Life Stressors as Mediators of the Relation Between Socioeconomic Position and Mental Health Problems in Early Adolescence: The TRAILS Study

Objective: Life stressors and family socioeconomic position have often been associated with mental health status. The aim of the present study is to contribute to the understanding of the pathways from low socioeconomic position and life stressors to mental problems. Method: In a cross-sectional analysis using data from a longitudinal study of early adolescents (N=2,149, 51% girls; mean age 13.6 years, SD 0.53, range 12-15), we assessed the extent of mediation of the association between family socioeconomic position and mental health problems by different types of life stressors in multiple regression models. Stressors were rated as environment related or person related. Information on socioeconomic position was obtained directly from parents, and internalizing and externalizing problem behaviors were assessed by reports from multiple informants (parents, self, and teachers). Results: Low socioeconomic position was associated with more mental health problems and more life stressors. Both environment-related and person-related stressors predicted mental health problems independently of socioeconomic position. The associations between socioeconomic position and all mental health outcomes were partly mediated by environment-related life stressors. Mediation by environment-related and person-related stressors as assessed by linear regression amounted to 56% (95% confidence interval [CI] 35%-78%) and 7% (95% Cl -25% to 38%) for internalizing problems and 13% (95% Cl 79%-9%) and 5% (95% Cl -2% to 13%) for externalizing problems, respectively. Conclusions: Environment-related, but not person-related, stressors partly mediated the association between socioeconomic position and adolescent mental problems. The extent of mediation was larger for internalizing than for externalizing problems. Because the effect sizes of the associations were relatively small, targeted interventions to prevent impaired mental health may have only modest benefits to adolescents from low socioeconomic background. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(10):1031-1038.