Socioeconomic Indicators and Psychopathology in Children with Chronic Physical Illness

Abstract

Background: Children with a chronic physical illness (CPI) have an increased risk of developing psychopathology. The combination of chronic stress and socioeconomic disadvantage often contributes to poor mental health in this vulnerable population of children.

Research Questions: This study addresses the following questions: (1) Are neighborhood-level socioeconomic indicators worse among families of children with CPI compared to the general population? (2) Are these socioeconomic indicators associated with psychopathology among children with CPI over a 48-month period? (3) Does child stress moderate associations between socioeconomic indicators and child psychopathology over time?

Methods: Data come from the Multimorbidity in Children and Youth across the Life-course (MY LIFE) study, which followed 263 children aged 2-16 years who had been diagnosed with a CPI, for 48 months. A one-sample t-test compared mean differences in socioeconomic indices, measured by the Ontario Marginalization Index (ON-MARG), between MY LIFE and the general population. Linear mixed models (LMMs) examined associations between ON-MARG dimensions and psychopathology symptoms, as measured with the Emotional Behavioural Scales. Moderation by child HCC was investigated using a time-varying product-term interaction.

Results: At baseline, the study included 263 children with a CPI (mean age: 9.4 years, 53% male). Children in MY LIFE resided in areas characterized by greater socioeconomic disadvantage relative to the general population (M= -0.38- -0.20, p= <0.001). Material resources (β=0.13, p=0.03) and the two-way interaction between households and dwellings and time (β=0.02, p=0.04) were significantly associated with parent-reported externalizing symptoms. Households and dwellings (β=0.09, p=0.02) and the three-way interaction between age and labour force, time, and child stress (β=0.02, p=0.04) were significantly associated with child-reported externalizing symptoms. No significant associations were noted between ON-MARG dimensions and parent- and child-reported internalizing symptoms.

Conclusion: Children with CPI were more likely to live in areas of high socioeconomic disadvantage with housing and material deprivation predicting elevated psychopathology symptoms. LMMs showed that time-varying child stress may have a moderating effect on indicators of socioeconomic disadvantage, particularly related to households and dwellings and material resources. Differences between parent- and child-reported models reinforce the importance of multi-informant perspectives. Findings highlight the need for integrated, equity-informed interventions targeting both socioeconomic and physiological drivers of child psychopathology among children with CPI.