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Is socioeconomic inequality in postnatal depression an early-life root of disadvantage for children?


This paper investigates the role that socioeconomic inequality in postnatal depression might play in intergenerational transmission of inequality. Infants’ development is thought to be particularly sensitive to mothers’ mental health at this time, suggesting that greater early-life exposure to maternal depression among disadvantaged groups might be a root of later socioeconomic inequalities. Heightened contact with health services during this period presents opportunities for intervention, but higher unmet need for treatment of postnatal depression among the disadvantaged might be widening inequalities. The aim of this study is to quantify the potential contribution of postnatal depression to socioeconomic inequalities in adverse childhood health and development outcomes. Regression-based decomposition of the concentration index is used to explore the association between income inequality in postnatal depressive symptoms and income inequality in children’s outcomes. Four problems of early adolescence are explored: emotional and conduct problems, special educational needs, and low self-assessed health. Data are taken from the UK Millennium Cohort Study, with a sample of 4359 mothers and children with complete data on outcomes and covariates, and a second sample of 5441 when missing covariates are filled using multiple imputation. The key finding is that socioeconomic inequality in maternal postnatal depression is a significant contributor to inequalities in special educational needs, emotional problems, and low self-assessed health for children at age 11 years, even after accounting for a range of other factors that might explain such associations. These findings highlight the importance of understanding the impact of postnatal depression interventions on inequalities, and the downstream influence on children’s outcomes. Addressing inequalities in mothers’ postnatal depression might be an avenue for reducing early-life disadvantage for children.

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  1. 1.

    Reiss, F.: Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc. Sci. Med. 90, 24–31 (2013).

    PubMed  Article  Google Scholar 

  2. 2.

    Case, A., Lubotsky, D., Paxson, C.: Economic status and health in childhood: the origins of the gradient. Am. Econ. Rev. 92(5), 1308–1334 (2002)

    PubMed  Article  Google Scholar 

  3. 3.

    Fleurbaey, M., Schokkaert, E.: Unfair health inequality. In: Culyer, A.J. (ed.) Encyclopedia of Health Economics. Academic Press, Amsterdam (2014)

    Google Scholar 

  4. 4.

    Marmot, M., Bell, R.: Fair society, healthy lives. Public. Health. 126(Suppl 1), S4–S10 (2012).

    PubMed  Article  Google Scholar 

  5. 5.

    Haas, S.: Trajectories of functional health: the ‘long arm’ of childhood health and socioeconomic factors. Soc. Sci. Med. 66(4), 849–861 (2008).

    PubMed  Article  Google Scholar 

  6. 6.

    Goodman, A., Joyce, R., Smith, J.P.: The long shadow cast by childhood physical and mental problems on adult life. Proc. Natl. Acad. Sci. 108, 6032–6037 (2011)

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Crombie, I.K., Irvine, L., Elliott, L., Wallace, H.: Closing the health inequalities gap: an intenational perspective. World Health Organization Europe, Copenhagen (2005)

    Google Scholar 

  8. 8.

    Elgar, F.J., Pförtner, T.-K., Moor, I., De Clercq, B., Stevens, G.W., Currie, C.: Socioeconomic inequalities in adolescent health 2002–2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study. Lancet. 385(9982), 2088–2095 (2015)

    PubMed  Article  Google Scholar 

  9. 9.

    Gavin, N.I., Gaynes, B.N., Lohr, K.N., Meltzer-Brody, S., Gartlehner, G., Swinson, T.: Perinatal depression: a systematic review of prevalence and incidence. Obstet. Gynecol. 106(5 Pt 1), 1071–1083 (2005).

    PubMed  Article  Google Scholar 

  10. 10.

    Roberts, J., Donkin, A., Marmot, M.: Opportunities for reducing socioeconomic inequalities in the mental health of children and young people—reducing adversity and increasing resilience. J. Public. Mental. Health. 15(1), 4–18 (2016)

    Article  Google Scholar 

  11. 11.

    Matijasevich, A., Golding, J., Smith, G.D., Santos, I.S., Barros, A.J., Victora, C.G.: Differentials and income-related inequalities in maternal depression during the first two years after childbirth: birth cohort studies from Brazil and the UK. Clin. Pract. Epidemiol. Mental. Health. 5, 12 (2009).

    Article  Google Scholar 

  12. 12.

    Seguin, L., Potvin, L., St-Denis, M., Loiselle, J.: Socio-environmental factors and postnatal depressive symptomatology: a longitudinal study. Women. Health. 29(1), 57–72 (1999)

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Ban, L., Gibson, J.E., West, J., Fiaschi, L., Oates, M.R., Tata, L.J.: Impact of socioeconomic deprivation on maternal perinatal mental illnesses presenting to UK general practice. Brit. J. Gen. Pract. 62(603), e671–e678 (2012).

    Article  Google Scholar 

  14. 14.

    Goyal, D., Gay, C., Lee, K.A.: How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers? Women’s. Health. Issues. 20(2), 96–104 (2010)

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Mayberry, L.J., Horowitz, J.A., Declercq, E.: Depression symptom prevalence and demographic risk factors among US women during the first 2 years postpartum. J. Obstet. Gynecol. Neonatal. Nurs. 36(6), 542–549 (2007).

    PubMed  Article  Google Scholar 

  16. 16.

    O’Hara, M.W., McCabe, J.E.: Postpartum depression: current status and future directions. Annu. Rev. Clin. Psychol. 9, 379–407 (2013)

    PubMed  Article  Google Scholar 

  17. 17.

    Hahn-Holbrook, J., Cornwell-Hinrichs, T., Anaya, I.: Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front. Psychiatry. 8, 248 (2018)

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Stein, A., Pearson, R.M., Goodman, S.H., Rapa, E., Rahman, A., McCallum, M., Howard, L.M., Pariante, C.M.: Effects of perinatal mental disorders on the fetus and child. Lancet. 384(9956), 1800–1819 (2014)

    PubMed  Article  Google Scholar 

  19. 19.

    Goodman, S.H., Rouse, M.H., Connell, A.M., Broth, M.R., Hall, C.M., Heyward, D.: Maternal depression and child psychopathology: a meta-analytic review. Clin. Child. Fam. Psychol. Rev. 14(1), 1–27 (2011)

    PubMed  Article  Google Scholar 

  20. 20.

    Ahun, M.N., Côté, S.M.: Maternal depressive symptoms and early childhood cognitive development: a review of putative environmental mediators. Arch. Women’s. Mental. Health. 22(1), 15–24 (2019).

    Article  Google Scholar 

  21. 21.

    Goodman, J.H.: Postpartum depression beyond the early postpartum period. J. Obstet. Gynecol. Neonatal. Nurs. 33(4), 410–420 (2004).

    PubMed  Article  Google Scholar 

  22. 22.

    Philipps, L.H.C., O’Hara, M.W.: Prospective-study of postpartum depression—41/2-year follow-up of women and children. J. Abnorm. Psychol. 100(2), 151–155 (1991).

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Turney, K.: Prevalence and correlates of stability and change in maternal depression: evidence from the fragile families and child wellbeing study. PLoS. One. 7(9), e45709 (2012).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Netsi, E., Pearson, R.M., Murray, L., Cooper, P., Craske, M.G., Stein, A.: Association of persistent and severe postnatal depression with child outcomes. JAMA. Psychiatry. 75(3), 247–253 (2018)

    PubMed  PubMed Central  Article  Google Scholar 

  25. 25.

    Stein, A., Pearson, R.M., Goodman, S.H., Rapa, E., Rahman, A., McCallum, M., Howard, L.M., Pariante, C.M.: Effects of perinatal mental disorders on the fetus and child. Lancet. 384(9956), 1800–1819 (2014).

    PubMed  Article  Google Scholar 

  26. 26.

    Tsivos, Z.-L., Calam, R., Sanders, M.R., Wittkowski, A.: Interventions for postnatal depression assessing the mother–infant relationship and child developmental outcomes: a systematic review. Int. J. Women’s. Health. 7, 429 (2015)

    Google Scholar 

  27. 27.

    Stein, A., Netsi, E., Lawrence, P.J., Granger, C., Kempton, C., Craske, M.G., Nickless, A., Mollison, J., Stewart, D.A., Rapa, E., West, V., Scerif, G., Cooper, P.J., Murray, L.: Mitigating the effect of persistent postnatal depression on child outcomes through an intervention to treat depression and improve parenting: a randomised controlled trial. Lancet. Psychiatry. 5(2), 134–144 (2018).

    PubMed  Article  Google Scholar 

  28. 28.

    Newton, J.: Preventing Mental Ill-Health: Informing Public Health Planning and Mental Health Practice. Taylor and Francis, Routledge (2013)

    Book  Google Scholar 

  29. 29.

    Murray, L., Woolgar, M., Murray, J., Cooper, P.: Self-exclusion from health care in women at high risk for postpartum depression. J. Public. Health. Med. 25(2), 131–137 (2003).

    PubMed  Article  Google Scholar 

  30. 30.

    Goyal, N.K., Hall, E.S., Jones, D.E., Meinzen-Derr, J.K., Short, J.A., Ammerman, R.T., Van Ginkel, J.B.: Association of maternal and community factors with enrollment in home visiting among at-risk, first-time mothers. Am. J. Public. Health. 104(S1), S144–S151 (2014)

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    O’Mahen, H.A., Richards, D.A., Woodford, J., Wilkinson, E., McGinley, J., Taylor, R.S., Warren, F.C.: Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol. Med. 44(8), 1675–1689 (2014).

    PubMed  Article  Google Scholar 

  32. 32.

    Bate, A., Parkin, E., Mackley, A.: Perinatal mental illness: debate pack. London House of Commons Library, vol. CDP-2018-0178 (2018).

  33. 33.

    Jackson, M.I., Kiernan, K., McLanahan, S.: Maternal education, changing family circumstances, and children’s skill development in the United States and UK. Ann. Am. Acad. Political. Soc. Sci. 674(1), 59–84 (2017)

    Article  Google Scholar 

  34. 34.

    Ban, L., Gibson, J.E., West, J., Tata, L.J.: Association between perinatal depression in mothers and the risk of childhood infections in offspring: a population-based cohort study. BMC. Public. Health. 10, 799 (2010).

    PubMed  PubMed Central  Article  Google Scholar 

  35. 35.

    Turney, K.: Maternal depression and childhood health inequalities. J. Health. Soc. Behav. 52(3), 314–332 (2011).

    PubMed  Article  Google Scholar 

  36. 36.

    Sanger, C., Iles, J.E., Andrew, C.S., Ramchandani, P.G.: Associations between postnatal maternal depression and psychological outcomes in adolescent offspring: a systematic review. Arch. Women. Mental. Health. 18(2), 147–162 (2015).

    Article  Google Scholar 

  37. 37.

    Wagstaff, A., Paci, P., van Doorslaer, E.: On the measurement of inequalities in health. Soc. Sci. Med. 33(5), 545–557 (1991)

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Wagstaff, A., van Doorslaer, E., Watanabe, N.: On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J. Econom. 112(1), 207–223 (2003). (Pii S0304-4076(02)00161-6)

    Article  Google Scholar 

  39. 39.

    Connelly, R., Platt, L.: Cohort profile: UK millennium cohort study (MCS). Int. J. Epidemiol. 43(6), 1719–1725 (2014).

    PubMed  Article  Google Scholar 

  40. 40.

    Dex, S., Joshi, H.: Children of the 21st century: from birth to nine months. Policy Press, Bristol (2005)

    Book  Google Scholar 

  41. 41.

    Gjerdingen, D., Crow, S., McGovern, P., Miner, M., Center, B.: Postpartum depression screening at well-child visits: validity of a 2-question screen and the PHQ-9. Ann. Fam. Med. 7(1), 63–70 (2009)

    PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    Tonei, V.: Mother’s mental health after childbirth: does the delivery method matter? J. Health. Econ. 63, 182–196 (2019).

    PubMed  Article  Google Scholar 

  43. 43.

    Centre for longitudinal studies: measuring signs of psychological distress or depression in teenagers and adults: the malaise inventory. Accessed 17 Aug 2015

  44. 44.

    Boyle, D., Burton, E.: Making Sense of SEN: Special Educational Needs, a Guide for Donors and Grant-Makers. New Philanthropy Capital, London (2004)

    Google Scholar 

  45. 45.

    Goodman, R.: The strengths and difficulties questionnaire: a research note. J. Child. Psychol. Psychiatry. 38(5), 581–586 (1997)

    CAS  PubMed  Article  Google Scholar 

  46. 46.

    Goodman, R., Ford, T., Simmons, H., Gatward, R., Meltzer, H.: Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br. J. Psychiatry. 177(6), 534–539 (2000)

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Goodman, A., Lamping, D.L., Ploubidis, G.B.: When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the strengths and difficulties questionnaire (SDQ): data from British parents, teachers and children. J. Abnorm. Child. Psychol. 38(8), 1179–1191 (2010)

    PubMed  Article  Google Scholar 

  48. 48.

    Shaw, M., Lawlor, D.A., Najman, J.M.: Teenage children of teenage mothers: psychological, behavioural and health outcomes from an Australian prospective longitudinal study. Soc. Sci. Med. 62(10), 2526–2539 (2006)

    PubMed  Article  Google Scholar 

  49. 49.

    Riley, A.W.: Evidence that school-age children can self-report on their health. Ambul. Pediatr. 4(4), 371–376 (2004)

    PubMed  Article  Google Scholar 

  50. 50.

    Hansen, K., Johnson, J., Calderwood, L., Mostafa, T., Platt, L., Rosenberg, R., Smith, K.: Millennium cohort study: a guide to the datasets. First, second, third, fourth and fifth surveys. In: Hansen, K. (ed.) Centre for Longitudinal Studies. University of London, London (2014)

    Google Scholar 

  51. 51.

    Noble, M., Wright, G., Smith, G., Dibben, C.: Measuring multiple deprivation at the small-area level. Environ. Plann. A. 38(1), 169–185 (2006)

    Article  Google Scholar 

  52. 52.

    Anders, Y., Sammons, P., Taggart, B., Sylva, K., Melhuish, E., Siraj-Blatchford, I.: The influence of child, family, home factors and pre-school education on the identification of special educational needs at age 10. Br. Edu. Res. J. 37(3), 421–441 (2011)

    Article  Google Scholar 

  53. 53.

    Plewis, I., Calderwood, L., Hawkes, D., Hughes, G., Joshi, H.: Millennium Cohort Study: Technical Report on Sampling. Centre for Longitudinal Studies, London (2007)

    Google Scholar 

  54. 54.

    O’Donnell, O.A., Wagstaff, A.: Analyzing health equity using household survey data: a guide to techniques and their implementation. World Bank Publications, Washington (2008)

    Google Scholar 

  55. 55.

    Kjellsson, G., Gerdtham, U.G.: On correcting the concentration index for binary variables. J. Health. Econ. 32(3), 659–670 (2013).

    PubMed  Article  Google Scholar 

  56. 56.

    Erreygers, G.: Correcting the concentration index. J. Health. Econ. 28, 569 (2009).

    Article  Google Scholar 

  57. 57.

    van Doorslaer, E., Koolman, X., Jones, A.M.: Explaining income-related inequalities in doctor utilisation in Europe. Health. Econ. 13(7), 629–647 (2004).

    PubMed  Article  Google Scholar 

  58. 58.

    Wilson, G.: The effects of season of birth, sex and cognitive abilities on the assessment of special educational needs. Educ. Psychol. 20(2), 153–166 (2000)

    Article  Google Scholar 

  59. 59.

    Dearden, L., Sibieta, L., Sylva, K.: The socio-economic gradient in early child outcomes: evidence from the Millennium Cohort Study. Longitud. Life. Course. Stud. 2(1), 19–40 (2011)

    Google Scholar 

  60. 60.

    Kelly, Y., Sacker, A., del Bono, E., Francesconi, M., Marmot, M.: What role for the home learning environment and parenting in reducing the socioeconomic gradient in child development? Findings from the Millennium Cohort Study. Arch. Dis. Child. 96, 832–837 (2011)

    CAS  PubMed  Article  Google Scholar 

  61. 61.

    Zilanawala, A., Sacker, A., Nazroo, J., Kelly, Y.: Ethnic differences in children’s socioemotional difficulties: findings from the Millennium Cohort Study. Soc. Sci. Med. 134, 95–106 (2015).

    PubMed  Article  Google Scholar 

  62. 62.

    Sabates, R., Dex, S.: The impact of multiple risk factors on young children’s cognitive and behavioural development. Child. Soc. 29(2), 95–108 (2015).

    Article  Google Scholar 

  63. 63.

    Jo, H., Schieve, L.A., Sharma, A.J., Hinkle, S.N., Li, R., Lind, J.N.: Maternal prepregnancy body mass index and child psychosocial development at 6 years of age. Pediatrics. 135, 2014–3058 (2015)

    Article  Google Scholar 

  64. 64.

    Washbrook, E., Gregg, P., Propper, C.: A decomposition analysis of the relationship between parental income and multiple child outcomes. J. R. Stat. Soc. Stat. 177(4), 757–782 (2014).

    Article  Google Scholar 

  65. 65.

    Gledhill, J., Ford, T., Goodman, R.: Does season of birth matter?: the relationship between age within the school year (season of birth) and educational difficulties among a representative general population sample of children and adolescents (aged 5–15) in Great Britain. Res. Educ. 68(1), 41–47 (2002)

    Article  Google Scholar 

  66. 66.

    Rubin, D.B.: Multiple Imputation for Nonresponse in Surveys, vol. 81. Wiley, New York (2004)

    Google Scholar 

  67. 67.

    Erreygers, G., Kessels, R.: Regression-based decompositions of rank-dependent indicators of socioeconomic inequality of health. In: Rosa Dias, P., O’Donnell, O. (eds.) Health and Inequality (Research on Economic Inequality, Volume 21, Chapter 9). Emerald Group Publishing Limited, London (2013)

    Google Scholar 

  68. 68.

    Hay, D.F., Pawlby, S., Sharp, D., Asten, P., Mills, A., Kumar, R.: Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. J. Child. Psychol. Psychiatry. 42(7), 871–889 (2001)

    CAS  PubMed  Article  Google Scholar 

  69. 69.

    Zhang, C., Zhao, C., Liu, X., Wei, Q., Luo, S., Guo, S., Zhang, J., Wang, X., Scherpbier, R.W.: Inequality in early childhood neurodevelopment in six poor rural counties of China: a decomposition analysis. Int. J. Equity. Health. 16(1), 212 (2017)

    PubMed  PubMed Central  Article  Google Scholar 

  70. 70.

    Straatmann, V., Campbell, M., Rutherford, C., Wickham, S., Taylor-Robinson, D.: OP61 understanding social inequalities in child mental health: findings from the uk millennium cohort study. J. Epidemiol. Commun. H. 71(Suppl 1), A31 (2017).

    Article  Google Scholar 

  71. 71.

    Sahrakorpi, N., Koivusalo, S.B., Eriksson, J.G., Kautiainen, H., Stach-Lempinen, B., Roine, R.P.: Perceived financial satisfaction, health related quality of life and depressive symptoms in early pregnancy. Matern. Child. Health. J. 21(7), 1493–1499 (2017)

    PubMed  Article  Google Scholar 

  72. 72.

    Petrou, S., Kupek, E., Gray, R.: Income inequalities and self-reported maternal health status: cross-sectional national survey. BJOG Int. J. Obstet. Gynecol. 114(8), 1018–1022 (2007).

    CAS  Article  Google Scholar 

  73. 73.

    Halligan, S.L., Murray, L., Martins, C., Cooper, P.J.: Maternal depression and psychiatric outcomes in adolescent offspring: a 13-year longitudinal study. J. Affect. Disord. 97(1–3), 145–154 (2007).

    PubMed  Article  Google Scholar 

  74. 74.

    Hay, D.F., Pawlby, S., Waters, C.S., Sharp, D.: Antepartum and postpartum exposure to maternal depression: different effects on different adolescent outcomes. J. Child. Psychol. Psychiatry. 49(10), 1079–1088 (2008).

    PubMed  Article  Google Scholar 

  75. 75.

    Pearson, R.M., Evans, J., Kounali, D., Lewis, G., Heron, J., Ramchandani, P.G., O’Connor, T.G., Stein, A.: Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA. Psychiatry. 70(12), 1312–1319 (2013).

    PubMed  PubMed Central  Article  Google Scholar 

  76. 76.

    Boardman, J.D.: Self-rated health among US adolescents. J. Adolesc. Health. 38(4), 401–408 (2006).

    PubMed  PubMed Central  Article  Google Scholar 

  77. 77.

    Bauldry, S., Shanahan, M.J., Boardman, J.D., Miech, R.A., Macmillan, R.: A life course model of self-rated health through adolescence and young adulthood. Soc. Sci. Med. 75(7), 1311–1320 (2012).

    PubMed  PubMed Central  Article  Google Scholar 

  78. 78.

    De Los Reyes, A., Kazdin, A.E.: Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychol. Bull. 131(4), 483 (2005)

    PubMed  Article  Google Scholar 

  79. 79.

    Najman, J.M., Williams, G.M., Nikles, J., Spence, S., Bor, W., O’callaghan M, M., Brocque, R.L., Andersen, M.J.: Mothers’ mental illness and child behavior problems: cause-effect association or observation bias? J. Am. Acad. Child. Adolesc. Psychiatry. 39(5), 592–602 (2000)

    CAS  PubMed  Article  Google Scholar 

  80. 80.

    Bradley, R.H., Corwyn, R.F.: Socioeconomic status and child development. Annu. Rev. Psychol. 53(1), 371–399 (2002)

    PubMed  Article  Google Scholar 

  81. 81.

    Brockington, I.: Postpartum psychiatric disorders. Lancet. 363(9405), 303–310 (2004).

    PubMed  Article  Google Scholar 

  82. 82.

    Dickerson, A., Popli, G.K.: Persistent poverty and children’s cognitive development: evidence from the UK Millennium Cohort Study. J. R. Stat. Soc. Stat. 179(2), 535–558 (2016).

    Article  Google Scholar 

  83. 83.

    Gawlik, S., Muller, M., Hoffmann, L., Dienes, A., Wallwiener, M., Sohn, C., Schlehe, B., Reck, C.: Prevalence of paternal perinatal depressiveness and its link to partnership satisfaction and birth concerns. Arch. Women. Mental. Health. 17(1), 49–56 (2014).

    CAS  Article  Google Scholar 

  84. 84.

    Edoka, I.P., Petrou, S., Ramchandani, P.G.: Healthcare costs of paternal depression in the postnatal period. J. Affect. Disord. 133(1–2), 356–360 (2011).

    PubMed  PubMed Central  Article  Google Scholar 

  85. 85.

    Schumacher, M., Zubaran, C., White, G.: Bringing birth-related paternal depression to the fore. Women. Birth. 21(2), 65–70 (2008).

    PubMed  Article  Google Scholar 

  86. 86.

    Woodward, A., Kawachi, I.: Why reduce health inequalities? J. Epidemiol. Commun. H. 54(12), 923–929 (2000)

    CAS  Article  Google Scholar 

  87. 87.

    Asaria, M., Griffin, S., Cookson, R., Whyte, S., Tappenden, P.: Distributional cost-effectiveness analysis of health care programmes–a methodological case study of the UK bowel cancer screening programme. Health. Econ. 24(6), 742–754 (2015).

    PubMed  Article  Google Scholar 

  88. 88.

    Armstrong, K., Morris, J.: Promoting secure attachment, maternal mood and child health in a vulnerable population: a randomized controlled trial. J. Paediatr. Child. H. 36(6), 555–562 (2000)

    CAS  Article  Google Scholar 

  89. 89.

    Zlotnick, C., Tzilos, G., Miller, I., Seifer, R., Stout, R.: Randomized controlled trial to prevent postpartum depression in mothers on public assistance. J. Affect. Disord. 189, 263–268 (2016).

    PubMed  Article  Google Scholar 

  90. 90.

    Cowley, S., Whittaker, K., Malone, M., Donetto, S., Grigulis, A., Maben, J.: Why health visiting? Examining the potential public health benefits from health visiting practice within a universal service: a narrative review of the literature. Int. J. Nurs. Stud. 52(1), 465–480 (2015).

    PubMed  Article  Google Scholar 

  91. 91.

    Brugha, T.S., Morrell, C.J., Slade, P., Walters, S.J.: Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care. Psychol. Med. 41(4), 739–748 (2011).

    CAS  PubMed  Article  Google Scholar 

  92. 92.

    Whitehead, M., Dahlgren, G.: Levelling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health. World Health Organization, Copenhagen (2006)

    Google Scholar 

  93. 93.

    Kessels, R., Erreygers, G.: Structural equation modeling for decomposing rank-dependent indicators of socioeconomic inequality of health: an empirical study. Health. Econ. Rev. 6(1), 56 (2016)

    PubMed  PubMed Central  Article  Google Scholar 

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I am very grateful to Guido Erreygers, Stavros Petrou, Dennis Petrie, and Emily Lancsar for their helpful advice and comments on earlier versions of this paper.

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Ride, J. Is socioeconomic inequality in postnatal depression an early-life root of disadvantage for children?. Eur J Health Econ 20, 1013–1027 (2019).

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  • UK
  • Socioeconomic inequality
  • Postnatal depression
  • Childhood difficulties
  • Decomposition of the concentration index

JEL Classification

  • I140