Latinos in the United States , 2009, Journal of General Internal Medicine.

[34]  J. Durlak How to select, calculate, and interpret effect sizes. , 2009, Journal of pediatric psychology.

[35]  A. Goodman,et al.  Strengths and difficulties questionnaire as a dimensional measure of child mental health. , 2009, Journal of the American Academy of Child and Adolescent Psychiatry.

[36]  Norito Kawakami,et al.  Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. , 2007, World psychiatry : official journal of the World Psychiatric Association.

[37]  T. B. Üstün,et al.  Age of onset of mental disorders: a review of recent literature , 2007, Current opinion in psychiatry.

[38]  O. Solar,et al.  A conceptual framework for action on the social determinants of health. , 2007 .

[39]  N. Butler,et al.  Attention-deficit/hyperactivity disorder: an overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women. , 2007, Clinical psychology review.

[40]  M. Mclaughlin,et al.  Sociocultural Correlates of Disciplinary Exclusion Among Students With Emotional, Behavioral, and Learning Disabilities in the SEELS National Dataset , 2007 .

[41]  A. Boomsma Reporting Analyses of Covariance Structures , 2000 .

[42]  I. Gotlib,et al.  Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. , 1999, Psychological review.

[43]  R. Goodman The Strengths and Difficulties Questionnaire: a research note. , 1997, Journal of child psychology and psychiatry, and allied disciplines.

[44]  N. Bharmal,et al.  Understanding the Upstream Social Determinants of Health , 2015 .

[45]  E. Stuart,et al.  Associations Between Maternal Mental Health and Child Emotional and Behavioral Problems: Does Prenatal Mental Health Matter? , 2013, Journal of Abnormal Child Psychology.

[46]  StataCorp Stata structural equation modeling reference manual , 2011 .

[47]  Juha Mikkonen,et al.  Social determinants of health: Canadian facts , 2010 .