Early‐life pathways to inequalities in child mental health

This study analysed data from eight birth cohorts across 10 high-income countries to examine how early-life socioeconomic disadvantage is linked to children’s mental health at school entry. Children from lower socioeconomic backgrounds were more likely to experience behavioural and emotional difficulties. Smoking during pregnancy, postpartum depression and breastfeeding emerged as important pathways linking socioeconomic circumstances with children’s behavioural and emotional difficulties. While several early-life factors helped explain socioeconomic differences in children’s mental health, the authors note that these factors may reflect broader social and psychosocial circumstances affecting families, rather than acting as isolated causes of children’s behavioural and emotional difficulties.

Why is this important?

• Children from socioeconomically disadvantaged families are more likely to experience emotional and behavioural difficulties than their more advantaged peers. These inequalities emerge early in life and can have long-term impacts on health and wellbeing.
• Understanding the early-life factors that contribute to these inequalities may help identify opportunities for mental health promotion and mental ill-health prevention.

What did they do?

• The authors analysed data from eight large birth cohort studies across Europe and Australia, including children born between 1989 and 2011, to examine the association between socioeconomic circumstance and child mental health outcomes, including externalising (behavioural) and internalising (emotional) difficulties.
• Maternal education was used as an indicator of socioeconomic circumstance, and children’s emotional and behavioural difficulties were assessed at school-entry age using parent-reported measures.
• The authors examined whether several early-life factors contributed to differences in child mental health outcomes between socioeconomic groups. Factors included smoking during pregnancy, gestational age, birthweight, postpartum depression and breastfeeding practices.

What did they find?

• Across the eight cohorts, children growing up in more socioeconomically disadvantaged circumstances were more likely to experience both behavioural and emotional difficulties around school-entry age than children growing up in more advantaged circumstances.
• Early-life factors explained a substantial proportion of these inequalities, particularly for behavioural difficulties. However, this varied across countries and cohorts.
• Smoking during pregnancy, postpartum depression and lower rates of breastfeeding emerged as important pathways linking socioeconomic circumstances with children’s behavioural and emotional difficulties.
• Prematurity and low birthweight explained relatively little of the socioeconomic differences in mental health outcomes.
• While several early-life factors were associated with differences in children’s mental health outcomes, the authors noted these factors may reflect broader family circumstances and support needs, rather than directly causing children’s behavioural or emotional challenges. For example, maternal smoking during pregnancy may indicate that a mother is experiencing other health or wellbeing concerns.

What does this mean for practice?

• Practitioners should be aware that children’s behavioural and emotional difficulties are shaped by their broader family and social circumstances as well as by individual risk factors. Understanding these wider influences may help practitioners support children experiencing disadvantage.
• Early childhood and perinatal services can help promote children’s mental health by supporting family wellbeing during pregnancy and the early years. This can include supports for parental mental health, healthy pregnancies and positive early caregiving experiences.
• The findings highlight the importance of taking a holistic approach to supporting families. Factors such as parental wellbeing, infant health and early caregiving experiences often occur together and may interact to influence children’s mental health outcomes.

This summary is one of the child mental health research highlights for July 2026, prepared by the Australian Institute of Family Studies (AIFS).