title: The impact of the social environment on children's mental health in a prosperous city: an analysis with data from the city of Munich.
abstract: BACKGROUND
  Children with a low socioeconomic position are more affected by mental difficulties as compared to children with a higher socioeconomic position. This paper explores whether this socioeconomic pattern persists in the prosperous German city of Munich which features high quality of life and coverage of children mental health specialists that lies well above the national average and is among the highest in Europe.
  
  
  METHODS
  1,265 parents of preschool children participated in a cross-sectional health survey. They were given a self-administered questionnaire (including socioeconomic variables) and the 'Strengths and Difficulties Questionnaire (SDQ)', a well-established method to identify mental difficulties among children and adolescents. Prevalence estimates for the 'SDQ-Total Difficulties Score' were calculated, with a special focus on differences by parental (resp. household) socioeconomic position. The association between parental education, household income, single parenthood, nationality, and parental working status on one hand, and their children's mental health on the other, was explored using multivariable logistic regression models. The coverage of mental health specialists per 100,000 children aged 14 or younger in the city of Munich was also calculated.
  
  
  RESULTS
  In Munich, the distribution of mental health difficulties among children follows the same socioeconomic pattern as described previously at the national level, but the overall prevalence is about 30% lower. Comparing different indicators of socioeconomic position, low parental education and household income are the strongest independent variables associated with mental difficulties among children (OR = 2.7; CI = 1.6 - 4.4 and OR = 2.8; CI = 1.4 - 5.6, respectively).
  
  
  CONCLUSIONS
  Socioeconomic differences in the prevalence of childhood mental difficulties are very stable. Even in a city such as Munich, which is characterized by high quality of life, high availability of mental health specialists, and low overall prevalence of these mental difficulties, they are about as pronounced as in Germany as a whole. It can be concluded that the effect of several characteristics of socioeconomic position 'overrules' the effect of a health promoting regional environment.
authors.affiliation: Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. laura.perna@helmholtz-muenchen.de
authors.forename: Laura
authors.initials: L
authors.lastname: Perna
authors.forename: Gabriele
authors.initials: G
authors.lastname: Bolte
authors.forename: Heidi
authors.initials: H
authors.lastname: Mayrhofer
authors.forename: Gabriele
authors.initials: G
authors.lastname: Spies
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002947:Cities; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health; D008605:Mental Health Services; D010290:Parents / Q000193:education / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life; D012923:Social Class; D012931:Social Environment; D011795:Surveys and Questionnaires; D000078329:Workforce
references.citation: Health Aff (Millwood). 1995 Fall;14(3):147-59
references.pmid: 7498888
references.citation: Br J Psychiatry. 2000 Dec;177:534-9
references.pmid: 11102329
references.citation: Arch Gen Psychiatry. 1987 Sep;44(9):832-6
references.pmid: 3498458
references.citation: Eur J Public Health. 2009 Jan;19(1):52-8
references.pmid: 19033356
references.citation: JAMA. 2009 Jun 3;301(21):2262-4
references.pmid: 19491188
references.citation: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007 May-Jun;50(5-6):784-93
references.pmid: 17514464
references.citation: Gesundheitswesen. 2013 Jun;75(6):380-5
references.pmid: 23292968
references.citation: J Am Acad Child Adolesc Psychiatry. 1996 Jul;35(7):889-97
references.pmid: 8768348
references.citation: Eur Child Adolesc Psychiatry. 2004 Dec;13(6):395-401
references.pmid: 15619054
references.citation: JAMA. 2009 Jun 3;301(21):2252-9
references.pmid: 19491187
references.citation: J Am Acad Child Adolesc Psychiatry. 2005 Oct;44(10):972-86
references.pmid: 16175102
references.citation: Arch Gen Psychiatry. 2005 Jun;62(6):593-602
references.pmid: 15939837
references.citation: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007 Apr;50(4):476-83
references.pmid: 17387440