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One of the key findings of the thesis – conducted by Baojing Li at the Department of Public Health Sciences, Stockholm University – is that various forms of misfortune do not exist in isolation, but rather are interconnected, and often times co-occur and are transmitted across generations in complex ways.

For instance, there are interconnected associations between grandparents’ psychiatric disorders and low income of both their children and grandchildren. And transmission of psychiatric disorders from grandfathers to grandsons operates through the fathers’ economic struggles. Moreover, a combination of grandparental socioeconomic and parental psychosocial disadvantages elevates the risk of grandchild psychiatric disorders.

Policies and interventions aimed at enhancing family relationship quality, fostering positive peer relationships, and promoting educational success during childhood, as well as improving psychosocial conditions during adulthood could have far-reaching benefits for the future generations.

However, improved socioeconomic and psychosocial circumstances across previous generations predicts a lower risk of psychiatric disorders in grandchildren.

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“The interconnected nature of socioeconomic and mental health disadvantages and constellations of various dimensions of disadvantages emphasize the importance of integrated and coordinated policy and intervention responses”, Li says. She defended her thesis Misfortune (dis)continues across generations – Multigenerational studies linking socioeconomic and psychosocial disadvantages to psychiatric disorders on June 5 at the Department of Public Health Sciences, Stockholm University.

The chain could be broken

The thesis highlights how the parental generation, especially their childhood experiences, matters deeply. For the parental generation, despite exposure to economic hardship from the family of origin, growing up with strong family relationships, good friendships, and solid school performance played a protective role, reducing their own adulthood psychosocial stressors and, by extension, their children’s risk of psychiatric disorders.

Li found that positive changes – like improved childhood experiences or better adulthood psychosocial conditions in the parent generation – significantly lowers the risk of mental health problems in their children. In other words, breaking the chain is possible.

“Policies and interventions aimed at enhancing family relationship quality, fostering positive peer relationships, and promoting educational success during childhood, as well as improving psychosocial conditions during adulthood could have far-reaching benefits for the future generations”, Li says.

Specifically, there is scope for the healthcare sector to provide, for example, intervention programs on parental stress management and more effective treatment of parental psychiatric disorders.

“Social services play a role by providing material support, such as affordable childcare and housing assistance, to relieve economic stressors that can potentially impact parental psychosocial conditions and family relationship dynamics. The school system could facilitate, for instance, preschool and early learning programs that support cognitive and social development, especially for children from disadvantaged family backgrounds”, Li says.

Different gender patterns

Her thesis also shows that there are gender differences in this context. Low income was found to be transmitted through the paternal side to grandchildren. Meanwhile, mental illness in grandparents influenced their grandsons’ mental health across both the maternal and paternal lines.

In the association between grandparental socioeconomic disadvantages and grandchildrens psychiatric disorders, the fathers’ friendships and school performance in their own childhood were particularly influential. During childhood, the mothers’ quality of family relationships was shown to have a greater impact.

“The lineage- and gender-sensitive transmission patterns of multigenerational disadvantages point to the need for tailored gender-sensitive public health interventions”, Li says.

Interventions should consider social determinants

Taken together, the findings suggest that offspring mental health is shaped by a mix of socioeconomic and psychosocial challenges in previous generations – and that public health strategies aimed at improving mental health of future generations should consider its social determinants in terms of both socioeconomic and psychosocial aspects and adopt a multigenerational perspective.

“These findings highlight strong evidence that what happens in one generation may not continue across generations, and there are potentials for resilience and recovery that may help break this vicious cycle, leading to the discontinuity of multigenerational disadvantages.” Li says. “To truly promote mental health of future generations, we need to think not just in terms of individual treatment, but of socially determined and long-term multigenerational approaches. Empowering one generation creates opportunities for the next. .”

What are you going to do now that you are finished with your PhD?

"I will be joining the statistical consulting company Red Door Analytics to further pursue my interest in advanced statistical models to turn complex data into actionable insights."

How did you end up in Stockholm, Sweden and doing your PhD at the Department of Public Health Sciences, Stockholm University?

"During my bachelor’s studies, I discovered my passion for health inequalities research and statistics. Thanks to the scholarship from Karolinska Institutet, I came to Sweden to pursue a master’s degree. I also worked there as a research assistant thereafter, investigating how educational level relates to mental health using a register-based approach. When the opportunity arose to pursue a PhD at the Department of Public Health Sciences, Stockholm University, it felt like a natural next step for me. My doctoral project builds directly on my earlier work, allowing me to take a multigenerational perspective to understand how inequalities are reproduced over time, while exploring the beauty of a variety of statistical methods."

Håkan Soold