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Original Investigation
October 23, 2019

Association Between Parental Income During Childhood and Risk of Schizophrenia Later in Life

Author Affiliations
  • 1Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  • 2iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
  • 3National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
  • 4CIRRAU Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
  • 5Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
  • 6Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
  • 7NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
JAMA Psychiatry. Published online October 23, 2019. doi:https://doi.org/10.1001/jamapsychiatry.2019.2299
Key Points

Question  How are parental income level and income mobility during childhood associated with subsequent risk for schizophrenia?

Findings  This Danish cohort study of more than 1 million persons found a dose-response association between increasing amount of time spent in low-income conditions and greater schizophrenia risk. Regardless of parental income level at birth, upward income mobility was associated with lower schizophrenia risk compared with downward mobility.

Meaning  Although causality cannot be assumed, this study’s findings suggest that enabling upward family income mobility during childhood may reduce subsequent schizophrenia incidence.

Abstract

Importance  Evidence linking parental socioeconomic position and offspring’s schizophrenia risk has been inconsistent, and how risk is associated with parental socioeconomic mobility has not been investigated.

Objective  To elucidate the association between parental income level and income mobility during childhood and subsequent schizophrenia risk.

Design, Setting, and Participants  National cohort study of all persons born in Denmark from January 1, 1980, to December 31, 2000, who were followed up from their 15th birthday until schizophrenia diagnosis, emigration, death, or December 31, 2016, whichever came first. Data analyses were from March 2018 to June 2019.

Exposure  Parental income, measured at birth year and at child ages 5, 10, and 15 years.

Main Outcomes and Measures  Hazard ratios (HRs) for schizophrenia were estimated using Cox proportional hazard regression. Cumulative incidence values (absolute risks) were also calculated.

Results  The cohort included 1 051 033 participants, of whom 51.3% were male. Of the cohort members, 7544 (4124 [54.7%] male) were diagnosed with schizophrenia during 11.6 million person-years of follow-up. There was an inverse association between parental income level and subsequent schizophrenia risk, with children from lower income families having especially elevated risk. Estimates were attenuated, but risk gradients remained after adjustment for urbanization, parental mental disorders, parental educational levels, and number of changes in child-parent separation status. A dose-response association was observed with increasing amount of time spent in low-income conditions being linked with higher schizophrenia risk. Regardless of parental income level at birth, upward income mobility was associated with lower schizophrenia risk compared with downward mobility. For example, children who were born and remained in the lowest income quintile at age 15 years had a 4.12 (95% CI, 3.71-4.58) elevated risk compared with the reference group, those who were born in and remained in the most affluent quintile, but even a rise from the lowest income quintile at birth to second lowest at age 15 years appeared to lessen the risk elevation (HR, 2.80; 95% CI, 2.46-3.17). On the contrary, for those born in the most affluent quintile, downward income mobility between birth and age 15 years was associated with increased risks of developing schizophrenia.

Conclusions and Relevance  This study’s findings suggest that parental income level and income mobility during childhood may be linked with schizophrenia risk. Although both causation and selection mechanisms could be involved, enabling upward income mobility could influence schizophrenia incidence at the population level.

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