Adolescent mental health and behavioural problems, and intergenerational social mobility: A decomposition of health selection effects.

According to the health selection hypothesis, poor mental health and behavioural problems in adolescence limit socioeconomic attainment. But to what extent is health selection driven by prior social causation? This paper quantifies the extent to which health selection - here, restricted or downward intergenerational social class mobility due to poor mental health or behavioural problems - can be attributed to the influence of modifiable childhood risk factors. The UK National Child Development Study provides measures of socioeconomic deprivation and childhood adversities, as well as multiple-informant ratings of adolescents' mental health and behavioural problems, for which confirmatory factor analysis supports a three-factor model. Decomposition analysis is used to robustly assess the extent of attenuation of selection effects when conditioning on the childhood environment. Conduct problems, hyperactivity, and to a lesser extent emotional symptoms at age 16 are associated with individuals' chances of achieving (un)desirable mobility outcomes. When prior childhood risk factors are taken into account, the association of conduct problems with mobility is attenuated by around 50%, indicating a substantial role for confounding and earlier processes of social causation in the generation of this health selection effect. Further analyses indicate that this attenuation is greater for those from the most disadvantaged backgrounds and is mostly driven by the inclusion of indicators of generalised disadvantage such as crowded housing and low income. On the other hand, the effects of emotional symptoms and hyperactivity on mobility outcomes are not significantly accounted for by childhood risk factors. This study adds to the health inequalities literature by interrogating the empirical validity of the usual interpretation of health selection effects as indicating the causal priority of the onset of poor mental health.