Socioeconomic inequality in child mental health during the COVID-19 pandemic: First evidence from China

Background: There are increasing concerns that the coronavirus disease (COVID-19) pandemic will disproportionately affect socioeconomically disadvantaged children. However, there lacks empirical evidence on socioeconomic inequalities in child mental health and associated factors.

Methods: We conducted a population-based online survey in 21,526 children in China, when children were confined at home for nearly two months during the pandemic. We assessed child mental health problems with the Strengths and Difficulties Questionnaire (SDQ). Parental education level and provincial gross domestic product (GDP) per capita were treated as proxies for individual- and population-level socioeconomic status (SES), respectively. Lifestyle and family environment factors included sleep disturbances, physical activity, screen time, primary caregiver, parental mental health, and harsh parenting.

Results: Of the children, 32.31% demonstrated mental health problems. Parental education from the highest (undergraduate and above) to the lowest (middle school and below) increased the adjusted odds ratio(aOR) for child mental health problems by 42% (aOR, 1.42; 95% CI, 1.29-1.57); provincial GDP per capita (RMB) from the highest (>¥100K) to the lowest (≤¥70K) increased aOR by 41% (aOR, 1.41; 95% CI%, 1.28-1.55). Sleep disturbances, physical activity <1 h/day, media exposure ≥2 h/day, non-parental care, poor parental mental health, and harsh parenting were independently associated with increased child mental health problems, regardless of SES.

Limitations: The potential sampling bias, subjective measures, and the cross-sectional design are the main limitations.

Conclusion: The first evidence from China suggests socioeconomic inequality in child mental health during the pandemic. As unhealthy lifestyle and unfavorable family environment are contributory factors, prioritized interventions are needed to reduce socioeconomic inequality in child mental health problems.