Association of a child’s mental disorder with parental income and employment: Analysis of nationwide register-based cohorts in Finland and Denmark

Background The onset of a severe physical illness of a child has been associated with earnings and employment losses among parents, but less is known in the context of children’s mental disorders.

Objectives We estimated parental income and employment trajectories associated with a child’s mental disorder diagnosis in nationwide register-based cohorts from Finland and Denmark.

Methods All parents whose child was diagnosed with a mental disorder (F00–F99 in ICD-10) at ages 1–25 in Finland and in Denmark during 1994–2019 were matched 1:1 to parents with a child without a mental disorder on psychiatric and sociodemographic characteristics. Generalized estimating equations were used to estimate the associations of a child’s mental disorder with parental annual income and employment outcomes from five years before to five years after the child’s diagnosis.

Findings In 1994–2019, over one million parents in Finland and Denmark had at least one child diagnosed with a mental disorder at age 1–25. Parents exposed to a child’s mental disorder had consistently lower income and were more often unemployed compared to the matched unexposed parents, already five years before the child’s diagnosis. These differences became slightly larger over time, especially in analyses on strata involving parents whose child was diagnosed at a younger age. However, there was no consistent evidence of a change in parental annual income or employment around the time of their child’s diagnosis.

Conclusions Our analysis shows that even in countries with strong welfare systems, a younger child’s mental disorder may contribute to widening socioeconomic inequity among families. However, the inequity in children’s mental health appears to primarily exist prior to, rather than in response to, a child’s mental disorder.

Clinical implications Clinical and policy efforts should prioritize addressing pre-existing socioeconomic vulnerabilities for effective primary prevention of children’s mental disorders.

What is already known on this topic

• Previous studies have shown earnings and employment losses among parents of a child diagnosed with a severe physical illness, but less is known in the context of mental disorders.

What this study adds

• In this analysis of Finnish and Danish nationwide register-based cohorts, a child’s mental disorder was consistently associated with lower annual income and a lower annual probability of employment among parents, already several years before the child’s diagnosis.

• There was no consistent evidence of a change in parental annual income or employment around the time of their child’s diagnosis.

How this study might affect research, practice or policy

• While a child’s mental disorder can disrupt family life, it does not necessarily translate into immediate socioeconomic consequences for parents in welfare states.

• Further studies are needed in populations with different welfare systems and less universal access to healthcare.