Early childhood exposure to childcare and mental health trajectories in England

Background: Most children growing up in England and other Western countries attend childcare prior to attending school. The years before starting school are a critical period for child development, and children are susceptible to their environment. From a policy perspective, childcare has been outlined as an environment that should improve physical and mental health and wellbeing of children. Through positively impacting child development and by providing parents with the opportunity to work, childcare has the potential to reduce socio-economic inequalities between families. Yet childcare is not equally accessible to all, and usage remains stratified by socio-economic and family characteristics. Some studies have linked broad measures of non-parental childcare to mental health; however, evidence is limited, and there is a lack of detail in the way childcare has been looked at. There is limited knowledge about how different patterns of childcare use during early childhood are associated with long-term mental health and related behaviours.

Aim: The aim of this PhD was to explore the relationship between early non-parental childcare attendance and mental health trajectories during childhood and adolescence in England.

Methods: This was addressed through four empirical studies. A scoping review identified and synthesised the published research since 2007 on the association between childcare and mental health in childhood and adolescence. The other three studies used data from the Millennium Cohort Study to:

1) understand how families select childcare identify potential social inequalities in childcare use;

2) analyse the association between childcare use and problem behaviours;

3) analyse the association between formal childcare use and psychological wellbeing.

Results: The review highlighted a lack of studies that explored positive mental health outcomes and studies that explored the association of childcare and mental health in adolescence. The analyses of the Millennium Cohort Study revealed that children from a higher income family, living in more advantaged areas, who had single parents or had more educated mothers used more childcare, particularly formal childcare. Associations between family characteristics and childcare use were stronger before age 3 when no government-funded childcare was available, showing that needing to pay for childcare is a great barrier for many families. Results about the association between childcare and problem behaviour suggest that children who start attending childcare late or that attend at very high intensities display more problem behaviours. For all other children, childcare use was unrelated to problem behaviour. After controlling for the socio-economic position of children, childcare use was not related to psychological wellbeing (measured as self-esteem and life satisfaction) in adolescence.

Conclusions: Early childcare use had limited associations with mental health trajectories in England. Families from different backgrounds use childcare differently, and children whose socio-economic position puts them at a higher risk of mental illness are less likely to attend childcare early or at high intensities.