BACKGROUND: Gender discrimination may be a novel mechanism through which gender inequality negatively affects the health of women and girls. We investigated whether children's mental health varied with maternal exposure to perceived gender discrimination. METHODS: Complete longitudinal data was available on 2,567 mother-child dyads who were enrolled between March 1, 1991 and June 30, 1992 in the European Longitudinal Cohort Study of Pregnancy and Childhood-Czech cohort and were surveyed at multiple time points between pregnancy and child age up to 15 years. The Strengths and Difficulties Questionnaire (SDQ) was administered at child age 7, 11, and 15 years to assess child emotional/behavioural difficulties. Perceived gender discrimination was self-reported in mid-pregnancy and child age 7 and 11 years. Multilevel mixed-effects linear regression of SDQ scores were estimated. Mediation was tested using structural equation models. FINDINGS: Perceived gender discrimination, reported by 11.2% of mothers in mid-pregnancy, was related to increased emotional/behavioural difficulties among children in bivariate analysis (slope = 0.24 [95% confidence interval (CI): 0.15, 0.32], p<0.0001) and in the fully adjusted model (slope = 0.18 [95% CI: 0.09, 0.27], p<0.0001). Increased difficulties were evident among children of mothers with more depressive symptoms (slope = 0.04 [95% CI: 0.03, 0.05], p<0.0001), boys (slope = 0.26 [95% CI: 0.19, 0.34], p<0.0001), first children (slope = 0.16 [95% CI: 0.09, 0.23], p<0.0001), and families under financial hardship (slope = 0.09 [95% CI: 0.04, 0.14], p<0.0001). Effects were attenuated for married mothers (slope-0.12 [95% CI: -0.22, -0.01], p<0.05]. Maternal depressive symptoms and financial hardship mediated about 37% and 13%, respectively, of the total effect of perceived gender discrimination on SDQ scores. INTERPRETATION: Perceived gender discrimination among child-bearing women in family contexts was associated with more mental health problems among their children and adolescents, extending prior research showing associations with maternal mental health problems. Maternal depressive symptoms and, to a lesser extent, financial hardship both partially mediated the positive relationship between perceived gender discrimination and child emotional/behavioural problems. This should be taken into consideration when measuring the societal burden of gender inequality and gender-based discrimination. Moreover, gender-based discrimination affects more than one gender and more than one generation, extending to boys in the household even moreso than girls, highlighting that gender discrimination is everyone's issue. Further research is required on the intergenerational mechanisms whereby gender discrimination may lead to maternal and child mental health consequences. FUNDING: Bill and Melinda Gates Foundation; Ministry of Education, Youth and Sports, Czech Republic and European Structural and Investment Funds.

Department of Criminology Sociology and Geography Arkansas State University Jonesboro Arkansas USA

Department of Pediatrics Stanford University School of Medicine Stanford California USA

Department of Sociology University of Alabama at Birmingham Birmingham Alabama USA

RECETOX Faculty of Science Masaryk University Brno Czech Republic

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EClinicalMedicine. 2022 Nov 29;53:101775. doi: 10.1016/j.eclinm.2022.101775. PubMed

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Collishaw S. Annual research review: secular trends in child and adolescent mental health. J Child Psychol Psychiatry Allied Discip. 2015;56:370–393. PubMed

Polanczyk G V, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry Allied Discip. 2015;56:345–365. PubMed

Husky MM, Boyd A, Bitfoi A, et al. Self-reported mental health in children ages 6–12 years across eight European countries. Eur Child Adolesc Psychiatry. 2018;27:785–795. PubMed

Ayalon L. Perceived age, gender, and racial/ethnic discrimination in Europe: results from the European Social Survey. Educ Gerontol. 2014;40:499–517.

Homan P. Structural sexism and health in the United States: a new perspective on health inequality and the gender system. Am Sociol Rev. 2019;84:486–516.

Heise L, Greene ME, Opper N, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet. 2019;393:2440–2454. PubMed

Weber AM, Cislaghi B, Meausoone V, et al. Gender norms and health: insights from global survey data. Lancet. 2019;393:2455–2468. PubMed

Vines AI, Ward JB, Cordoba E, Black KZ. Perceived racial/ethnic discrimination and mental health: A review and future directions for social epidemiology. Curr Epidemiol Reports. 2017;4:156–165. PubMed PMC

Stepanikova I, Acharya S, Abdalla S, Baker E, Klanova J, Darmstadt GL. Gender discrimination and depressive symptoms among child-bearing women: ELSPAC-CZ cohort study. EClin Med. 2020;20 PubMed PMC

Tran AGTT. Family contexts: parental experiences of discrimination and child mental health. Am J Community Psychol. 2014;53:37–46. PubMed

Khan M, Ilcisin M, Saxton K. Multifactorial discrimination as a fundamental cause of mental health inequities. Int J Equity Health. 2017;16:1–12. PubMed PMC

Bécares L, Nazroo J, Kelly Y. A longitudinal examination of maternal, family, and area-level experiences of racism on children's socioemotional development: patterns and possible explanations. Soc Sci Med. 2015;142:128–135. PubMed

Pearlin LI, Menaghan EG, Lieberman MA, Mullan JT. The stress process. J Health Soc Behav. 1981;22:337–356. PubMed

Kang NR, Kwack YS, Song J-K, et al. The intergenerational transmission of maternal adverse childhood experiences on offspring’s psychiatric disorder and the mediating role of maternal depression: results from a cross sectional study. Clin Child Psychol Psychiatry. 2022;27(3):613–629. doi: 10.1177/13591045211056919. PubMed DOI

Thomas-Argyriou JC, Letourneau N, Dewey D, Campbell TS, Giesbrecht GF. The role of HPA-axis function during pregnancy in the intergenerational transmission of maternal adverse childhood experiences to child behavior problems. Dev Psychopathol. 2021;33:284–300. PubMed

Deighton J, Lereya ST, Casey P, Patalay P, Humphrey N, Wolpert M. Prevalence of mental health problems in schools: poverty and other risk factors among 28 000 adolescents in England. Br J Psychiatry. 2019;215:565–567. PubMed PMC

Priel A, Djalovski A, Zagoory-Sharon O, Feldman R. Maternal depression impacts child psychopathology across the first decade of life: oxytocin and synchrony as markers of resilience. J Child Psychol Psychiatry. 2019;60:30–42. PubMed

Mazza JRSE, Lambert J, Zunzunegui MV, Tremblay RE, Boivin M, Côté SM. Early adolescence behavior problems and timing of poverty during childhood: a comparison of lifecourse models. Soc Sci Med. 2017;177:35–42. PubMed

Russell DW, Clavél FD, Cutrona CE, Abraham WT, Burzette RG. Neighborhood racial discrimination and the development of major depression. J Abnorm Psychol. 2018;127:150–159. PubMed PMC

Earnshaw VA, Rosenthal L, Lewis JB, et al. Maternal experiences with everyday discrimination and infant birth weight: a test of mediators and moderators among young, urban women of color. Ann Behav Med. 2013;45:13–23. PubMed PMC

Perry BL, Harp KL, Oser CB. Racial and gender discrimination in the stress process: implications for African American women's health and well-being. Sociol Perspect. 2013;56:25–48. PubMed PMC

Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;11:407–440. PubMed PMC

Fuchs A, Resch F, Kaess M, Moehler E. Early parenting stress links obstetric complications and child psychopathology in middle childhood in an at-risk sample. J Dev Behav Pediatr. 2022;43(1):e48–e55. PubMed

Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378. PubMed

Wheeler LA, Updegraff KA, Crouter A. Mexican-origin parents' work conditions and adolescents' adjustment. J Fam Psychol. 2015;29(3):447–457. PubMed PMC

Piler P, Kandrnal V, Kukla L, et al. Cohort profile: the European longitudinal study of pregnancy and childhood (ELSPAC) in the Czech Republic. Int J Epidemiol. 2017;46 doi: 10.1093/ije/dyw091. PubMed DOI PMC

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Brit Journal Psychiatry: J Mental Sci. 1987;150:782–786. PubMed

Liskola K, Raaska H, Lapinleimu H, et al. The effects of maternal depression on their perception of emotional and behavioral problems of their internationally adopted children. Child Adolesc Psychiatry Ment Health. 2021;15:41. PubMed PMC

Lasalvia A, Zoppei S, Van Bortel T, et al. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet. 2013;381(9860):55–62. PubMed

Pascoe EA, Richman LS. Perceived Discrimination and Health: A Meta-Analytic Review. Psychol Bull. 2009;135:531–554. PubMed PMC

Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity. 2008;16:1129–1134. PubMed

Gunzler D, Chen T, Wu P, Zhang H. Introduction to mediation analysis with structural equation modeling. Shanghai Arch Psychiatry. 2013;25(6):390–394. PubMed PMC

Mehmetoglu M. Medsem: a Stata package for statistical mediation analysis. Intl J Computational Econ Econometrics. 2018;8:63–78.

Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173. PubMed

Iacobucci D, Saldanha N, Deng X. A meditation on mediation: evidence that structural equations models perform better than regressions. J Consum Psychol. 2007;17:139–153.

Zhao X, Lynch JG, Jr, Chen Q. Reconsidering Baron and Kenny: myths and truths about mediation analysis. J Consum Res. 2010;37(2):197–206.

Raghunathan TE, Lepkowski JM, Van Hoewyk J, Solenberger P. A multivariate technique for multiply imputing missing values using a sequence of regression models. Surv Methodol. 2001;27:85–96.

Szymanski DM, Stewart DN. Racism and sexism as correlates of African American women's psychological distress. Sex Roles. 2010;63:226–238.

Dias BG, Ressler KJ. Experimental evidence needed to demonstrate inter- and trans-generational effects of ancestral experiences in mammals. BioEssays. 2014;36:919–923. PubMed PMC

Brown RH, Eisner M, Walker S, et al. The impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries. J Affect Disord. 2021;295:612–619. PubMed

Lux V, Non AL, Pexman PM, Stadler W, Weber LAE, Krüger M. A developmental framework for embodiment research: the next step toward integrating concepts and methods. Front Syst Neurosci. 2021;15 doi: 10.3389/fnsys.2021.672740. PubMed DOI PMC

Hou Y, Kim SY, Hazen N, Benner AD. Parents’ perceived discrimination and adolescent adjustment in Chinese American families: mediating family processes. Child Dev. 2017;88:317–331. PubMed PMC

Levy JK, Darmstadt GL, Ashby C, et al. The influence of gender-transformative programming on the health and well-being of children and adolescents: a systematic review. Lancet Global Health. 2020;8(2):e225–e236. PubMed PMC

Gupta GR, Oomman N, Grown C, et al. Gender equality and gender norms: framing the opportunities for health. Lancet. 2019;393(10190):2550–2562. PubMed

Heymann J, Levy JK, Bose B, et al. Improving health with programmatic, legal, and policy approaches to reduce gender inequality and change restrictive gender norms. Lancet. 2019;393(10190):2522–2534. PubMed

Taylor K, Guerin PT. 3rd Ed. Red Globe Press 2019; London, UK: 2019. Health Care and Indigenous Australians: Cultural Safety in Practice; pp. 1–264. Accessed 22 May 2022.

Wagman P, Nordin M, Alfredsson L, Westerholm PJM, Fransson EI. Domestic work division and satisfaction in cohabiting adults: associations with life satisfaction and self-rated health. Scand J Occup Ther. 2017;24:24–31. PubMed

Křížková A, Vohlídalová M, Pospíšilová K, Maříková H. 2017. Aktuální rozdíly v odměňování žen a mužů v ČR Hloubková analýza statistik a mezinárodní srovnani. [Current differences in the remuneration of men and women in the Czech Republic. In-depth analysis of statistical data and international comparison.] Ministerstvo práce a sociálních věcí, Praha. [Ministry of Labor and Social Matters, Prague]. ISBN 978-80-7421-147-8. https://www.rovnaodmena.cz/www/img/uploads/336b8482.pdf. Accessed 22 May 2022

Schwab K, Eide EB, Zahidi S, et al. 2014. The Global Gender Gap Report 2014.www3.weforum.org/docs/GGGR14/GGGR_Comp Accessed 22 May 2022.

Koldinská K. 2015. The policy on gender equality in the Czech Republic: In-depth analysis for the FEMM committee. Brussels. Accessed 22 May 2022.

Mozny I, Rabusic L. Unmarried cohabitation in Czechoslovakia. Czechoslovak Sociological Rev. 1992;28:107–117. PubMed