Abstract
BACKGROUND: Socioeconomic inequalities in mental health are already evident in early life. During the COVID-19 pandemic, many families experienced additional stress. This study examines the development of mental health problems in children and adolescents in relation to their family's socioeconomic status in times of global crises, taking into account other risk and resource factors. METHODS: Data were used from the population-based BELLA study (pre-pandemic, N = 1,580) and from the longitudinal COPSY study (post-/pandemic, N = 1,586-1,701) with participants aged 7 to 22 years. Surveys were conducted before (BELLA T0, 2017), during (COPSY T1-T5, 2020-2022) and after the COVID-19 pandemic (COPSY T6-T7, 2023-2024) in Germany. Mental health problems (SDQ), socioeconomic status (parental education, net equivalent household income), and additional factors (parental psychopathology, social support, family cohesion) were examined. Prevalence in mental health problems, differences in mean values (SDQ) and panel regression analyses were calculated. RESULTS: Over the entire survey period, children and adolescents with a low socioeconomic status were more affected by mental health problems than their peers with a high status (e.g., pre-pandemic: 6.2% vs. 14.6%; post-pandemic: 11.0% vs. 18.3%). During the pandemic, mental health problems increased significantly in all status groups. Health inequality remained stable and even narrowed towards the end of the pandemic, whereby mean values in youth mental health problems were nearly the same for high and low educated parents in autumn 2022. After the pandemic, mental health inequalities started to re-increase. This pattern is also visible, but less pronounced, for household income. Personal resources, family cohesion, and social support served as protective factors for youth mental health. CONCLUSION: Socioeconomic inequalities in the mental health of children and adolescents remain evident in times of global crisis. Over the course of the pandemic, these mental health inequalities have not increased and even equalized, but post-pandemic recovery effects are only visible for young people in higher socioeconomic status. However, there is still an ongoing need for targeted health promotion and prevention that strengthens personal and social resources especially, but not only, for socially disadvantaged children and families at both an individual and societal level.