Area deprivation and child psychosocial problems - A national cross-sectional study among school-aged children

Background We examined the association of area deprivation with the occurrence of psychosocial problems among children aged 4-16 in a representative national sample of children based on standardised measures of parent-reported problems and diagnoses made by doctors and nurses working in child healthcare (child health professionals, CHPs). Methods The study comprised 4480 children aged 4-16 years, eligible for a routine health assessment (response: 90.1%), in 19 Child Healthcare Services across the Netherlands that routinely provided preventive child healthcare to nearly all school-aged children. Parents completed the Child Behaviour Checklist (CBCL). CHPs examined the child and interviewed parents and child during their routine health assessments. Main outcome measures concerned psychosocial problems as reported by parents (i.e. a clinical score on the CBCL) and as identified by CHPs. Results Prevalence rates of psychosocial problems were 8.6% for parent-reported problems and 10.1% for CHP-identified problems. They were much higher in the most deprived third of the areas. Odds ratios (95% confidence intervals) compared with the least deprived third were 1.93 (1.41-2.64) regarding parent-reported problems and 1.76 (1.30-2.38) regarding CHP-identified problems. Regarding parent reports, associations were slightly stronger for behavioural problems than for emotional problems. Less than a quarter of the area differences could be explained by individual and family characteristics. Conclusions Child psychosocial problems occur more frequently in deprived areas. Both preventive and curative health services should be better equipped for this concentration of child and adolescent morbidity in deprived areas.