Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 2, pp 193–203 | Cite as

Parental socio-economic position during childhood as a determinant of self-harm in adolescence

  • Andrew Page
  • Glyn Lewis
  • Judi Kidger
  • Jon Heron
  • Catherine Chittleborough
  • Jonathan Evans
  • David Gunnell
Original Paper



Socio-economic position (SEP) during childhood and parental social mobility have been associated with subsequent health outcomes in adolescence and adulthood. This study investigates whether parental SEP during childhood is associated with subsequent self-harm in adolescence.


This study uses data from a prospective birth-cohort study (the Avon Longitudinal Study of Parents and Children) which followed 14,610 births in 1991–1992 to age 16–18 years (n = 4,810). The association of parental SEP recorded pre-birth and throughout childhood with self-harm was investigated using logistic regression models, with analyses conducted separately for those reporting self-harm (a) with and (b) without suicidal intent. The impact of missing data was investigated using multiple imputation methods.


Lower parental SEP was associated with increased risk of offspring self-harm with suicidal intent, with less consistent associations evident for self-harm without suicidal intent. Associations were somewhat stronger in relation to measures of SEP in later childhood. Depressive symptoms appeared to partially mediate the associations. Adolescents of parents reporting consistently low income levels during childhood were approximately 1.5 times more likely to engage in SH than those never to report low income.


Lower SEP during childhood is associated with the subsequent risk of self-harm with suicidal intent in adolescence. This association is stronger in those experiencing consistently lower SEP.


Self-harm Suicide Income Education Social class Socio-economic factors Adolescents ALSPAC 



This research was funded by the Economic and Social Research Council UK to study the impact of family socio-economic status on outcomes in childhood and adolescence (principal investigator, Paul Gregg; Grant RES-060-23-0011). We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The UK Medical Research Council (Grant Ref: 74882), the Wellcome Trust (Grant Ref: 076467) and the University of Bristol provide core support for ALSPAC. The publication is the work of the authors who serve as guarantors for the contents of this paper. CRC is supported by funds from an Australia Fellowship awarded to John Lynch by the National Health and Medical Research Council of Australia. GL and DG are NIHR Senior Investigators.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Kivimaki M, Gunnell D, Lawlor DA, Davey Smith G, Pentti J, Virtanen M et al (2007) Social inequalities in antidepressant treatment and mortality: a longitudinal register study. Psychol Med 37(3):373–382PubMedCrossRefGoogle Scholar
  2. 2.
    Qin P, Agerbo E, Mortensen PB (2003) Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. Am J Psychiatry 160(4):765–772PubMedCrossRefGoogle Scholar
  3. 3.
    Fergusson DM, Boden JM, Horwood LJ (2007) Unemployment and suicidal behavior in a New Zealand birth cohort: a fixed effects regression analysis. Crisis 28(2):95–101PubMedGoogle Scholar
  4. 4.
    Fergusson DM, Woodward LJ, Horwood LJ (2000) Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med 30(1):23–39PubMedCrossRefGoogle Scholar
  5. 5.
    Mittendorfer-Rutz E, Rasmussen F, Wasserman D (2004) Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet 364(9440):1135–1140PubMedCrossRefGoogle Scholar
  6. 6.
    Lynch J, Kaplan G (2000) Socioeconomic position. In: Berkman L, Kawachi I (eds) Social epidemiology. Oxford University Press, New YorkGoogle Scholar
  7. 7.
    Pensola TH, Martikainen P (2003) Effect of living conditions in the parental home and youth paths on the social class gradient differences in mortality among women. Scand J Public Health 31:428–438PubMedCrossRefGoogle Scholar
  8. 8.
    Kposowa AJ (2001) Unemployment and suicide: a cohort analysis of social factors predicting suicide in the US National Longitudinal Mortality Study. Psychol Med 31(1):127–138PubMedCrossRefGoogle Scholar
  9. 9.
    Lesage AD, Boyer R, Grunberg F, Vanier C, Morissette R, Menard-Buteau C et al (1994) Suicide and mental disorders: a case-control study of young men. Am J Psychiatry 151(7):1063–1068PubMedGoogle Scholar
  10. 10.
    Strand BH, Kunst A (2007) Childhood socioeconomic position and cause-specific mortality in early adulthood. Am J Epidemiol 165(1):85–93PubMedCrossRefGoogle Scholar
  11. 11.
    Page A, Morrell S, Taylor R (2002) Suicide differentials in Australian males and females by various measures of socio-economic status, 1994–98. Aust N Z J Public Health 26(4):318–324PubMedCrossRefGoogle Scholar
  12. 12.
    Muntaner C, Eaton WW, Miech R, O’Campo P (2004) Socioeconomic position and major mental disorders. Epidemiol Rev 26:53–62PubMedCrossRefGoogle Scholar
  13. 13.
    Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157(2):98–112PubMedCrossRefGoogle Scholar
  14. 14.
    Timms D (1998) Gender, social mobility and psychiatric diagnoses. Soc Sci Med 46(9):1235–1247PubMedCrossRefGoogle Scholar
  15. 15.
    Ritsher JE, Warner V, Johnson JG, Dohrenwend BP (2001) Inter-generational longitudinal study of social class and depression: a test of social causation and social selection models. Br J Psychiatry Suppl 40:s84–s90PubMedCrossRefGoogle Scholar
  16. 16.
    Wiersma D, Giel R, De Jong A, Slooff CJ (1983) Social class and schizophrenia in a Dutch cohort. Psychol Med 13(1):141–150PubMedCrossRefGoogle Scholar
  17. 17.
    Claussen B, Smits J, Naess O, Davey Smith G (2005) Intragenerational mobility and mortality in Oslo: social selection versus social causation. Soc Sci Med 61(12):2513–2520PubMedCrossRefGoogle Scholar
  18. 18.
    Pensola TH, Martikainen P (2003) Cumulative social class and mortality from various causes of adult men. J Epidemiol Community Health 57(9):745–751PubMedCrossRefGoogle Scholar
  19. 19.
    Andover MS, Gibb BE (2010) Non-suicidal self-injury, attempted suicide, and suicidal intent among psychiatric inpatients. Psychiatry Res 178(1):101–105PubMedCrossRefGoogle Scholar
  20. 20.
    Jacobson CM, Gould M (2007) The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature. Arch Suicide Res 11(2):129–147PubMedCrossRefGoogle Scholar
  21. 21.
    Harriss L, Hawton K (2005) Suicidal intent in deliberate self-harm and the risk of suicide: the predictive power of the Suicide Intent Scale. J Affect Disord 86(2–3):225–233PubMedCrossRefGoogle Scholar
  22. 22.
    Boyd A, Golding J, Macleod J, Lawlor DA, Fraser A, Henderson J et al (2013) Cohort profile: The ‘Children of the 90s’—the index offspring of the Avon Longitudinal Study of Parents and Children. Int J Epidemiol 42(1):111–127Google Scholar
  23. 23.
    Golding J, Pembrey M, Jones R, Team AS (2001) ALSPAC–the Avon Longitudinal Study of Parents and Children. I. Study methodology. Paediatr Perinat Epidemiol 15(1):74–87PubMedCrossRefGoogle Scholar
  24. 24.
    Kidger J, Heron J, Lewis G, Evans J, Gunnell D (2012) Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: a self-report survey in England. BMC Psychiatry 12(1):69PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Office of Population Censuses and Surveys (1991) Standard occupational classification. Her Majesty’s Stationery Office, LondonGoogle Scholar
  26. 26.
    Gregg P, Propper C, Washbrook E (2008) Understanding the relationship between parental income and multiple child outcomes: A decomposition analysis. Working Paper No. 08/193. Bristol, United Kingdom Centre for Market and Public OrganizationGoogle Scholar
  27. 27.
    Angold A, Costello EJ, Messer SC, Pickles A, Winder F, Silver D (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5(4):237–249Google Scholar
  28. 28.
    Patton GC, Olsson C, Bond L, Toumbourou JW, Carlin JB, Hemphill SA et al (2008) Predicting female depression across puberty: a two-nation longitudinal study. J Am Acad Child Adolesc Psychiatry 47(12):1424–1432PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Mann JJ, Bortinger J, Oquendo MA, Currier D, Li S, Brent DA (2005) Family history of suicidal behavior and mood disorders in probands with mood disorders. Am J Psychiatry 162(9):1672–1679PubMedCrossRefGoogle Scholar
  30. 30.
    Li X, Sundquist J, Sundquist K (2008) Age-specific familial risks of depression: a nation-wide epidemiological study from Sweden. J Psychiatr Res 42(10):808–814PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Deave T, Heron J, Evans J, Emond A (2008) The impact of maternal depression in pregnancy on early child development. BJOG 115(8):1043–1051PubMedCrossRefGoogle Scholar
  32. 32.
    de Weerth C, Buitelaar JK (2005) Physiological stress reactivity in human pregnancy–a review. Neurosci Biobehav Rev 29(2):295–312PubMedCrossRefGoogle Scholar
  33. 33.
    Murray D, Cox JL (1990) Screening for depression during pregnancy with the Edinburgh depression scale (EDDS). J Reprod Infant Psychol 8(2):99–107CrossRefGoogle Scholar
  34. 34.
    Melotti R, Heron J, Hickman M, Macleod J, Araya R, Lewis G (2011) Adolescent alcohol and tobacco use and early socioeconomic position: the ALSPAC birth cohort. Pediatrics 127(4):e948–e955PubMedCrossRefGoogle Scholar
  35. 35.
    Stata Corp (2009) STATA Version 11.0. College Station, TexasGoogle Scholar
  36. 36.
    van Buuren S, Boshuizen HC, Knook DL (1999) Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med 18(6):681–694PubMedCrossRefGoogle Scholar
  37. 37.
    Sterne JAC, White IR, Carlin JB, Spratt M, Royston P, Kenward MG et al (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338:b2393PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Spratt M, Carpenter J, Sterne JAC, Carlin JB, Heron J, Henderson J et al (2010) Strategies for multiple imputation in longitudinal studies. Am J Epidemiol 172(4):478–487PubMedCrossRefGoogle Scholar
  39. 39.
    Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Mike Grady M et al (2010) Fair society, health lives: strategic review of health inequalities in England post-2010—The Marmot review. London. ISBN: 978–0–9564870–0–1Google Scholar
  40. 40.
    Naess O, Claussen B, Smith GD, Leyland AH (2008) Life course influence of residential area on cause-specific mortality. J Epidemiol Community Health 62(1):29–34PubMedCrossRefGoogle Scholar
  41. 41.
    Wadsworth ME, Achenbach TM (2005) Explaining the link between low socioeconomic status and psychopathology: testing two mechanisms of the social causation hypothesis. J Consult Clin Psychol 73(6):1146–1153PubMedCrossRefGoogle Scholar
  42. 42.
    Gould MS, Shaffer D, Fisher P, Garfinkel R (1998) Separation/divorce and child and adolescent completed suicide. J Am Acad Child Adolesc Psychiatry 37(2):155–162PubMedCrossRefGoogle Scholar
  43. 43.
    Klonsky ED, Moyer A (2008) Childhood sexual abuse and non-suicidal self-injury: meta-analysis. Br J Psychiatry 192(3):166–170PubMedCrossRefGoogle Scholar
  44. 44.
    Williams SB, O’Connor EA, Eder M, Whitlock EP (2009) Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force. Pediatrics 123(4):e716–e735PubMedCrossRefGoogle Scholar
  45. 45.
    Horowitz LM, Ballard ED, Pao M (2009) Suicide screening in schools, primary care and emergency departments. Curr Opin Pediatr 21(5):620–627PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Luoma JB, Martin CE, Pearson JL (2002) Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry 159(6):909–916PubMedCrossRefGoogle Scholar
  47. 47.
    Belsky J, Melhuish E, Barnes J, Leyland AH, Romaniuk H (2006) Effects of Sure Start local programmes on children and families: early findings from a quasi-experimental, cross sectional study. BMJ 332(7556):1476PubMedCrossRefGoogle Scholar
  48. 48.
    Costello EJ, Erkanli A, Copeland W, Angold A (2010) Association of family income supplements in adolescence with development of psychiatric and substance use disorders in adulthood among an American Indian population. JAMA 303(19):1954–1960PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Costello EJ, Compton SN, Keeler G, Angold A (2003) Relationships between poverty and psychopathology: a natural experiment. JAMA 290(15):2023–2029PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Andrew Page
    • 1
  • Glyn Lewis
    • 2
  • Judi Kidger
    • 3
  • Jon Heron
    • 3
  • Catherine Chittleborough
    • 4
  • Jonathan Evans
    • 2
  • David Gunnell
    • 3
  1. 1.Discipline of Epidemiology and Biostatistics, School of Population HealthUniversity of QueenslandHerstonAustralia
  2. 2.Academic Unit of PsychiatryUniversity of BristolBristolUK
  3. 3.School of Social and Community MedicineUniversity of BristolBristolUK
  4. 4.School of Population HealthUniversity of AdelaideAdelaideAustralia

Personalised recommendations