Background
Risk factors for mental health
Empirical approach towards multiple risk factors
The current study
Methods
Sample
Measures
Indicators
Risk factor | Instrument | Reference | Item/Scale Description | Time period | Report |
---|---|---|---|---|---|
Individual level | |||||
Low birth weight | Self-constructed | Low birth weight < 2500 g (1), else (0) | T0 | Parent | |
Postnatal problems | Self-constructed | One or more problems like infection, adjustment (1), else (0) | T0 | Parent | |
Breastfeeding | Self-constructed | Partly to fully (1), never (0) | T0 | Parent | |
Chronic illness | Mini European Health Module (MEHM) | [79] | One or more illness like asthma, epilepsy or diabetes (1), else (0) | T0, T1 | Parent |
Self-efficacy | General Self-efficacy Scale (GSE) | [80] | Within-person mean < 25% of distribution of sum scores (1), else (0) | T0, T1, T2 | Parent and Self |
Family level | |||||
Parental education | Comparative Analysis of Social Mobility in Industrial Nations classification (CASMIN) | [81] | Low education qualification (1), else (0) based on T0 or if missing T2 | T0, T2 | Parent |
Parental severe illness | Self-constructed | In case of stroke, heart attack or cancer (1), else (0) | T2 | Self | |
Parental well-being | Personal Well-being index (PWI-A) | [82] | Sum score < 25% of distribution; low (1), else (0) | T2 | Parent |
Parental unemployment | Self-constructed | Present (1), else (0) | T0, T2 | Parent | |
Prenatal exposure to alcohol and tabacco | Self-constructed | Smoking or drinking during pregnancy (1), else (0) | T0 | Parent | |
Teenage mother | Self-constructed | Maternal age < 18 (1), else (0) | T0 | Parent | |
Parental divorce | Self-constructed | Parental divorce (1), else (0) | T2 | Parent | |
Family instability | Self-constructed | Not living with both parents at one of the three measurement times (1), else (0) | T0, T1, T2 | Parent and Self | |
Parental attention | Self-constructed | Frequency of a selection of eight joint activities such as playing, singing, or sports. Sum score < 25% of distribution; low (1) else (0) | T0 | Parent | |
Family size | Self-constructed | Number of siblings > = 2 (1), else (0) | T2 | Self | |
Parental stress | Adapted from [83] | Covering parental stressors e.g. family demands, household requirements, child-related stress, conflicts with current or former spouse or life partner, compatibility of family and work, and financial strain Sum score < 25% of distribution; high (1), else (0) | T2 | Parent | |
Family cohesion | Family climate scales (FKS) | [84] | Within-person mean < 25% of distribution; low (1), else (0) | T0, T1, T2 | Parent and Self |
Family dysfunction | Adapted from the Adverse Childhood Experiences International Questionnaire (ACE-IQ) | [85] | Either parent incarceration, drug/alcohol addiction, mental illness/suicide attempt of a household member (1), none (0) | T2 | Parent |
Parenting: warmth and support | Zurich Short Inventory for Parenting Behavior (ZKE) | [86] | Sum score < 25% of distribution; low (1), else (0) | T2 | Parent and Self |
Parenting: psychological pressure | Zurich Short Inventory for Parenting Behavior (ZKE) | [86] | Sum score > 25% of distribution; high (1), else (0) | T2 | Parent and Self |
Physical neglect or abuse | Childhood trauma Questionnaire (CTQ) | [87] | Never (0), sometimes to very often (1) | T2 | Self |
Emotional neglect or abuse | Childhood trauma Questionnaire (CTQ) | [87] | Never (0), sometimes to very often (1) | T2 | Self |
Sexual abuse | Childhood trauma Questionnaire (CTQ) | [87] | Never (0), sometimes to very often (1) | T2 | Self |
Social level | |||||
Well-being with peers | KINDL-R, Kidscreen-27 | [88] | Within-person mean < 25% of distribution of standardized scores (1) else (0) | T0, T2 | Parent and Self |
Well-being in school | KINDL-R, Kidscreen-27 | [88] | Within-person mean < 25% of distribution of standardized scores (1) else (0) | T0, T2 | Parent and Self |
Perceived social support | Social support scale | Within-person mean < 25% of distribution (1) else (0) | T0, T1, T2 | Parent and Self | |
Discrimination experiences | Adapted from German Youth Institute (DJI) Foreigners Survey | [89] | Any discrimination experience averaged across eight domains (i.e., race, gender, weight) sometimes to very often (1), never | T2 | Self |
Mental health outcomes
Statistical analysis
Latent class analysis (LCA)
Multinomial logistic regression
Results
Descriptive statistics
Risk factors | % | n |
---|---|---|
Individual level | ||
Low Birth Weight | 5.51 | 583 |
Early infant problems | 20.50 | 2096 |
Breastfeeding | 19.04 | 2029 |
Chronic illness | 24.70 | 2681 |
Self-efficacy | 25.88 | 2726 |
Family level | ||
Parental education | 12.68 | 1367 |
Parental severe illness | 35.93 | 3900 |
Parental well-being | 23.28 | 1037 |
Parental unemployment | 14.11 | 1531 |
Prenatal smoking or drinking | 25.60 | 2719 |
Teenage mother | 0.31 | 33 |
Parental divorce | 12.20 | 548 |
Family instability | 22.95 | 2479 |
Parental attention | 1.47 | 160 |
Large family size | 17.15 | 1861 |
Parental stress | 28.34 | 1250 |
Family cohesion | 30.74 | 3296 |
Family dysfunction | 54.80 | 5947 |
Parenting: warmth and support | 22.76 | 982 |
Parenting: psychological pressure | 28.16 | 1215 |
Physical neglect or abuse | 21.68 | 1317 |
Emotional neglect or abuse | 31.23 | 1897 |
Sexual abuse | 5.26 | 320 |
Social level | ||
Well-being with peers | 27.06 | 2878 |
Well-being in school | 24.90 | 2609 |
Perceived social support | 21.95 | 2335 |
Discrimination experiences | 45.33 | 4920 |
Model selection and number of classes
Model | AIC | BIC | aBIC | Entropy | LMRT p value | BLRT p value | |
---|---|---|---|---|---|---|---|
Two-class | 235,638.280 | 236,053.935 | 235,872.797 | 0.618 | 0.000 | 0.000 | |
Three-class | 232,624.262 | 233,251.391 | 232,978.094 | 0.704 | 0.000 | 0.000 | |
Four-class | 231,236.097 | 232,074.700 | 231,709.245 | 0.750 | 0.000 | 0.000 | |
Five-class | 230,389.630 | 231,439.706 | 230,982.093 | 0.763 | 0.000 | 0.000 | |
Six-classa | 229,846.766 | 231,108.316 | 230,558.545 | 0.725 | 0.000 | 0.000 | |
Seven-classa | 229,480.724 | 230,953.747 | 230,311.818 | 0.667 | 0.000 | 0.000 |
Indicators | Basic-risk (51.4%) | Parental-risk (11.8%) | Social-risk (13.4%) | High-risk (23.4%) |
---|---|---|---|---|
Individual level | ||||
Low Birth Weight | 0.051 | 0.065 | 0.054 | 0.059 |
Postnatal Problems | 0.191 | 0.235 | 0.211 | 0.218 |
No Breastfeeding | 0.183 | 0.201 | 0.165 | 0.216 |
Chronic illness | 0.233 | 0.24 | 0.168 | 0.324 |
Low Self-efficacy | 0.154 | 0.272 | 0.378 | 0.396 |
Family level | ||||
Low Parental Education | 0.119 | 0.103 | 0.104 | 0.168 |
Severe Parental Illness | 0.361 | 0.330 | 0.240 | 0.438 |
Low Parental Well-being | 0.138 | 0.433 | 0.205 | 0.368 |
Parental Unemployment | 0.094 | 0.213 | 0.132 | 0.211 |
Prenatal Alcohol/Smoking | 0.213 | 0.365 | 0.239 | 0.306 |
Teenage Mother | 0.001 | 0.010 | 0.002 | 0.005 |
Parental Divorce | 0.003 | 0.727 | 0.003 | 0.087 |
Family instability | 0.060 | 0.993 | 0.093 | 0.315 |
Low Parental attention | 0.001 | 0.018 | 0.085 | 0.000 |
Large Family | 0.103 | 0.290 | 0.122 | 0.286 |
Parental Stress | 0.209 | 0.428 | 0.277 | 0.371 |
Low Family Cohesion | 0.181 | 0.251 | 0.262 | 0.617 |
Family Dysfunction | 0.069 | 0.082 | 0.000 | 0.351 |
Low Parental Warmth | 0.079 | 0.193 | 0.196 | 0.781 |
High Parental Pressure | 0.152 | 0.235 | 0.312 | 0.653 |
Physical neglect/abuse | 0.108 | 0.093 | 0.248 | 0.428 |
Emotional neglect/abuse | 0.095 | 0.124 | 0.44 | 0.718 |
Sexual abuse | 0.012 | 0.043 | 0.02 | 0.126 |
Social level | ||||
Low Well-being with Peers | 0.103 | 0.362 | 0.933 | 0.196 |
Low Well-being in School | 0.096 | 0.296 | 0.784 | 0.236 |
Low Social support | 0.093 | 0.172 | 0.341 | 0.427 |
Discrimination | 0.422 | 0.346 | 0.077 | 0.781 |
Latent class membership prediction
Basic-risk (51.4%) | Parental-risk (11.8%) | Social-risk (13.4%) | High-risk (23.4%) | |
---|---|---|---|---|
Agea | 20 (4.72) | 18 (4.99) | 13 (3.46) | 22 (4.44) |
Gender (female) | 53.5 (52.2, 54.8) | 53.6 (50.8, 56.3) | 47.9 (45.4, 50.5) | 56.1 (54.2, 58.0) |
Internalizing problems | 22.2 (21.2, 23.4) | 39.6 (36.9, 42.3) | 44.2 (41.6, 46.7) | 38.4 (36.5, 40.3) |
Depression diagnosis | 2.8 (2.4, 3.3) | 2.7 (1.9, 3.8) | 0.7 (0.4, 1.3) | 13.3 (12.1, 14.7) |
Externalizing problems | 19.2 (18.2, 20.3) | 34.5 (31.9, 37.1) | 41.1 (38.6, 43.6) | 32.2 (30.4, 34.1) |
ADHD diagnosis | 4.2 (3.7, 4.8) | 8.6 (7.2, 10.3) | 6.9 (5.7, 8.3) | 9.4 (8.3, 10.5) |
Covariates/ Outcomes | Parental vs. Basic | Social vs. Basic | Risk vs. Basic | Parental vs. Risk | Social vs. Risk | Parental vs. Social | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
RRR | 95% CI | p value | RRR | 95% CI | p value | RRR | 95% CI | p value | RRR | 95% CI | p value | RRR | 95% CI | p value | RRR | 95% CI | p value | |
Agea | 0.94 | 0.93–0.96 | 0.000 | 0.65 | 0.63–0.67 | 0.000 | 1.09 | 1.09–1.11 | 0.000 | 0.86 | 0.84–0.87 | 0.000 | 0.59 | 0.57–0.61 | 0.000 | 1.44 | 1.40–1.48 | 0.000 |
Gender | 1.05 | 0.93–1.19 | 0.401 | 0.82 | 0.71–0.94 | 0.005 | 1.11 | 1.00–1.23 | 0.042 | 0.95 | 0.82–1.09 | 0.482 | 0.74 | 0.63–0.86 | 0.000 | 1.28 | 1.09–1.51 | 0.003 |
Internalizing problems | 1.81 | 1.58–2.08 | 0.000 | 1.86 | 1.62–2.14 | 0.000 | 2.07 | 1.85–2.32 | 0.000 | 0.87 | 0.75–1.01 | 0.077 | 0.89 | 0.76–1.05 | 0.187 | 0.97 | 0.82–1.14 | 0.744 |
Depression diagnosis | 1.27 | 0.87–1.85 | 0.207 | 3.11 | 1.63–5.91 | 0.001 | 3.97 | 3.23–4.87 | 0.000 | 0.31 | 0.22–0.46 | 0.000 | 0.78 | 0.41–1.47 | 0.449 | 0.40 | 0.20–0.82 | 0.013 |
Externalizing problems | 1.57 | 1.36–1.81 | 0.000 | 1.38 | 1.19–1.59 | 0.000 | 2.08 | 1.84–2.35 | 0.000 | 0.75 | 0.64–0.88 | 0.001 | 0.66 | 0.56–0.78 | 0.000 | 1.13 | 0.95–1.35 | 0.151 |
ADHD diagnosis | 1.57 | 1.22–2.01 | 0.000 | 1.30 | 0.98–1.72 | 0.065 | 1.52 | 1.24–1.87 | 0.000 | 1.02 | 0.79–1.32 | 0.844 | 0.85 | 0.63–1.14 | 0.295 | 1.20 | 0.88–1.64 | 0.243 |