Effects of early institutionalization involving psychosocial deprivation on cognitive functioning 60 years later: Findings of the LifeStories project.

BACKGROUND: Institutionalization involving psychosocial deprivation affects child development negatively. However, there are few longitudinal studies, and no prospective study has yet examined the consequences of institutionalization in late adulthood. OBJECTIVE: Investigating effects of psychosocial deprivation on cognitive functioning 60 years later. PARTICIPANTS AND SETTING: A population-based survey of institutionalized infants and toddlers was conducted in Switzerland from 1958 to 1961 (n = 387; Mage = 0.93 years, SD = 0.53, 48 % female, 48 % Swiss nationality). In parallel, a comparison group of 399 family-raised children were assessed (Mage = 0.85 years, SD = 0.50, 46 % female, 100 % Swiss nationality). Six decades later, data on cognitive functioning were collected for 88 of the institutionalized group (Mage = 62.63 years, SD = 1.32), and 148 of the comparison group (Mage = 65.06, SD = 1.32). METHODS: Standardized tests were used: the Brunet-Lézine Developmental Test in early childhood and a short form of the Wechsler Adult Intelligence Scale in late adulthood. RESULTS: Formerly institutionalized individuals scored lower on cognitive functioning (d = - 0.67, p < .001), with the greatest difference in working memory (d = -0.78, p < .001). Longer duration of institutionalization increased the risk of lower cognitive functioning, indicating a dose-response effect. Institutionalization's impact on adult cognitive functioning was mediated by early childhood developmental status but not by later educational attainment. CONCLUSIONS: This study confirms the early experience hypothesis, indicating that early life conditions have lasting effects on human development, even into late adulthood.

The LifeStories project: Empowering voices and avoiding harm-Ethics protocol of a long-term follow-up study of individuals placed in infant care institutions in Switzerland.

Little empirical data exist to guide ethical decisions when conducting research with vulnerable populations. The current study assesses a protocol designed to mitigate risks in a population-based cohort of 246 individuals placed in care institutions as infants in a non-selective 60-year follow-up. In total, 116 (47%) individuals chose to participate, of whom 53 (55%) reported positive effects of participation such as the opportunity to fill some gaps in their life stories, to better deal with their past, and to understand previous family dynamics. Only three individuals (2.5%) explicitly reported negative short-term consequences such as feeling upset as a result of thinking about stressful times, but they nonetheless rated the usefulness of the study as high. For six participants (5%), psychological counseling sessions were initiated as a support measure. Our findings suggest that risk of harm can be managed with a rigorous ethics protocol when conducting research with a vulnerable cohort and therefore enable the voices of survivors to be heard. A step wise approach in which increasing amounts of information were presented at each step, clearly operationalized passive decline, and direct and consistent contact with highly trained staff were considered key to mitigating distress.

Long-Term Promotive and Protective Effects of Early Childcare Quality on the Social-Emotional Development in Children.

The present study aimed to examine the longitudinal promotive and protective role of process quality in regular early childhood education and care (ECEC) centers in the context of early cumulative family risks on children's social-emotional development from early to middle childhood. The sample consisted of 293 (T1; M age = 2.81), 239 (T2; M age = 3.76), and 189 (T3; M age = 9.69) children from 25 childcare centers in Switzerland. Fourteen familial risk factors were subsumed to a family risk score at T1. Parents and teachers reported on children's conduct problems (CP), emotional problems (EP), and prosocial behavior (PB) at T2 and T3. Childcare process quality was assessed at T2 using external observations of teaching and interaction, provisions for learning, and key professional tasks. Results showed that early family risks were positively associated with CP and EP and negatively associated with PB in the long term. High-quality teaching and interaction as well as caregivers' professional behavior in terms of systematic observation, documentation, and planning of children's individual learning processes and needs protected children from the undesirable long-term effects of early family risks on conduct problems, emotional problems, and prosocial behavior from early to middle childhood. The results indicate that a high process quality in ECEC might serve as an essential contextual protective factor in the development of resilience in children at risk.

Development and Health of Adults Formerly Placed in Infant Care Institutions - Study Protocol of the LifeStories Project.

A growing volume of research from global data demonstrates that institutional care under conditions of deprivation is profoundly damaging to children, particularly during the critical early years of development. However, how these individuals develop over a life course remains unclear. This study uses data from a survey on the health and development of 420 children mostly under the age of three, placed in 12 infant care institutions between 1958 and 1961 in Zurich, Switzerland. The children exhibited significant delays in cognitive, social, and motor development in the first years of life. Moreover, a follow-up of a subsample of 143 children about 10 years later revealed persistent difficulties, including depression, school related-problems, and stereotypies. Between 2019 and 2021, these formerly institutionalized study participants were located through the Swiss population registry and invited to participate once again in the research project. Now in their early sixties, they are studied for their health, further development, and life-course trajectories. A mixed-methods approach using questionnaires, neuropsychological assessments, and narrative biographical interviews was implemented by a multidisciplinary team. Combining prospective and retrospective data with standardized quantitative and biographical qualitative data allows a rich reconstruction of life histories. The availability of a community sample from the same geographic location, the 1954-1961 cohort of the Zurich Longitudinal Studies, described in detail in a paper in this issue (Wehrle et al., 2020), enables comparison with an unaffected cohort. This article describes the study design and study participants in detail and discusses the potential and limitations of a comparison with a community sample. It outlines a set of challenges and solutions encountered in the process of a lifespan longitudinal study from early childhood into the cusp of old age with a potentially vulnerable sample and summarizes the lessons learned along the way.

Acute stress reactions in the first 3 weeks postpartum: a study of 219 parturients.

OBJECTIVES: There is increasing research on posttraumatic stress (PS) 4-6 weeks and 3 months postpartum, but, there are no data on acute stress reactions (ASR) in the first 3 weeks postpartum, i.e. the potential precursors of PS. However, ASR may have long-term effects, e.g., on a subsequent pregnancy without having manifested as PS in the meantime. We propose: (i) to describe the patterns of ASR after childbirth, (ii) to explore differences between women with normal and traumatogenic ASR, and (iii) to provide data on the early detection of traumatogenic ASR 2 and 3 weeks postpartum. STUDY DESIGN: Intra-event variables (relationship with caregivers, overall birth experience, and dissociative experiences, as well as obstetric variables) were assessed 48-96 h. postpartum, as were ASR (by means of the Impact-of-Event Scale IES) in weeks 1, 2, and 3 postpartum. According to research on PS the upper 33%-range of ASR in weeks 2 and 3 was defined as 'traumatogenic'. RESULTS: Normal ASR in week 1 are at a level which in non-obstetric trauma-situations is considered as the upper range of low stress or lower range of medium distress. ASR decline constantly from week 1 to week 3. However, high ASR in week 1 do not drop faster than do low ones, thus indicating a prolonged stress reaction in women with high ASR in week 1. Low ASR (IES-scores <10) and high ASR (IES-scores >20) in week 1 are highly predictive for normal ASR, and traumatogenic ASR in weeks 2 and 3, respectively. Medium ASR (IES-scores 10-20) in week 1 are of uncertain predictive value for stress reactions in weeks 2 and 3 and have to be re-assessed at that time. CONCLUSIONS: Clinical screening for ASR appears to be helpful in detecting women with a compromised ability to process childbirth-related stress. The association between ASR and long-term development should be further explored.

Depressive symptoms and psychosocial stress across the transition to parenthood: associations with parental psychopathology and child difficulty.

The transition to parenthood is often accompanied by depression and stress. Several studies have established risk factors for postpartum depression, e.g., antenatal depression. However, only a few studies have involved fathers. Moreover, most studies focus on the prevalence of depression instead of intraindividual changes over time. Our study investigated differential effects of parental psychopathology and child difficulty on the course of depressive symptoms and feelings of stress for first-time mothers and fathers. Seventy-four mothers and 58 fathers completed questionnaires on depressive symptoms (EPDS) and feelings of stress during pregnancy, and at 1, 3, 12, and 18 months postpartum. Parents rated children's difficulty-fussiness at 3, 12, and 18 months postpartum (ICQ). Parental psychopathology was established during pregnancy using self-reports (SCL-90-R) and anamnestic data. In mentally healthy mothers and fathers depressive symptoms decreased from pregnancy to 18 months postpartum, whereas parents with psychopathology in pregnancy showed a tendency to prolonged depressive phases. In parents with psychopathology, feelings of stress peaked at 12 months postpartum. Child difficulty was associated with elevated levels of psychosocial stress, but only for some participants. Parental psychopathological symptoms during pregnancy should thus be considered as a risk factor for elevated and prolonged depression and elevated psychosocial stress in mothers and fathers across the transition to parenthood.

Intergenerational transmission of marital quality across the transition to parenthood.

One of the most frequently reported changes across the transition to parenthood is a decline in marital quality after the birth of a first baby. Experiences in the family of origin may influence the trajectory of marital quality. Our study aimed to investigate the impact of recollections of family-of-origin marriage on marital quality (self-reports and clinical evaluation) from pregnancy to 1 year after the birth of a first child. A total of 62 first-time parents completed questionnaires (self-reported marital satisfaction) and clinical interviews (clinical evaluation of couples' dialogue quality). Although self-reported marital satisfaction and observed dialogue quality were highly associated, only self-reported marital satisfaction declined from pregnancy to 1 year after birth. This decrease was partly due to very high marital satisfaction during pregnancy. Different trajectories for self-reported marital satisfaction and observed dialogue quality were found for participants with recollections of low-, average-, and high-quality family-of-origin marriage. A structural equation model showed that participants who recollected a negative quality in their parents' relationship reported more negative changes in the quality of their own marriages. There seems to be an intergenerational transmission of marital quality that comes to light when couples are challenged by the birth and rearing of a baby.

Parental psychopathology, marital quality, and the transition to parenthood.

This study of 80 expectant first-time parents investigated the associations among marital quality, parental psychiatric disorders, and parents' capacity to form triadic relationships (Triadic Capacity). The results suggest that marital quality as well as maternal and paternal psychopathology affect child and family development as early as pregnancy, when parents prepare themselves to integrate the future child into their relational world.