Social inequalities in social-emotional problems among preschool children: a population-based study in Sweden

ABSTRACT

Background

Social-emotional ability is important for overall health and wellbeing in early childhood. Recognizing preschool children in need of extra support, especially those living in unfavourable conditions, can have immediate positive effects on their health and benefit their wellbeing in the long-term.

Objectives

The aim of this study is to investigate whether there are social inequalities in preschool children’s social-emotional problems, and whether inequalities differ between boys and girls.

Method

This study utilized repeated measures from cross-sectional population-based surveys of three-year old children (2014–2018). The final study population comprised of 9,099 children which was 61% of all the eligible children in Västerbotten County during the study period. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) 36-month interval was used to measure children’s social-emotional ability. Social inequalities were studied with respect to parents’ income, education, and place of birth, for which data was obtained from Statistics Sweden. Multiple logistic and ordered regressions were used.

Results

Among 3-year-olds, social-emotional problems were more common in the most vulnerable social groups, i.e. parents in the lowest income quintile (OR: 1.45, p < 0.001), parents with education not more than high school (OR: 1.51, p < 0.001), and both parents born outside Sweden (OR: 2.54, p < 0.001). Notably, there was a larger difference in social-emotional problems between the lowest and highest social categories for girls compared to boys. Higher odds of social-emotional problems were associated with boys not living with both parents and girls living in the areas of Skellefteå and Umeå, i.e. more populated geographical areas.

Conclusion

Already at 3-years of age social-emotional problems were more common in children with parents in the most vulnerable social groups. This does not fulfil the ambition of an equitable start in life for every child and might contribute to reproduction of social inequalities across generations.

KEYWORDS:

• Ages and Stages Questionnaires: Social-Emotional (ASQ:SE)
• mental health
• preschool children
• social inequality
• Population-based

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgments

The authors are grateful to all participating parents and their children and to the healthcare professionals for their efforts with data collection and for the support received from Region Västerbotten’s Competence Centre for Maternal and Child health Care and the Public Health Unit. We also acknowledge the critical reviews and constructive comments received from Associate Professor Marjan Vaez and Anna-Karin Eriksson from the Public Health Agency of Sweden.

Author contributions

MV and AI conceived and designed the study. MV together with ML and WL managed the data and carried out the statistical analyses and reported the results. All authors contributed to discussing and interpreting the results, and revisions in data analysis were made by MV. MV, AMPB, SAS, and AI prepared the first draft. All authors contributed to the writing process and have approved the final manuscript.

Disclosure statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethics and consent

The Regional Ethical Review Board in Umeå, northern Sweden, approved the study (2013–268-31ö and 2017/401–32). Only children whose parents had given written informed consent were included in this study, which was carried out in accordance with the ethical principles stated in the Helsinki Declaration of 1975 (as revised in 1983).

Paper context

While most of the research on health inequalities focuses on adults, we investigated social inequalities in preschool children’s social-emotional problems. Already at 3-years of age social-emotional problems were more common in children with parents in the most vulnerable social groups. This does not fulfil the ambition of an equitable start in life for every child and might contribute to reproduction of social inequalities across generations.

Data availability statement

The datasets presented in this article are not readily available because Region Västerbotten originally collected the data for a child health survey (https://www.regionvasterbotten.se/salut). We accessed data for the present study after approval from both the Region Västerbotten and the Ethical Vetting Board. The data are not publicly available but access for replication analyses is possible. Requests to access the datasets should be directed to https://www.regionvasterbotten.se/salut.

Additional information

Funding

This study was funded by the Public Health Agency of Sweden, Region Västerbotten and Umeå University.