The quality of child-parent relationships and parental mental health in childhood are strongly associated with subsequent mental well-being in adulthood, even more so than childhood socioeconomic circumstances.
Researchers from University College London, University of Oxford, University of Edinburgh, and the Health Foundation analysed data from three British birth cohort studies to investigate how multiple aspects of the childhood environment were associated with subsequent mental well-being in adulthood across different generations. Using equivalent measures across multiple studies, the researchers were able to determine how childhood experiences compare across cohorts, and to explore how these experiences influence adult mental well-being.
Mental well-being is a key aspect of healthy ageing, and thus it is important to understand what specific factors promote positive adult well-being across the life-course.
The Medical Research Council (MRC) National Survey of Health and Development (NSHD) is the oldest and longest running of the British birth cohort studies; it is a nationally representative sample (N=5,362) of men and women born in England, Scotland or Wales in March 1946.
The 1958 National Child Development Study (NCDS) follows the lives of 17,415 people born in England, Scotland and Wales in a single week of 1958.
The 1970 British Cohort Study (BCS70) follows the lives of 17,198 people born in England, Scotland and Wales in a single week of 1970.
Well-being was measured at ages 60-64 years in NSHD, age 50 in NCDS, and age 40 in BCS70, using the self-completed Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). This instrument comprises 14 items, measured on a five-point Likert scale, combining hedonic (happiness, pleasure, and pain avoidance) and eudemonic (self-realisation and positive functioning) aspects of well-being into a single factor. A total well-being score on the instrument ranges from 14-70, with a higher score denoting greater well-being.
Building upon previous analysis which explored individual childhood domains in isolation, the researchers drew from a number of bespoke questionnaire instruments in each study to measure multiple indicators of the childhood environment. Where there was variability within and between the studies in the methods of assessment, the researchers utilised retrospective data harmonisation techniques to foster better comparability. The different aspects of childhood environment examined were:
Family socioeconomic circumstances: across all studies, father’s occupational social class was measured at ages 10-11 and subsequently coded according to the Registrar General’s 1990 classification, ranging from I-professional to V-unskilled.
Parental education: the age parents left full-time continuous education, reported when cohort members were age 6 in NSHD, age 16 in NCDS and ages 5 and 16 in BCS70.
Teen parenthood: defined as parents being under 20 years old at cohort member’s birth.
Lack of amenities (including sole use of the bathroom or kitchen, and access to hot running water): measured at age 2 and 11 in NSHD, age 7 and 11 in NCDS, and age 5 and 10 years in BCS70.
Overcrowding: the average number of people per room exceeding 1, was measured at ages 2, 4, 6, 8 and 11 in NSHD, ages 7, 11, and 16 in NCDS, and age 5 years in BCS70.
Housing tenure: whether accommodation was rented or owned, was measured at ages 2 and 11 in NSHD, 7 and 11 in NCDS, and 5 and 10 years in NSC70.
Whether the cohort member was breastfed was collected at age 2 in NSHD, age 7 in NCDS, and age 5 in BCS70.
Parental care and overprotection subscales were derived from the Parental Bonding Instrument using factor analysis. In NSHD, this measure was administered retrospectively at age 43, included 24 items, and asked about each parent individually with average scores derived across parents. In BCS70, a shortened 11-item version of the instrument was administered prospectively at age 16 and its items asked about both parents together. For NCDS, a measurement of how well cohort members got on with either parent was collected at age 16.
Parental interest in child’s education was reported by the mother when cohort members were aged 11 years in NSHD, and by both parents in NCDS and BSC70 when children were aged 7 and 10 years in NCDS and BSC70, with data from the most interested parent used in analysis.
Experience of parental divorce before or up to the age of 16 years was measured in each study.
The number of residential moves was collected at age 15 years in NSHD, age 16 in NCDS, and age 10 in BCS70.
Experience of separation from mother over one night or longer was measured at age 4 in NSHD and age 7 in NCDS. Conversely, in BCS70, experience of long-term separation was measured at age 10, with responses categorised into ‘separated for less than one week or never’ and ‘separated for more than one week’.
A measure for parental chronic health conditions was collected at age 15 years in NSHD, age 11 in NCDS, and age 10 in BCS70.
Family mental health was measured at age 15 years in NSHD using the self-reported Maudsley Personality Inventory to determine maternal neuroticism, age 7 in NCDS using a measure of family mental health collected by a health visitor, and age 10 in BCS70 using the self-reported Malaise Inventory, to measure maternal depression.
Despite changes in social context experienced by the cohorts in childhood and cross-study differences in the measurement of most childhood variables, indicators of child rearing, parenting quality and parental health were associated with later adult mental well-being across all cohorts. Poorer quality parent-child relationships including low parental care and high parental overprotection (NSHD and BCS70) and not getting on with parents (NCDS) were associated with lower adult well-being. Poor maternal/ family mental health (NSHD and BCS70) and health problems for the father (NCDS) were also associated with lower adult well-being.
In contrast to the NSHD, where no such association was found, in NCDS and BSC70, a lack of parental interest in education was independently associated with lower levels of adult mental well-being. Moreover, in BCS70, where parental divorce rates were highest, this was additionally found to be independently associated with poorer mental well-being.
Having a father in a more disadvantaged social class was associated with lower well-being in all three cohorts. However, compared to psychosocial childhood indicators, when comparing standardised coefficients and effect sizes, the association between socioeconomic circumstances and adulthood mental well-being was smaller in magnitude.
Many of the determinants of well-being begin early in the life course, and using longitudinal data allows researchers to access a wide range of prospectively collected measures to explore how childhood circumstances may be associated with mental well-being later in adulthood. This is in contrast to studies that utilise retrospective measurements, which may be subject to issues of recall bias.
A challenge of working with longitudinal data is attrition, as cohort members who experienced adverse childhood socioeconomic conditions may be more likely to drop out of the studies. This could lead to underestimation of the association between childhood socioeconomic circumstances and adulthood mental well-being.
An advantage of using multiple longitudinal datasets is the opportunity to make cross-cohort comparisons, although it should be acknowledged that each cohort experienced a different childhood social context which may have influenced the associations being explored. For example, the NSHD cohort grew up in the post-war period which meant they experienced different housing conditions to NCDS and BCS70 cohort members. Additionally, divorce rates in the BCS70 cohort were higher, suggesting changes occurred in family structure between cohorts. Even so, researchers found that across all cohorts the indicators of the childhood environment included were associated with adult mental well-being.
In the present paper, the researchers found differences between the studies in how they captured the relevant indicators of the childhood environment. As a consequence, they needed to employ different techniques to foster a basis for cross-study comparison and co-analysis. Addressing such measurement heterogeneity can require a range of solutions, some more complex than others.
In the case of parental social class and educational attainment, a basis for harmonisation had been already established elsewhere. Where existing harmonisation protocols were unavailable, bespoke methods had to be employed. In some cases, measures with variable scale lengths or different numbers of categories were standardised to make responses more comparable.
For characteristics where the researchers found that overtly comparable indicators were not available, they relied on variables that tapped into similar underlying constructs. As an illustration, three different instruments of family mental health were used in the present paper: a measure for maternal neuroticism (NSHD), family mental health (NCDS), and maternal depression (BCS70).
Testing the assumptions inherent in such data preparation can be an important step in data harmonisation. Moreover, techniques for evaluating measurement equivalence in latent constructs (e.g., mental well-being) can help validate harmonisation decisions and the basis for the inferences drawn. That this was not done in the current paper is a limitation of this research.
A further challenge in such cross-study longitudinal research is that the age of assessment and frequency of follow-up can vary between studies. To address this in the present study, the researchers derived means across the repeated measures or defined variables in terms of whole childhood experience (e.g., parental divorce at any point up to age 16).
Cross-study variability in age of assessment however also occurred for the outcome measure of adult mental well-being. This meant that direct comparisons could not be made to explore age or cohort effects, making it difficult to determine if the childhood social context or age at measurement influenced associations with well-being. The barrier to addressing such heterogeneity retrospectively underlines the advantage of increased alignment across cohort data collection efforts.
Unlike previous research which has typically assessed individual childhood indicators in isolation, this paper has analysed multiple domains of the childhood environment in evaluating their impact on adult mental well-being. This approach acknowledges that mental well-being is influenced by several factors. As in the case of the present paper, the use of prospectively collected longitudinal data allows researchers to effectively ascertain how these might trace back to the childhood environment. Data harmonisation allows exploration of these childhood domains across several studies to determine how these experiences might vary between cohorts, but it is not without challenges.
The findings of this research suggest that interventions should be twofold, focusing on reducing childhood poverty, and supporting positive parenting and parental mental health during childhood in order to promote lifelong mental well-being. Policies that focus on improving childhood socioeconomic circumstances and parental practices would therefore reduce the need for later life interventions.
Wood, N., Hardy, R., Bann, D., Gale, C., Stafford, M. (2021) Childhood Correlates of adult positive mental well-being in three British longitudinal studies. Journal of Epidemiology & Community Health. (75)2, pp. 177-184. https://doi.org/10.1136/jech-2019-213709
Walsh, S., Kaye, N. & O’Neill, D. (2021). Research Case Studies: Childhood environment and adult mental well-being. CLOSER Learning Hub, London, UK: CLOSER.