Socioeconomic Status and Child Mental Health: The Roleof Parental Emotional Well-Being and Parenting Practices

Tormod Bøe & Børge Sivertsen & Einar Heiervang &

Robert Goodman & Astri J. Lundervold & Mari Hysing

Published online: 23 October 2013# Springer Science+Business Media New York 2013

Abstract This study examined the role of parental emotionalwell-being and parenting practices as mediators of theassociation between familial socioeconomic status (SES) andchild mental health problems. The sample included 2,043 5th-7th graders (50.7 % female) participating in the second waveof the Bergen Child Study. Children completed the Strengthsand Difficulties Questionnaire, parents reported familyeconomy and education level, emotional well-being(measured with the Everyday Feelings Questionnaire), andthe use of negative disciplinary and affirmative parentingpractices (measured using the Family Life Questionnaire).Path analyses were conducted to examine the associations

between SES and externalizing and internalizing problems.Results supported a model where family economy wasassociated with externalizing problems through parentalemotional well-being and parenting practices, whereasmaternal education level was associated with externalizingproblems through negative discipline. The direct associationbetween paternal education level and externalizing problemswas not mediated by parenting. For internalizing problems,we found both direct associations with family economy andindirect associations with family economy through parentalemotional well-being and parenting. The results suggest thatparental emotional well-being and parenting practices are twopotential mechanisms through which low socioeconomicstatus is associated with child mental health problems.

Keywords Bergen child study . Socioeconomic status .

Internalizing and externalizing problems . Family process

Introduction

Socioeconomic disadvantage in childhood is related to bothimmediate and persisting impairments in mental health andwell-being (Bradley and Corwyn 2002; Poulton et al. 2002;Velez et al. 1989). Children and adolescents who grow up infamilies with a lower socioeconomic status (SES) have bothmore internalizing symptoms such as anxiety and depression,and externalizing symptoms such as aggressiveness,opposition and hyperactivity, as compared to those raised inmore affluent families (Reiss 2013; Starfield et al. 2002a, b).One of the main perspectives on the pathways mediating theassociation between SES and child mental health is the familyprocess model predicting that family economy affectschildren’s socioemotional development through influencingthe psychological well-being of parents and thereby theirparenting practices (Conger and Elder 1994; Elder and Caspi

Electronic supplementary material The online version of this article(doi:10.1007/s10802-013-9818-9) contains supplementary material,which is available to authorized users.

T. Bøe (*) :A. J. Lundervold :M. HysingRegional Centre for Child and Youth Mental Health and ChildWelfare, West, Uni Health, Uni Research, PO Box 7800,5020 Bergen, Norwaye-mail: tormod.boe@uni.no

B. SivertsenDivision of Mental Health, Norwegian Institute of Public Health,Bergen, Norway

B. SivertsenUni Health, Uni Research, Bergen, Norway

B. SivertsenDepartment of Psychiatry, Helse Fonna HF, Haugesund, Norway

E. HeiervangInstitute of Clinical Medicine, University of Oslo, Oslo, Norway

R. GoodmanKing’s College London, Institute of Psychiatry, London, UK

A. J. LundervoldDepartment of Biological and Medical Psychology, University ofBergen, Bergen, Norway

J Abnorm Child Psychol (2014) 42:705–715DOI 10.1007/s10802-013-9818-9

1988). In a series of pioneering studies on the associationbetween economic hardship, punitive and harsh disciplineand children’s well-being in families of the Great Depression,the direct association between economic distress andchildhood socioemotional functioning was fully mediated bynegative, rejecting tendencies of fathers towards theirdaughters (Elder et al. 1985). Several other studies have foundthat parenting that lacks warmth and involvement, and whereharsh and erratic discipline is practiced, is associated withaggressiveness, hostility, opposition, anxiety and depressionin children and adolescents (Ge et al. 1994; Ma et al. 2012;Patterson and Stouthamer-Loeber 1984; Skinner et al. 1992).The negative influence of economic pressure on childhoodadjustment through adverse influence on parent mental healthand parenting has also been confirmed in several more recentinvestigations (Benner and Kim 2010; Conger et al. 1992,1995; Mistry et al. 2002; Parke et al. 2004).

A limitation of the previous empirical work on the familyprocess model is that studies have focused exclusively on theeconomic aspect of socioeconomic status and further studiesthat examine other indicators of socioeconomic status, such asparental education levels, have been called for (Conger et al.2010). Family economy and parental education levels mayhave differential influences on family processes and childadjustment (Duncan and Magnuson 2003), and act throughdifferent pathways. Higher maternal education levels areassociated with increased knowledge about childrearing andchild development, and more supportive mothering(Morawska et al. 2009; Waylen and Stewart-Brown 2010).Increased maternal knowledge about parenting is also relatedto fewer early childhood behavior problems (Benasich andBrooks-Gunn 1996; Huang et al. 2005). Parental educationlevels may therefore influence parenting directly, whereasfamily economy affects parenting indirectly through theadverse effects on parent mental well-being.

Few studies have investigated the influence of paternaleducation levels on fathering. One exception was a study thatfound highly educated fathers to have more positiveengagement with their school-aged children (Blair et al.1994). Others have found little influence of paternal educationon their involvement with younger children after controllingfor factors such as father’s age, relationship satisfaction,supportive work-family interface and the residential status ofthe father (Castillo et al. 2011; Volling and Belsky 1991).

Studying individual markers of socioeconomic statusenables us to investigate their unique contributions to childadjustment. In a previous publication from the Bergen ChildStudy, it was found that family economywas associated with awide range of mental health problems, whereas parentaleducation levels had more specific associations withexternalizing problems (Bøe et al. 2012). Similarly, Huismanet al. (2010) found that poor family economy was associatedwith both externalizing and internalizing problems whereas

lower maternal education levels were associated withinternalizing problems only. Thus, extending the frameworkof the family process model to also include parental educationenables us to study the unique and combined influences ofparental education and family economy on family processesand child adjustment.

In addition, epidemiological studies of child and adolescentmental health problems have found large degrees of overlapbetween diagnostic groups (Ford et al. 2003; Heiervang et al.2007; Merikangas et al. 2010), but few studies of the familyprocess model have considered comorbidity (i.e. presence ofmultiple disorders) or co-occurrence (i.e., associationsbetween symptoms at non-clinical levels). A further extensionof the family process model would therefore be to conductanalyses where different domains of mental health problemsare included simultaneously in the analyses.

Gershoff et al. (2010) suggest that there has been an over-reliance on North American children and parents in studies ofparenting. Cultures differ in the extent they judge certainparenting practices as physically or emotionally abusive(Korbin 2003), and the use of particular parenting techniquesis moderated by mother’s perceptions of normativeness, andthe extent to which children respond with aggression oranxiety to perceived negative events (such as corporalpunishment and yelling) is moderated by children’s perceptionof the normativeness of such techniques (Gershoff et al.2010). In fact, the association between use of harsh corporalpunishment and children’s aggression and anxiety symptomsis stronger in samples where such punishment is leastnormative (Lansford et al. 2005). In Norway, corporalpunishment is prohibited (Bitensky 1997), and Norwegianparents are presumptively more likely to judge certainparenting practices as physically or emotionally abusive(Korbin 2003). Taken together, the findings on culturaldifferences in parenting practices suggest a need for studiesof the association between parenting and children’s mentalhealth in societies such as Norway.

The first aim of the current study was to investigateassociations between SES, measured by parent perception offamily economy and parental education levels, parentalemotional well-being, and parenting practices in a Norwegiansample. Secondly, we wanted to assess whether associationsbetween SES indicators and internalizing or externalizingchild mental health problems are mediated through parentalwell-being and parenting practices. Based on previousfindings, we hypothesized that 1) the effect of family economyon childhood mental health problems is mediated by parentalemotional well-being in turn influencing parenting behaviors,and 2) that the effect of maternal education level on mentalhealth problems is mediated by parenting behaviors. There areconflicting findings in the literature regarding the influence ofpaternal education level on fathering. This precludes us fromforming very strong expectations with regards to possible

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pathways through which paternal education levels mayinfluence childhood mental health problems. Still, wehypothesized that the direct effect of paternal education levelson mental health problems would be mediated by parenting.

Method

Participants

The current analyses are based on data from the Bergen ChildStudy, a series of cross-sectional multi-phase surveys targetingall children born between 1993 and 1995 living in Bergen, thesecond largest city in Norway (see http://www.uib.no/bib formore information). In 2006 when data for the current studywere collected, Bergen had a total population of around242,000, approximately 8 % of the population wereimmigrants of which 6 % were from non-Western countries(Statistics Norway 2009).

The present study uses data from the second cross-sectionalstudy carried out in 2006 (previously described by Heiervangand Goodman 2011), when the children were in fifth toseventh grade (11–13 years old), in a target population of 9,218. Mean age was 11.8 (SD =0.8), with 52 % females. In thefirst phase of this wave, parents, children and teacherscompleted questionnaires on a total of 5,781 children (teacherdata is not included in the following study). It has been shownpreviously that high teacher scores on the Strengths andDifficulties Questionnaire (SDQ) were predictive of non-participation in the first cross-sectional study (Stormark et al.2008), and it is likely that non-response in the second cross-sectional study may have been influenced by the samemechanisms, although we were unable to assess this. Allparents who took part in the first phase were invited toparticipate in the second phase conducted a few months later,which involved detailed psychiatric assessment using theDevelopment and Well-Being Assessment (DAWBA;Goodman et al. 2000a). The participants provided informationabout their children using a website that required them to logon with a unique identification number and password.Responses from 2,043 participants were obtained. Two caseshad missing values on all variables and were excluded fromthe analyses. The study was approved by the RegionalCommittee for Medical Research Ethics in Western Norwayand the National Data Inspectorate.

Instruments

SES was assessed by asking parents to report their level ofeducation by choosing one of the following response options:compulsory education (< 11 years); additional technicalqualification/vocational high school studies (2–3 additionalyears); additional academic qualification/theoretical high

school studies (2–3 additional years); up to 4 years atcollege/university; more than 4 years at college/university.Parents were also asked to rate their family economy eitheras very poor, poor, fair, good or very good . The rating offamily economy was found to correlate reasonably well (r =0.586, p <0.001) with information about taxable monetaryincome which was available for a subsample of 642participants. In addition, the DAWBA includes a questionabout having ever experienced a serious financial crisis (equalto losing 3 months of income), and one question about currentexperiences of economic difficulties. Amongst those whorated their family economy as poor or very poor, 51.4 % hadexperienced a financial crisis, and 74.3 % confirmed that theywere currently experiencing economic difficulties.

Child mental health problems were measured using theStrengths and Difficulties Questionnaire (SDQ; Goodman1997) completed by the children themselves. The SDQ asksabout 25 attributes divided between five scales that generatescores for emotional symptoms, conduct problems,hyperactivity-inattention, peer problems and prosocialbehavior (Goodman 1997, 1999). In the current study, thepeer problems and emotional problems subscales of theSDQ were combined into an internalizing problems scale(Cronbach’s α =0.73), while the conduct problems andhyperactivity-inattention subscales were combined into anexternalizing problem scale (Cronbach’s α =0.73), assuggested by Goodman et al. (2010) for analyses in low-riskepidemiological samples.

Parenting practice was measured using the Family LifeQuestionnaire (FaLQ; Last et al. 2012). The FaLQ wasincluded as part of the DAWBA (Goodman et al. 2000a)administered in phase two. The majority of respondentscompleting the DAWBA were “Mothers” (63.5 %), otherrespondents were “Both parents” (14.9 %), “Parent” (i.e.gender of parent was not specified, 10.1 %), “Fathers”(10.4 %) and others (e.g. grand-/foster-/step parents, 1.1 %).The FaLQ consists of four scales: Affirmation (consisting offour items related to the child–parent relationship, e.g. getslove and affection, is praised and rewarded), Negativediscipline (consisting of four items related to punishment;e.g., is physically punished, is blamed unfairly), Rules(consisting of two items measuring structure and organizationwithin the family; e.g., have clear rules, rules are appliedconsistently) and Special allowances (consisting of two itemsrelated to over- and underinvolvement from parents; this scalewas not used in the current analyses). Parents are asked toindicate how well the descriptions in the questionnaire applyto their child using four ordered response options (not at all, alittle, a medium amount and a great deal). In the current studythree scales from the FaLQ were used: Affirmation(Cronbach’s α =0.722), Rules (Cronbach’s α =0.745) andNegative discipline (Cronbach’s α =0.442). The lowerCronbach’s α of the Negative discipline scale was in part

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due to the item “Physical punishment” having a relativelylow item-total correlation (r =0.19). Last et al. (2012)previously found the internal consistency and test-retestreliability of Affirmation and Rules to vary betweenmoderate and very good, whereas the Negative disciplinesubscale had a poor internal consistency. In order to testthe factor structure of the three subscales (Affirmation,Rules and Negative discipline) in the current sample, aconfirmatory factor analysis with maximum likelihoodestimation was run. Goodness of fit indices suggested areasonably good fit for a three-factor solution (χ 2 [41]=209.301, p <0.001, CFI=0.939, RMSEA=0.050, 90 %confidence interval [CI] for RMSEA=0.043–0.057).Although the χ 2-test was significant, other, less stringent,indices are usually more relied on when evaluating modelfit (Brown 2006).

The emotional well-being of the children’s caretakerswas measured using the self-report version of theEveryday Feelings Questionnaire (EFQ; accessible fromhttp://www.youthinmind.info/EFQ) which is designed tobe used in a non-clinical population. The EFQ wasincluded as part of the DAWBA (Goodman et al. 2000a)administered in phase two. The EFQ consists of 10 itemsthat measure symptoms related to depression and anxiety,as well as items reflecting psychological well-being, suchas optimism, self-esteem and coping. There are fiveresponse options (none of the time, a little of the time,some of the time, most of the time, and all of the time )reflecting the frequency of experiencing each feeling inthe past 4 weeks. Well-being items are reverse scored,meaning that higher scores represent higher levels ofdistress and lower levels of well-being. The EFQ wasadministered as part of the DAWBA and completed bythe same responders as for the FaLQ described above.Uher and Goodman (2010) found the EFQ to be internallyconsistent with all items loading strongly on a singlecommon factor, and item-response theory analysis showedthat the ten items had excellent sensitivity and goodinformation content (Cronbach’s α in the current study =0.85). In order to test the factor structure of the EFQ inthe current sample, a confirmatory factor analysis withmaximum likelihood estimation was run. The model fitindices for a one-factor solution were acceptable (χ 2

[35]=398.347, p <0.001, CFI=0.927, RMSEA=0.079,90 % CI for RMSEA=0.072–0.086), again, relying onCFI and RMSEA indicators for evaluation of model fit.

Statistical Analysis

Children taking part in both phases (with completeinformation) and children only taking part in the first phasewere compared on SES variables and SDQ subscale meanswith Pearson chi square tests and unequal samples t -tests.

Correlation analyses were used to measure associationsbetween SES, parental emotional well-being and parentingcharacteristics.

Based on previous findings in the literature, weexpected the direct effect of our SES indicators onexternalizing and internalizing problems to be mediatedby parental emotional well-being and/or parentingpractices. The first step in model development thereforeconsisted of fitting a model where all the direct pathsfrom the SES indicators to externalizing and internalizingproblems were constrained to zero, whereas other pathswere estimated freely. The next step involved inspectingthe modification indices to see if this model could beimproved by respecification. Jöreskog (1993) suggestedthat model respecification should start by iterativelyfreeing constraints on the parameters where the largestmodification index (MI) and expected parameter change(EPC) value is observed, before re-testing the model. Thisapproach may also solve problems with high MI and EPCvalues in additional parameters. This purely statisticalapproach must be accompanied by a theoretical rationalefor why certain parameters are freed, in order to establisha model that gives meaning theoretically as well as fitsthe data statistically (Brown 2006). Externalizing andinternalizing problems were included simultaneously inthe same model and allowed to correlate (separate modelsfor internalizing and externalizing problems are availableas online supplements). In path analyses, confidenceintervals of the indirect effects were generated using 1,000 bootstrap samples.

Model fit were evaluated according to the recommendationsby Hu and Bentler (1999) for use with maximum likelihoodestimation; standardized root mean square residual (SMR)values close to 0.08 or below, Comparative Fit index (CFI)close to 0.95 or greater, and root mean square error ofapproximation (RMSEA) close to, or below, 0.06indicates good fit between the target model and theobserved data. If the upper limit of the 90 % confidenceinterval of the RMSEA is below 0.08, this indicatesadditional support for the model (Brown 2006). Theclassic goodness-of-fit index Χ 2, is also reported, but theother fit indices will be relied more heavily upon whenevaluating model fit, as the Χ 2 has very stringentassumptions and is sensitive to inflation by sample sizeand thereby routinely rejects solutions with a large N(Brown 2006).

All statistical analyses were conducted in version 12.1 ofSTATA for Windows7 (StataCorp 2011) with the exception ofthe confirmatory factor analyses and path analyses which werecarried out in Mplus for Windows, version 6.1 (Muthén andMuthén 1998–2010). Model parameters in Mplus wereestimated using the full information maximum likelihoodapproach.

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Results

Sample Characteristics

Characteristics of participants taking part in phase one onlyand those taking part in both phases of the second BCS waveare shown in Table 1. Parents who took part in both phases hadhigher education and better perceived family economy. Thechildren in this full information sample had somewhat lowerhyperactivity and conduct scores, but effect sizes were small.The remaining analyses were conducted on the fullinformation sample of 2,043 respondents (50.7 % female;37.6 % 5th graders, 36.2 % 6th graders and 26.2 % 7thgraders).

SES, Parental Emotional Well-Being and ParentingCharacteristics

The association between socioeconomic status indicators,parenting style and parental emotional well-being can be seenin Table 2. The correlation between maternal and paternaleducation levels was moderate and correlations betweenperceived family economy and parental education was small.

Perceived family economy was negatively correlated withparental EFQ scores, while associations with parentingpractices (FaLQ) were mostly insignificant and/or trivial.Maternal education was significantly correlated with Negativediscipline, but the correlations with the other measures ofparenting were insubstantial. The correlations between thedifferent parenting practices subscales varied from trivial tomoderate.

Path Analysis of SES on Externalizing and InternalizingProblems

A correlation matrix between the SES indicators, the potentialmediators and internalizing and externalizing problems can beseen in Table 2. The Rules scale of the FaLQ was neithercorrelated with any of the SES indicators, nor withinternalizing or externalizing problems, and was thereforenot included in the path analyses. Figure 1 depicts the finalpath models and the path diagram specifies both direct andindirect paths linking perceived family economy and parentaleducation to externalizing/internalizing problems.Unstandardized coefficients (shown outside brackets) as wellas the standardized (STDYX) coefficients (shown in brackets)

Table 1 Characteristics of children participating in first phase only versus children taking part in both phases (full information sample)

Phase 1 only Phase 1 & 2 Statistical tests

Perceived family economy X2 (4)=22.99, p <0.001

Very poor N (%) 14 (0.47 %) 5 (0.26 %)

Poor N (%) 81 (2.72 %) 39 (1.99 %)

Fair N (%) 921 (30.89 %) 519 (26.48 %)

Good N (%) 1546 (51.84 %) 1048 (53.47 %)

Very good N (%) 420 (14.08 %) 349 (17.81 %)

Maternal education X2(4)=89.86, p <0.001

Basic N (%) 295 (9.98 %) 109 (5.58 %)

High school vocational N (%) 599 (20.26 %) 305 (15.63 %)

High school theoretical N (%) 612 (20.70 %) 343 (17.57 %)

College/university =<4 years N (%) 858 (29.03 %) 634 (32.48 %)

College/university >4 years N (%) 592 (20.03 %) 561 (28.74 %)

Paternal education X2(4)=69.43, p <0.001

Basic N (%) 258 (9.02 %) 147 (7.73 %)

High school vocational N (%) 917 (32.05 %) 466 (24.51 %)

High school theoretical N (%) 320 (11.18 %) 177 (9.31 %)

College/university =<4 years N (%) 728 (25.45 %) 504 (26.51 %)

College/university > 4 years N (%) 638 (22.30 %) 607 (31.93 %)

Strengths and Difficulties Questionnaire subscales

Hyperactivity M (SE) 2.61 (0.04) 2.46 (0.05) t=2.45, p =0.007, d =0.069

Conduct problems M (SE) 1.09 (0.02) 1.02 (0.03) t=2.221, p =0.013, d =0.062

Emotional symptoms M (SE) 1.65 (0.03) 1.65 (0.04) t=0.067, p =0.473, d =0.001

Peer problems M (SE) 1.12 (0.03) 1.16 (0.03) t=−1.018, p =0.154, d =−0.028

T-test: unequal variances used

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are shown in the figure. In order to enhance readability of thefigure, only the paths with significant coefficients areincluded.

The model where the direct paths from SES indicators tointernalizing/externalizing problems were constrained to zerofitted the data poorly, Χ2 (6)=72.679, p <0.001, SRMR=0.036, RMSEA=0.074 (90 % CI=0.059–0.089), CFI=0.930. Modification indices suggested that the direct pathfrom paternal education to externalizing problems should befreed (MI=40.450, EPC=−0.263, STDYX EPC=−0.126).Re-running the model after respecification improved modelfit (Χ 2 [5]=31.422, p <0.001, SRMR=0.024, RMSEA=0.051 [90 % CI=0.035–0.069], CFI=0.972), but modification

indices suggested that further improvements could beobtained by freeing the direct path from family economy tointernalizing problems (MI=19.011, EPC=−0.342, STDYXEPC=−0.091). Re-running the model after freeing this pathresulted in a model with good fit, Χ2 (4)=12.103, p =0.0166,SRMR=0.014, RMSEA=0.032 (90 % CI=0.012–0.053),CFI=0.992, and modification indices did not suggest furtherimprovements to the model. The resulting path model can beseen in Fig. 1. Only paths with significant coefficients areshown.

The indirect paths from family economy to externalizingproblems through Negative discipline (−0.006 [90 % CI=−0.008– −0.003], SE=0.001, p <0.001) and affirmation

Table 2 Associations between SES indicators, Family Life Questionnaire, Everyday Feelings Questionnaire, and Strengths and DifficultiesQuestionnaire scores

1 2 3 4 5 6 7 8 9 M (SD)

1. Family economy – –

2. Maternal education level 0.231* – –

3. Paternal education level 0.275* 0.503* – –

4. Affirmation (FaLQ) 0.064* −0.011 −0.017 – 10.45 (1.55)

5. Negative Discipline (FaLQ) 0.002 −0.072* −0.029 −0.187* – 2.37 (1.24)

6. Rules (FaLQ) 0.039 0.024 −0.004 0.347* 0.135* – 3.97 (1.16)

7. EFQ Parent −0.193* −0.015 −0.045 −0.237* 0.117* −0.125* – 11.09 (4.18)

8. SDQ Externalizing −0.094* −0.123* −0.160* −0.177* 0.251* −0.047 0.146* – 0.464* 3.48 (2.84)

9. SDQ Internalizing −0.135* −0.099* −0.059* −0.103* 0.111* −0.044 0.166* 0.464* – 2.81 (2.74)

FaLQ Family Life Questionnaire, EFQ Everyday Feelings Questionnaire, SDQ Strengths and Difficulties Questionnaire

* p <0.05

Fig. 1 Model of paths among socioeconomic status indicators, parentalemotional well-being (EFQ), parenting practices (FaLQ) and SDQexternalizing and internalizing problems. Estimates outside brackets areunstandardized path coefficients, estimates in brackets are standardized(STDYX). Double headed arrows indicate correlations between theexogenous variables and between the error terms of the endogenous

variables. Solid lines illustrate paths to externalizing problems anddashed lines illustrate paths to internalizing problems. Goodness-of-fitindices: Χ2 (4)=12.103, p =0.0166, SRMR=0.014, RMSEA=0.032(90 % CI=0.012–0.053), CFI=0.992. †p=0.053, *p<0.05, **p<0.01,***p <0.001

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(−0.006 [90 % CI=−0.008– −0.003], SE=0.002, p <0.001)were significant, as was the indirect path from familyeconomy to internalizing problems through Negativediscipline (−0.002 [90 % CI=−0.004– −0.001], SE=0.001,p =0.008). The model accounted for 11.2 % of the variance inexternalizing problems, and 5.2 % of the variance ininternalizing problems.

Discussion

The main finding from the present study was that familyeconomy and parental education levels influenced childmental health problems through distinct pathways. Familyeconomy was associated with externalizing problems throughparental emotional well-being and parenting practices,whereas maternal education level was associated withexternalizing problems through negative discipline. The directassociation between paternal education levels andexternalizing problems was not mediated by parenting. Forinternalizing problems, we found both direct associations withfamily economy and indirect associations with familyeconomy through maternal emotional well-being andparenting.

Although associations between economic distress, poorparental mental health, maladaptive parenting and childhoodmental health problems have been replicated in prior studiesusing North American samples (e.g., Conger et al. 1994,1995; Mcleod and Shanahan 1996), to our knowledge onlyone prior study has reported this using a Nordic sample. Thestudy included 527 Finnish 12-year-olds and their parents whoexperienced an economic recession during the 1990s(Leinonen et al. 2002; Solantaus et al. 2004). The resultsconfirmed that financial hardship affected children’s mentalhealth through negative changes in parental mental health andparenting quality. This showed that, even in a Nordic welfarecountry with a social security system that to some extentbuffers families against economic crisis, the family processmodel accounted for mediation of effects on child mentalhealth. The current study generally supported this model usinga Norwegian sample, although the strengths of theassociations were somewhat weaker than in the Finnish study.Other measures of family economy, but also a better economicsituation in Norway with less inequality might havecontributed to these attenuated associations. Studies wherefamily economy has been increased in experiment-like ways,or where individual fixed-effects designs have capitalized onimprovements in income due to natural fluctuations,demonstrate beneficial effects on children’s mental health(Costello et al. 2003; Dearing et al. 2006; Salkind andHaskins 1982). It is also possible that the social programavailability and differences in the acceptability of negative

discipline in Norway may have contributed to the diminishedassociations observed in the current study.

Our extension of the family process model to includeparent education levels revealed that SES indicators weredifferently associated with parenting, and in turn child mentalhealth problems. Maternal education influenced externalizingproblems through direct associations with negative discipline.This suggests that higher educated mothers make less use ofnegative disciplinary practices, which in turn is associatedwith fewer symptoms of childhood externalizing problems.In general, mothers with a lower SES have been found to usemore direct control practices with their children (see Hoff et al.2002 for review), and parental education levels have beenfound to directly influence the use of harsh disciplinarypractices with boys (Simons et al. 1991). The current studydemonstrated that these associations also appear in a societyprohibiting the use of corporal punishment (Bitensky 1997),presumptively more likely to judge certain parenting practicesas physically or emotionally abusive (Korbin 2003).Furthermore, these parenting practices may have even greaternegative consequences for children’s mental health in acountry such as Norway, where the use of harsh discipline isnon-normative (Lansford et al. 2005). The associations,however, were modest, which may be due to the highproportion of highly educated mothers in our sample, andmay also be a beneficial effect of prohibiting use of harshdiscipline in Norway. The modest associations could also beattributed to the age of the children in the current study, astheoretical and empirical studies suggest that negativeparenting may be especially detrimental for younger children(Keiley et al. 2001).

We found a direct association between paternal educationlevels and externalizing problems, but there were nosignificant paths from paternal education levels to parentingpractices. The lack of association may suggest that educationlevels play less of a role for fathering than for mothering, orthat the association between parental education levels andexternalizing problems are mediated by mechanisms notincluded in our model. It could also suggest that fathers areless involved in parenting compared to mothers. However,fewer fathers than mothers completed the well-being andparenting questionnaire. There is therefore some mismatchbetween informants for education level, parenting, andparental well-being. As a consequence, fathers are less wellrepresented in the models, thereby potentially underestimatingtheir influence and understating the associations betweenpaternal education levels, parenting and emotional well-being.

There was also a direct association between parental well-being and child mental health that was not mediated byparenting. This was not surprising, as there are other pathwaysthrough which parental mental health problems may betransmitted to children not captured by our model, forexample heritability and interactional characteristics such as

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less positivity and vocalizations, and slow and inconsistentresponses (Downey and Coyne 1990; Goodman and Gotlib1999; Ramchandani and Psychogiou 2009). In general, theoverall levels of explained variance by our models weremodest. This could probably be attributed to our restrictedset of explanatory variables. Low SES is associated with manyadditional co-factors that may contribute to the associationbetween low SES and mental health problems, such as poorerliving conditions and higher levels of family conflict (Evans2003; Thomson et al. 1994).

Our model explained more of the variance in externalizingproblems than in internalizing problems, and others havemade similar findings (e.g., Solantaus et al. 2004). In additionto poor parenting, important risk factors for childhoodinternalizing problems are shy temperament (e.g., Feng et al.2008) and insecure attachment (for review, see Colonnesiet al. 2011). It is likely that not having included such riskfactors in our model has contributed to the relatively lowproportion of explained variance in internalizing problems. Ithas also been suggested that, when used in communitysamples, the SDQ may be better at detecting externalizingand certain internalizing problems than others, which wouldrender our results less valid for those types of problems thatare likely to go undetected, such as phobias and eatingdisorders (Goodman et al. 2000b).

Furthermore, for internalizing problems, there weresignificant direct effects of family economy not accountedfor by parental mental health problems or parenting practices.Lempers et al. (1989) previously obtained similar results withregards to the direct association between financial hardshipand internalizing problems such as depression and loneliness.In another three-wave longitudinal study of 1,109 childrenspanning toddlerhood, kindergarten and second grade, Mianet al. (2011) found that the effects of sociodemographic riskfactors on parental reports of childhood anxiety inkindergarten and in second grade were mediated by anxietysymptoms during toddlerhood. The apparent direct effect fromfamily economy found in the current study could thereforepossibly be mediated by such factors that were not accountedfor in our model. Future longitudinal studies shouldinvestigate this possibility further by including more riskfactors for internalizing problems obtained at an early age intheir models.

Limitations

The findings from the current study should be viewed in thelight of several limitations. The cross-sectional design posessome restrictions on the conclusions that can be drawn. Theinternal consistency of the measure of Negative discipline waslow, in part due to the low item-total correlation for physicalpunishment which may suggest this item represents a separatefacet of negative parenting. For one, we cannot exclude the

possibility of a reciprocal association between childhoodmental health problems and parenting. Children are influentialagents, and family relationships are reciprocal in nature (e.g.,Kim et al. 2001). Prior studies have found that behavioralproblems and hyperactivity influence parenting practices(Campbell et al. 1991), and in the study by Solantaus et al.(2004), mental health problems in 8 year olds were found topredict both mental health problems as well as impairedparenting 4 years later. Recent research on differentialsusceptibility also suggests that some children are moreaffected than others by adverse parenting, depending ongenetic and early temperamental characteristics (Boyce andEllis 2005; Pluess and Belsky 2010a, b). Replication of thesefindings in a genetically informative design (e.g. a twin oradoption study) could distinguish, as we could not, betweenfamily links mediated genetically and environmentally.

Furthermore, there is a possibility that children’s mentalhealth problems could affect the socioeconomic status of theirparents, although this influence is limited during pre- andearly adolescence (Wadsworth and Achenbach 2005). Highlevels of psychological problems in children may forceparents to work reduced hours or prevent them from pursuingeducational or occupational opportunities which otherwisecould have benefited their socioeconomic status.

Also, evidence of full or partial statistical mediation fromstudies using cross-sectional data may not always beinformative with regard to longitudinal cauasal processes(Cole and Maxwell 2003; Maxwell and Cole 2007; Maxwellet al. 2011). However, when based on well-foundedtheoretical foundations for the causal direction, as well asprior findings from experimental and non-experimentalstudies, cross-sectional mediation has the potential to revealcausal mechanisms (MacKinnon et al. 2007; Shrout 2011). Inaddition, family economy is a subjective indicator ofeconomic adversity, and data on actual family income wasnot available in the current study. Although reporting a poor orvery poor perceived family economy was strongly related toexperiencing current economic difficulties, more objectivemeasures of income could have strengthened our findingsfurther. Despite the differences in operationalization, ourresults still align well with previous studies where familyeconomy has been defined using other, more traditional,methods.

Relatedly, there were also few respondents that reportedhaving a poor family economy. Although the responseproportion aligns well with poverty rates reported ingovernment statistics (Mogstad et al. 2007), it may alsoindicate lower response rates among participants with lowSES compared to high SES, a finding also reported by others(Lundberg et al. 2005). A low response proportion does notnecessarily produce biased results (Stang 2003), but may limitthe external validity of our findings. It has also beendemonstrated that selection bias is more likely to affect point

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estimates than patterns of association, and that regressionestimates are relatively robust to the influence of selectivedropout (Lundberg et al. 2005; Wolke et al. 2009).Furthermore, the results from the current study align well withthe pattern of results reported in previous studies, making itless likely that the low response proportion have biased theresults substantially.

Conclusion

The current study adds to the previous literature onsocioeconomic status and parenting by demonstrating thatboth family economy, through parental mental well-being,and maternal education levels simultaneously andindependently influence the use of disciplinary practices.Importantly, these indicators of SES appeared to be associatedwith child mental health problems through different pathways.Parental mental health problems also have negative influenceson the use of affirmative parenting practices. Our findingsmay have important clinical and policy implications.Parenting skills may be a useful candidate for clinicalintervention when working with parents and children whoare socioeconomically disadvantaged, and several promisingevidence-based parenting programs have become available(see review by Barth et al. 2005). A recent meta-analyticalreview, suggest that the largest positive gains may be obtainedby utilizing programs that teach parenting consistency,increases positive parent–child interactions and emotionalcommunication skills, and adaptive control strategies (WyattKaminski et al. 2008). Furthermore, the strengths of theassociations in the current study were of smaller magnitudethan those demonstrated in previous studies. This may beattributable to certain characteristics of the Norwegian societysuch as low levels of economic disparity and high educationlevels in the population, the family and economic policy, andthe low tolerance for punitive discipline among Norwegianparents.

Acknowledgments We are grateful to the children and parentsparticipating in the study. The authors are also grateful to two anonymousreviewers for constructive comments and suggestions.

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