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Open Access Research article

A national cohort study of parental socioeconomic status and non-fatal suicidal behaviour-the mediating role of school performance

Beata Jablonska1*, Frank Lindblad23, Viveca Östberg4, Lene Lindberg1, Finn Rasmussen5 and Anders Hjern46

Author Affiliations

1 Division of Applied Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

2 Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden

3 Stress Research Institute, Stockholm University, Stockholm, Sweden

4 Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden

5 Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

6 Department of Children's and Women's health, Uppsala University, Uppsala, Sweden

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BMC Public Health 2012, 12:17  doi:10.1186/1471-2458-12-17

Published: 9 January 2012



A link between low parental socioeconomic status and mental health problems in offspring is well established in previous research. The mechanisms that explain this link are largely unknown. The present study investigated whether school performance was a mediating and/or moderating factor in the path between parental socioeconomic status and the risk of hospital admission for non-fatal suicidal behaviour.


A national cohort of 447 929 children born during 1973-1977 was followed prospectively in the National Patient Discharge Register from the end of their ninth and final year of compulsory school until 2001. Multivariate Cox proportional hazards and linear regression analyses were performed to test whether the association between parental socioeconomic status and non-fatal suicidal behaviour was mediated or moderated by school performance.


The results of a series of multiple regression analyses, adjusted for demographic variables, revealed that school performance was as an important mediator in the relationship between parental socioeconomic status and risk of non-fatal suicidal behaviour, accounting for 60% of the variance. The hypothesized moderation of parental socioeconomic status-non-fatal suicidal behaviour relationship by school performance was not supported.


School performance is an important mediator through which parental socioeconomic status translates into a risk for non-fatal suicidal behaviour. Prevention efforts aimed to reduce socioeconomic inequalities in non-fatal suicidal behaviour among young people will need to consider socioeconomic inequalities in school performance.

Non-fatal suicidal behaviour; Socioeconomic status; School performance; Cohort studies