Repeated exposure to socioeconomic disadvantage and health selection as life course pathways to mid-life depressive and anxiety disorders

BACKGROUND: Socioeconomic position (SEP) in childhood and adulthood influences the risk of adult psychiatric disorder. This paper investigates first how cumulative childhood manual SEP influences the risk for mid-life depressive and anxiety disorders and secondly the effects of health selection based on psychological disorder in childhood and psychological distress in early adulthood on mid-life social position. METHODS: 9,377 participants of the 1958 Birth Cohort were followed up at 45 years with the Revised Clinical Interview Schedule to measure depressive and anxiety disorders. SEP was measured by Registrar General Social Class in childhood (ages 7, 11 and 16 years) and adulthood (ages 23, 33 and 42 years). Internalising and externalising disorders were also measured in childhood. RESULTS: Cumulative manual SEP in childhood was weakly associated with increased risk of mid-life disorder. Childhood internalising and externalising disorders were associated with less upward social mobility and manual adult social position. Psychological disorder on three occasions in childhood was associated with manual adult occupational status (OR = 3.33, 95% CI 2.63–4.21) even after adjusting for childhood SEP and malaise score at 42 years. CONCLUSIONS: Both social causation and health selection contribute to the association of childhood socioeconomic disadvantage and mid-life depressive and anxiety disorders. Tackling accumulation of disadvantage and understanding and treating childhood psychological disorders and their educational and occupational consequences could reduce the risk of mid-life psychiatric disorders.