BMJ 1999;318:18-22 ( 2 January )

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Social class in childhood and general health in adulthood: questionnaire study of contribution of psychological attributes

Hans Bosma, senior researcher,  H Dike van de Mheen, senior researcher,  Johan P Mackenbach, professor. 

Erasmus University Rotterdam, Department of Public Health, PO Box 1738, 3000 DR Rotterdam, Netherlands

Correspondence to: Dr Bosma bosma{at}mgz.fgg.eur.nl

Objective: To determine the contribution of psychological attributes (personality characteristics and coping styles) to the association between social class in childhood and adult health among men and women.
Design: Partly retrospective, partly cross sectional study conducted in the framework of the Dutch GLOBE study.
Subjects: Sample of general population from south east Netherlands consisting of 2174 men and women aged 25-74 years. Baseline self reported data from 1991 provided information on childhood and adult social class, psychological attributes, and general health.
Main outcome measure: Self rated poor health.
Results: Independent of adult social class, low childhood social class was related to self rated poor health (odds ratio 1.67 (95% confidence interval 1.02 to 2.75) for subjects whose fathers were unskilled manual workers versus subjects whose fathers were higher grade professionals). Subjects whose fathers were manual workers generally had more unfavourable personality profiles and more negative coping styles. External locus of control, neuroticism, and the absence of active problem focused coping explained about half of the association between childhood social class and self rated poor health. The findings were independent of adult social class and height.
Conclusions: A higher prevalence of negative personality profiles and adverse coping styles in subjects who grew up in lower social classes explains part of the association between social class in childhood and adult health. This finding underlines the importance of psychological mechanisms in the examination of the negative effects of adverse socioeconomic conditions in childhood.

Key messages Regardless of adult social class, low social class in childhood is related to poor general health in adulthood Adverse personality profiles and negative coping styles are more common in people who grew up in lower social classes Psychological attributes, such as low perceived control, explain a substantial part of the direct association between childhood social class and adult health Psychological mechanisms may explain adverse health outcomes in adults who have a low socioeconomic background

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