www.ssoar.info Impact of life events on child mental health before school entry at age six Furniss, Tilman; Beyer, Thomas; Müller, Jörg M. Postprint / Postprint Zeitschriftenartikel / journal article Zur Verfügung gestellt in Kooperation mit / provided in cooperation with: www.peerproject.eu Empfohlene Zitierung / Suggested Citation: Furniss, T., Beyer, T., & Müller, J. M. (2009). Impact of life events on child mental health before school entry at age six. European Child & Adolescent Psychiatry, 18(12), 717-724. https://doi.org/10.1007/s00787-009-0013-z Nutzungsbedingungen: Terms of use: Dieser Text wird unter dem "PEER Licence Agreement zur This document is made available under the "PEER Licence Verfügung" gestellt. Nähere Auskünfte zum PEER-Projekt finden Agreement ". 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Dokument nicht in irgendeiner Weise abändern, noch dürfen By using this particular document, you accept the above-stated Sie dieses Dokument für öffentliche oder kommerzielle Zwecke conditions of use. vervielfältigen, öffentlich ausstellen, aufführen, vertreiben oder anderweitig nutzen. Mit der Verwendung dieses Dokuments erkennen Sie die Nutzungsbedingungen an. Diese Version ist zitierbar unter / This version is citable under: https://nbn-resolving.org/urn:nbn:de:0168-ssoar-202700 Eur Child Adolesc Psychiatry (2009) 18:717–724 DOI 10.1007/s00787-009-0013-z ORIGINAL CONTRIBUTION Impact of life events on child mental health before school entry at age six Tilman Furniss Æ Thomas Beyer Æ Jo¨rg M. Mu¨ller Received: 30 September 2008 / Accepted: 17 March 2009 / Published online: 28 April 2009 Ó Springer-Verlag 2009 Abstract The study examined the association between Introduction life events and early child mental health prior to school entry. The impact of single life events and the cumulative Stressful life experiences constitute a potential threat to the effect of multiple life events on child mental health were mental health and development of children. Studies of examined. In a northern German city, the complete 1-year potential stressors distinguish between acute traumatic intake of preschool children at the primary school entry events, chronic strains or adversities, and stressful life assessment was included. In 1,887 children, life events and events [17]. The latter are the subject of the present study. psychiatric symptoms were recorded by means of stan- There has been extensive research over the last three dec- dardized parent questionnaires. Included were all life ades on stressful life events and their implications for events between child’s birth and school entry. For more emotional and behavioral psychopathology [17, 36]. The than 80 percent of all children, at least one life event was importance of life events for the onset of psychiatric dis- reported. The number of life events was independent of any orders was first shown in adults [4], and later also in demographic variable; the mean was 2.2. The number of children and adolescents [8, 15, 24]. A number of con- life events had a highly significant effect on the prevalence trolled studies in adolescents have shown that episodes of of child mental health problems. Six family-change-fac- depression were preceded by an accumulation of life events tors, especially coherent in content, could be identified by [16, 29]. factor analysis. The study provides important data on the A recent longitudinal study has shown a very strong epidemiology and clinical impact of life events and psy- association between stressful life events in childhood and chopathology in early childhood. For child mental health, depressive symptoms and antisocial behavior in young the cumulative effect of multiple life events was found to adults [34]. In children, a significantly increased number of be much more important than the effect of specific single life events was reported prior to the onset of such mental life events. health problems as mood disorders and depression [15, 21, 23, 38], as well as enuresis, externalizing behavior, suicidal Keywords Child mental health Á Life events Á tendencies, and anorexia nervosa [22]. The impact of Preschool age Á School entry stressful life events at preschool age was presented by Luby and colleagues [24]. In a clinical sample of N = 119, stressful life events accounted for 10% of the total variance in depression severity scores. A neurobiological mechanism proposed by Heim and Nemeroff [20] emphasizes the role of stressful life events & T. Furniss ( ) Á T. Beyer Á J. M. Mu¨ller especially in early childhood and preschool age. Early life Department of Child and Adolescent Psychiatry, University Hospital Muenster, 48129 Muenster, Germany stress induces persistent hyperactivity of hypothalamic e-mail: [email protected] pituitary axis (HPA), resulting in increased endocrine, T. Beyer autonomic, and behavioral stress responsiveness. With e-mail: [email protected] repeated exposure to early life stress, this vulnerability may 123 718 Eur Child Adolesc Psychiatry (2009) 18:717–724 result in symptoms of depression, anxiety disorders, and a 6 months prior to school entry, all children underwent a variety of psycho-physiological abnormalities [20]. mandatory pediatric and developmental assessment. At this Studies of stressful life events as risk factor for child point, the accompanying adult caregiver of each child was mental health have often focussed on the specificity of asked to take part in the study by completing some ques- either the stressor or the outcome [18, 26]. The most tionnaires. Basic demographic data, including educational complex model, the stressor-outcome specific model, and vocational data of the parents, number of siblings, simultaneously tests the hypotheses that particular stressful immigrant status, and marital status were recorded. The events predict particular psychiatric symptoms. Next to participation was voluntary and independent of the medical specificity, studies of life events and developmental psy- assessment. Either the questionnaires were completed by chopathology also consider models, wherein many differ- the parents immediately or they were taken home, com- ent stressors can lead to the same outcome (equifinality), pleted, and returned by mail. and similar stressors lead to multiple outcomes (multifi- The total number of children who were enrolled in the nality) [7]. The results of a comprehensive review on the school entry assessment was 2,561. Due to the represen- association between life events and psychiatric symptoms tative nature of the study, no exclusion criteria were provided some evidence of equifinality and multifinality defined. The questionnaires of exactly 2,000 children were [26]. completed and returned (78.1%). In accordance with the Despite numerous studies on the role of life events in manual [1] questionnaires were discarded as invalid, when adults, adolescents and older children, there is still little eight or more items had not been completed. The incom- research on life events and child mental health at preschool plete data of 113 subjects (5.7%) were excluded from the age [28]. Yet research on this specific age group is study. important, particularly with regard to the developmental The sample consisted of 1,887 children—975 boys stage of children at preschool age and their limited ability (51.7%) and 912 girls (48.3%) between the ages of 5.0 and to cope with stress and stressful life events [15]. Age dif- 6.9 years and a mean age of 6.0 (SD 0.38). The mean age ferences have been observed in judging the stressfulness of represented the relatively higher age at school entry in an event [5]. In addition, the psychological adjustment, Germany, which is set at age six. This age at school entry is which is required to cope successfully with a specific life comparable to the situation in some other European event, varies between adolescents and children. Therefore, countries, including Sweden and Finland. in research about life events experienced by preschool In 1,545 cases (81.9%), the child lived with both par- children, an age-appropriate assessment is needed. ents, 301 children (16.0) lived in a one parent family, 290 Most studies of life events covered a period of only 6 or (15.4%) of them with a single mother, 11 (0.6%) with a 12 months prior to investigation [32]. To examine the single father. Seven children (0.4%) lived with other rela- cumulative effect of multiple events over time [13, 33], it is tives or in foster care. In 349 cases, the child had no sibling necessary to include a broader time span. The examination (18.5%), 940 children had one sibling (49.8%), 413 had of possible cumulative effects of multiple life events is one two (21.9%), and 185 had three or more siblings (9.8%). of the key issues on methodology in life event research [33]. The parents of 1,773 children were German (94%) and 114 The present study investigated the frequencies of life were immigrants (6%). There was neither significant dif- events and their impact on child mental health. A popula- ference in the number of siblings, the educational level tion-based sample of preschool children was assessed and achieved by the parents and their job situation, in the the survey covered the period from birth to primary school number of single and two-parent families, nor in age and entry.