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. Generalised estimating equations were used to estimate the associations of a child's mental disorder with parental annual income and employment outcomes from 5 years before to 5 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 with the matched unexposed parents, already 5 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 prioritise addressing pre-existing socioeconomic vulnerabilities for effective primary prevention of children's mental disorders.