Association of a child's mental disorder with parental income and employment: analysis of nationwide register-based cohorts in Finland and Denmark

TY - JOUR

T1 - Association of a child's mental disorder with parental income and employment

T2 - analysis of nationwide register-based cohorts in Finland and Denmark

AU - Komulainen, Kaisla

AU - Niemi, Ripsa

AU - Gutvilig, Mai

AU - Momen, Natalie C

AU - Böckerman, Petri

AU - Elovainio, Marko

AU - Plana-Ripoll, Oleguer

AU - Hakulinen, Christian

PY - 2025/6/8

Y1 - 2025/6/8

N2 - BACKGROUND: The onset of a severe physical illness of a child has been associated with earnings and employment losses among parents, but less is known in the context of children's mental disorders.OBJECTIVES: We estimated parental income and employment trajectories associated with a child's mental disorder diagnosis in nationwide register-based cohorts from Finland and Denmark.METHODS: All parents whose child was diagnosed with a mental disorder (F00-F99 in ICD-10) at ages 1-25 in Finland and in Denmark during 1994-2019 were matched 1:1 to parents with a child without a mental disorder on psychiatric and sociodemographic characteristics. Generalised estimating equations were used to estimate the associations of a child's mental disorder with parental annual income and employment outcomes from 5 years before to 5 years after the child's diagnosis.FINDINGS: In 1994-2019, over one million parents in Finland and Denmark had at least one child diagnosed with a mental disorder at age 1-25. Parents exposed to a child's mental disorder had consistently lower income and were more often unemployed compared with the matched unexposed parents, already 5 years before the child's diagnosis. These differences became slightly larger over time, especially in analyses on strata involving parents whose child was diagnosed at a younger age. However, there was no consistent evidence of a change in parental annual income or employment around the time of their child's diagnosis.CONCLUSIONS: Our analysis shows that even in countries with strong welfare systems, a younger child's mental disorder may contribute to widening socioeconomic inequity among families. However, the inequity in children's mental health appears to primarily exist prior to, rather than in response to, a child's mental disorder.CLINICAL IMPLICATIONS: Clinical and policy efforts should prioritise addressing pre-existing socioeconomic vulnerabilities for effective primary prevention of children's mental disorders.

AB - BACKGROUND: The onset of a severe physical illness of a child has been associated with earnings and employment losses among parents, but less is known in the context of children's mental disorders.OBJECTIVES: We estimated parental income and employment trajectories associated with a child's mental disorder diagnosis in nationwide register-based cohorts from Finland and Denmark.METHODS: All parents whose child was diagnosed with a mental disorder (F00-F99 in ICD-10) at ages 1-25 in Finland and in Denmark during 1994-2019 were matched 1:1 to parents with a child without a mental disorder on psychiatric and sociodemographic characteristics. Generalised estimating equations were used to estimate the associations of a child's mental disorder with parental annual income and employment outcomes from 5 years before to 5 years after the child's diagnosis.FINDINGS: In 1994-2019, over one million parents in Finland and Denmark had at least one child diagnosed with a mental disorder at age 1-25. Parents exposed to a child's mental disorder had consistently lower income and were more often unemployed compared with the matched unexposed parents, already 5 years before the child's diagnosis. These differences became slightly larger over time, especially in analyses on strata involving parents whose child was diagnosed at a younger age. However, there was no consistent evidence of a change in parental annual income or employment around the time of their child's diagnosis.CONCLUSIONS: Our analysis shows that even in countries with strong welfare systems, a younger child's mental disorder may contribute to widening socioeconomic inequity among families. However, the inequity in children's mental health appears to primarily exist prior to, rather than in response to, a child's mental disorder.CLINICAL IMPLICATIONS: Clinical and policy efforts should prioritise addressing pre-existing socioeconomic vulnerabilities for effective primary prevention of children's mental disorders.

KW - Humans

KW - Finland/epidemiology

KW - Denmark/epidemiology

KW - Mental Disorders/epidemiology

KW - Child

KW - Child, Preschool

KW - Male

KW - Income/statistics & numerical data

KW - Registries

KW - Female

KW - Employment/statistics & numerical data

KW - Parents

KW - Adolescent

KW - Infant

KW - Adult

KW - Young Adult

KW - Cohort Studies

U2 - 10.1136/bmjment-2025-301701

DO - 10.1136/bmjment-2025-301701

M3 - Journal article

C2 - 40490271

SN - 2755-9734

VL - 28

JO - BMJ Mental Health

JF - BMJ Mental Health

IS - 1

ER -