Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic: An intersectional analysis

Elsa Lorthe; Viviane Richard; Roxane Dumont; Andrea Loizeau; Javier Perez-Saez; Hélène Baysson; Maria-Eugenia Zaballa; Julien Lamour; Nick Pullen; Stephanie Schrempft; Rémy P Barbe; Klara M Posfay-Barbe; Idris Guessous; Silvia Stringhini; SEROCoV-KIDS study group

doi:10.1016/j.ssmph.2023.101472

Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic: An intersectional analysis

SSM Popul Health. 2023 Jul 23:23:101472. doi: 10.1016/j.ssmph.2023.101472. eCollection 2023 Sep.

Authors

Elsa Lorthe^{1

2}, Viviane Richard^{1

3}, Roxane Dumont^{1

3}, Andrea Loizeau¹, Javier Perez-Saez^{1

4}, Hélène Baysson¹, Maria-Eugenia Zaballa¹, Julien Lamour¹, Nick Pullen¹, Stephanie Schrempft¹, Rémy P Barbe⁵, Klara M Posfay-Barbe^{6

7}, Idris Guessous^{3

8}, Silvia Stringhini^{1

3

9}; SEROCoV-KIDS study group

Collaborators

SEROCoV-KIDS study group:
Deborah Amrein, Isabelle Arm-Vernez, Andrew S Azman, Antoine Bal, Michael Balavoine, Rémy P Barbe, Hélène Baysson, Julie Berthelot, Patrick Bleich, Livia Boehm, Aminata R Bouchet, Gaëlle Bryand, Viola Bucolli, Prune Collombet, Alain Cudet, Vladimir Davidovic, Carlos de Mestral, Paola D'Ippolito, Richard Dubos, Roxane Dumont, Isabella Eckerle, Nacira El Merjani, Marion Favier, Natalie Francioli, Clément Graindorge, Idris Guessous, Munire Hagose, Séverine Harnal, Samia Hurst, Laurent Kaiser, Omar Kherad, Julien Lamour, Pierre Lescuyer, Arnaud G L'Huillier, Andrea Loizeau, Elsa Lorthe, Chantal Martinez, Stéphanie Mermet, Mayssam Nehme, Natacha Noël, Francesco Pennacchio, Javier Perez-Saez, Anne Perrin, Didier Pittet, Klara M Posfay-Barbe, Jane Portier, Géraldine Poulain, Caroline Pugin, Nick Pullen, Viviane Richard, Frederic Rinaldi, Deborah Rochat, Cyril Sahyoun, Irine Sakvarelidze, Khadija Samir, Hugo Alejandro Santa Ramirez, Jessica Rizzo, Stephanie Schrempft, Claire Semaani, Silvia Stringhini, Stéphanie Testini, Yvain Tisserand, Deborah Urrutia Rivas, Charlotte Verolet, Jennifer Villers, Guillemette Violot, Nicolas Vuilleumier, Sabine Yerly, María-Eugenia Zaballa, Christina Zavlanou, Silvia Stringhini

Affiliations

¹ Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
² Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France.
³ Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
⁵ Division of Child and Adolescent Psychiatry, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁶ Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁷ Department of Pediatrics, Gynecology & Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁸ Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁹ University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland.

Abstract

Background: Children and adolescents are highly vulnerable to the impact of sustained stressors during developmentally sensitive times. We investigated how demographic characteristics intersect with socioeconomic dimensions to shape the social patterning of quality of life and mental health in children and adolescents, two years into the COVID-19 pandemic.

Methods: We used data from the prospective SEROCoV-KIDS cohort study of children and adolescents living in Geneva (Switzerland, 2022). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 48 social strata defined by intersecting sex, age, immigrant background, parental education and financial hardship in Bayesian multilevel logistic models for poor health-related quality of life (HRQoL, measured with PedsQL) and mental health difficulties (measured with the Strengths and Difficulties Questionnaire).

Results: Among participants aged 2-17 years, 240/2096 (11.5%, 95%CI 10.1-12.9) had poor HRQoL and 105/2135 (4.9%, 95%CI 4.0-5.9) had mental health difficulties. The predicted proportion of poor HRQoL ranged from 3.4% for 6-11 years old Swiss girls with highly educated parents and no financial hardship to 34.6% for 12-17 years old non-Swiss girls with highly educated parents and financial hardship. Intersectional strata involving adolescents and financial hardship showed substantially worse HRQoL than their counterparts. Between-stratum variations in the predicted frequency of mental health difficulties were limited (range 4.4%-6.5%).

Conclusions: We found considerable differences in adverse outcomes across social strata. Our results suggest that, post-pandemic, interventions to address social inequities in HRQoL should focus on specific intersectional strata involving adolescents and families experiencing financial hardship, while those aiming to improve mental health should target all children and adolescents.

Keywords: Adolescents; Health equity; MAIHDA; Socioeconomic disparities; Youth.