Socioeconomic and Lifestyle Associates of Emotional and Behavioral Difficulties Among Lithuanian First-grade Children

Introduction: Emotional and behavioral difficulties in childhood are important indicators of mental health and may be influenced by both family socioeconomic circumstances and lifestyle-related factors. Identifying modifiable risk and protective factors in early childhood may support the development of targeted prevention strategies. This study examined associations between emotional and behavioral difficulties and selected socioeconomic and lifestyle factors among Lithuanian first-grade children.

Methods: Data on Lithuanian first-graders (n = 2744) were collected during the sixth round of  WHO’s European Childhood Obesity Surveillance Initiative in 2023. Emotional and behavioral difficulties were assessed using parent-reported Family and Strengths and Difficulties Questionnaire (SDQ) Total Difficulties Score (TDS). Associations with sex, family financial situation, parental education, sleep duration, screen time, and participation in organized sports were examined using a general linear model (GLM). Adjusted regression coefficients and their 95% confidence intervals (CIs) were calculated and reported.

Results: Multivariable GLM revealed that higher SDQ TDSs were associated with male sex (B=0.95, 95% CI 0.59–1.3), longer screen time (B=0.35, 95% CI 0.22–0.48), shorter sleep duration (B=1.33, 95% CI 0.35–2.31 shortest vs. longest sleep category),  no participation in sports (B=0.77, 95% CI 0.32–1.23). Children from families reporting adequate financial resources had significantly lower TDSs than children from families experiencing financial difficulties (B=-3.74, 95% CI -6.04 to -1.44), while lower parental education was associated with progressively higher difficulties scores, ranging from B=0.47 (95% CI 0.04–0.9 ) to B=2.29 (95% CI 1.53–3.05) compared with the highest education group. The final model explained 7.6% of the variance in SDQ TDS (R²=0.076; adjusted R²=0.073).

Conclusions: Emotional and behavioral difficulties among Lithuanian first-grade children were associated with family socioeconomic circumstances, screen time, sleep duration, and sports participation. Some of these factors are modifiable and could be included in an early mental health promotion profile.