The early years play a large role in determining mental health through childhood and beyond. A mentally healthy child is one with a clear sense of identity and self-worth, the ability to recognise and manage emotions, to learn, play, enjoy friendships and relationships, and deal with difficulties. A wide range of interrelated factors play a role, such as individual, family, wider society and environmental issues.
A child’s wellbeing is the result of healthy development within a nurturing environment. In the early years, infants make emotional attachments and form relationships that lay the foundation for future mental health. Attachment relationships are particularly important and have far-reaching effects on developing emotional, social and cognitive skills.
Mental health and wellbeing and inequalities in the early years
The positive mental health and wellbeing of children and their parents during first few months and years of a child's life enable their future health and attainment.
There is good evidence for a range of interventions that can mitigate experience of inequalities and promote mental health and wellbeing.
Quick links:
- What are health inequalities?
- Policy context
- How do inequalities relate to mental health and wellbeing in the early years?
- Identifying mothers at risk of mental health problems
- Effects of maternal mental illness on child development
- Cognitive development
- Bonding and attachment
- Postnatal depression and psychosis
- Teenage motherhood
- Nursery and pre-school
- Primary schools
What are health inequalities?
The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups."
For a fuller discussion, please see Inequalities in the early years.
Policy context
Activity in this area is consistent with commitments and priorities detailed in the Mental Health Strategy for Scotland: 2012-2015, the Early Years Framework and the National Parenting Strategy, Equally Well, Achieving our Potential, the Curriculum for Excellence, a range of NHS Scotland's Quality Indicators and is relevant to Scotland's national practice model for child-centred services - Getting it Right for Every Child (all external links).
How do inequalities relate to mental health and wellbeing in the early years?
Mental health problems can be both a cause and an effect of inequality.
There is an association between experience of deprivation and mental health problems.
Overall rates of suicide, schizophrenia, depression and anxiety are all higher among general populations living in the most deprived areas (ISD Scotland - Deprivation and Health (external link)).
Research conducted as part of the Growing Up in Scotland programme found that:
- maternal mental health difficulties are associated with a mother's social circumstances: those who experienced poverty and those living in an area of deprivation were more likely to experience brief and repeated mental health problems
- maternal mental health was significantly associated with child development outcomes
- there was evidence that the degree of a child's exposure to maternal mental ill-health affected child development outcomes.
(Growing Up In Scotland: Maternal mental health and its impact on child behaviour and development (external link)).
Some women with complex social problems, including mental health problems, have reported discrimination and judgemental behaviour from healthcare staff and that this impacts on their ongoing engagement with services (Reducing Antenatal Health Inequalities: Outcome Focused Evidence into Action Guidance, pp15).
Identifying mothers at risk of mental health problems
Risk factors for maternal mental health problems (including postnatal depression) include those for non-postnatal depression, a history of mental health problems during pregnancy, a lack of social support, a poor relationship with their partner, domestic abuse, adverse recent life events and baby blues.
A more comprehensive list of risk factors can be found in SIGN Guideline 127: Management of Perinatal Mood Disorders (external link).
The Guideline also recommends that:
- all pregnant mothers should be asked about their mental health history and family experience of postnatal depression and psychosis
- mothers should be asked about depressive symptoms at four to six weeks after giving birth and again at three to four months
- any significant and unexpected change in mental state in late pregnancy or early postnatal period should prompt referral to and further assessment by mental health services.
A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.
Effects of maternal mental illness on child development
Estimates suggest that up to 1 in 7 mothers will experience a mental health problem in the antenatal or postnatal period (NICE - Antenatal and postnatal mental health: implementation advice (external link)).
Anything that diminishes the ability of parents to communicate with and bond with babies and young children may affect their development of speech, language, communication and social abilities and contribute to behavioural problems.
A WHO literature review found that:
- Infants of chronically depressed mothers do not perform as well in thinking and intelligence tests at 18 months, with speech development in baby boys being affected most strongly.
- Children of depressed mothers are more distractible, less playful and less social up to the age of 5 years.
(WHO 2003: Literature review of risk factors and interventions on Postpartum Depression (external link)).
Cognitive development
Babies' brains develop rapidly in response to stimuli from caregivers and their environment. Cognitive development is supported by access to a range of toys and books, by spoken language and opportunities to move, play and explore the world.
Although low socioeconomic status is associated with lower scores in assessments of cognitive development, these effects can be moderated by being read to daily at 10 months and engaging in a range of activities and events by 22 months (Growing Up in Scotland (GUS): The Impact of Children’s Early Activities on Cognitive Development (external link)).
For more on cognitive development, please see Speech, language and communication development and inequalities in 5-8s.
Bonding and attachment
A child's 'attachment style' - i.e. the behaviours he or she will exhibit in situations where they have a need for comfort or safety - begins to form from birth.
Healthy attachment styles are promoted in part by secure bonding between mother and child, whereby the mother is disposed to react in sensitively and quickly to the child's expressed needs. Factors that inhibit the ability of mothers to bond with their children or to respond sensitively to their needs, including mental illness, can affect the child's developing attachment style.
Secure attachment is associated with positive outcomes including self esteem, self confidence, resilience and emotional regulation. Disorganised attachment is a strong predictor of later relationship and emotional difficulties. (NHS Health Scotland 2011: A Brief Guide to Attachment (external link).
For more on bonding and attachment in the early years, please see Parenting and inequalities in 5-8s.
Postnatal depression and psychosis
Around 10-15 per cent of mothers experience depression in the postnatal period, while one to two per thousand women experience postnatal psychosis (SIGN Guideline 127: Management of Perinatal Mood Disorders (external link)).
Risk factors for postnatal depression include:
- having a previous history of depression or other mental health problems
- having poor social support and
- having a poor relationship with their partner.
Social support and structured psychological short-term treatments are appropriate choices of treatment. Home visiting may be an acceptable way of providing psychological interventions, particularly in the late antenatal and postnatal phases.
(The Early Years Collaborative 2013: Guidance about Effective Interventions to Support Parents, Their Infants and Children in the Early Years (PDF download - 238KB)).
Teenage motherhood
As a group, teenage mothers experience poorer mental health in the first three years after giving birth than do older mothers. They are less likely to breastfeed and the children themselves are more likely to become teenage parents (Teenage pregnancy: An overview of the research evidence (external link)).
Additional targeted supports for young parents, such as the Family Nurse Partnership programme, can improve outcomes for this group.
Please see our section on promoting positive parenting in 5-8s.
Nursery and pre-school
Good quality nursery and pre-school education helps prepare children for school and assists with their cognitive and social development.
Research has also shown that attendance at high-quality pre-school education can help to overcome problems with behaviour and socialisation and is effective in mitigating the effects of inequalities on attainment at entry to primary school (The Effective Provision of Pre-School Education (EPPE) Project: Findings from the Early Primary Years (external link)).
For recommendations in this area, please see advice for nursery and pre-school staff.
Primary schools
Whole-school approaches to supporting mental, emotional and social wellbeing that involve teachers, pupils, parents and the wider community appear more effective than curriculum-based projects.
They should involve consideration of the physical environment, links with parents and the community, and the management, development and support of teachers.
Please see advice for teachers and education service managers.
