The association between preventing childhood adversities and children's common mental disorder and school outcomes: applying the parametric g-formula to Swedish registers

Matthias Pierce, Yushi Bai, Alicia Nevriana, Christina Dalman, Holly Hope, Kyriaki Kosidou, Anna Ohlis, Susanne Wicks, Kathryn Abel

Research output: Contribution to journalArticlepeer-review


Importance: Growing up with adversity can limit children’s chances of achieving their optimal developmental and psychological outcomes. Well-designed observational studies can help unravel which adversities are most implicated in this; thereby helping to identify potential targets for developing effective interventions.
Objective: To compare the association between preventing childhood poverty, parental mental illness and parental separation and the population rate of offspring common mental disorder (ages 16-21) or average school grades (age 16).
Design, setting and participants: Population-based, longitudinal study using Swedish registries. 163,529 children born in Sweden between 1996 and 1997 were followed-up until their 21st birthday. They were linked to registries using Sweden’s national personal identification number. Children were linked to birth parents, hospital records and school data. Parents were linked to registries containing health, income, socio-demographic and obstetric data. Analyses were conducted between January 2021 and August 2022.
Exposures: Childhood adversities of relative poverty (household disposable income below 50% of the median); parental inpatient admission for a mental illness; or parental separation. Adversities were categorised into developmental periods: 0-3yrs, 4-7yrs; 8-11yrs; and 12-16.
Main outcomes and measures: children’s hospital records with anxiety/depression between 16-21 years, and school grades at the end of compulsory education (age 16). The parametric g-formula modelled population changes in outcomes associated with the counterfactual, hypothetical preventing adversity exposures, accounting for fixed and time-varying confounders. Adjustments were made for parental demographics, obstetric variables and socio-economic data at birth.
Results: 163,529 children were included in the cohort (51% girls, 51% born in 1996). Preventing all adversities was associated with a change in prevalence of offspring common mental disorder from 10.2% to 7.6%; and an improvement in school grades by 0.149 of a standard deviation (95% CI 0.147 to 0.149). Preventing parental separation provided for the greatest improvement, with an estimated 2.34% (95% CI 2.23%–2.42%) fewer children with common mental disorder and an improvement in school grades by 0.13 standard deviations (0.125–0.129). Greater improvements were shown by hypothetically targeting adolescents (age 12-16) and those whose parents had a mental illness at birth.
Conclusion and relevance: This cohort study suggests that preventing childhood adversity could provide notable improvements in the rates of common mental disorder and school grades. We conclude that a significant number of children might achieve better life outcomes if resources are properly allocated to the right adversities (parental separation), the right groups (children with parental mental illness) and at the right time (adolescence).

Original languageEnglish
JournalJAMA Network Open
Publication statusAccepted/In press - 11 Aug 2023


Dive into the research topics of 'The association between preventing childhood adversities and children's common mental disorder and school outcomes: applying the parametric g-formula to Swedish registers'. Together they form a unique fingerprint.

Cite this