Does social disadvantage persist over generations due to an uneven distribution of mental health diagnoses? A longitudinal investigation of Finnish register data.

Social disadvantages persist over generations, while the mechanisms behind the intergenerational transmission are not well understood. To fill this gap, first, we examine to what degree being diagnosed with a mental health disorder in adolescence mediate the transmission of social disadvantage. Second, we investigate whether the role of mental health varies for different outcomes. Third, we examine differences between disorder groups and gender. We exploited register data on the full Finnish population including information on mental health diagnoses (MHD) based on ICD-10 classification recorded in public specialized health care. As socioeconomic outcomes, we used offspring's (N = 511,835) records for low educational attainment, unemployment, and social assistance dependency in early adulthood. In addition to linear probability models, the g-computation method was used to simulate the degree to which reducing mental health inequalities in adolescence could narrow the differences between children of different family backgrounds. Our results show that adolescents with MHD had a higher likelihood of experiencing social disadvantage as young adults even after accounting for parental socioeconomic status and alternative health pathways. The counterfactual analysis indicated that the proportion mediated by unevenly distributed MHD was with 7.5% highest for social assistance followed by 4.2% for education and 3.2% for unemployment. The effect of mental health was modified by gender yet direction and strength varied across methods and externalizing behaviors mattered more for the intergenerational persistence than internalizing behaviors. Hypothetically reducing MHD to the level of families with high socioeconomic status might indeed lower part of the intergenerational transmission of social assistance dependency but to lesser degree of unemployment and low educational attainment. We demonstrate the need of support and services for those with MHD, especially among socially disadvantaged groups. However, social disadvantage should not be overly medicalized as family background has an important independent effect on offspring's socioeconimic outcomes.

Neighbourhood effects on psychiatric disorders among Finnish adolescents: The moderating impact of family background.

We study whether childhood neighbourhood context affects mental health in adolescence in Finland. We also examine heterogeneous effects by family background. By exploiting register data for 1999-2018, we use sibling fixed effects models to gain more robust evidence on the existence of neighbourhood effects. We do not find evidence of an association between neighbourhood characteristics and psychiatric disorders within families. Differences in the effects by family background were not consistent, and variation was mainly found in random effects models. In general, observed family characteristics were strongly associated with psychiatric disorders. This means that interventions should be targeted to children at risk rather than certain neighbourhoods.