Abstract
BACKGROUND: Parent-child separation is one of the adverse childhood experiences, becoming more common due to economic migration worldwide today. However, there is a lack of understanding of the association between this separation during the critical first three years of life and the development of mental health issues in early childhood. This study aimed to determine the association of parent-child separation in the first three years and its specific patterns with mental health problems that emerged at preschool age. METHODS: We conducted a kindergarten-based parent-reported questionnaire survey in Nanling, Anhui Province, from October 30 to November 3, 2023. Data on parent-child separation in the first three years and its specific patterns concerning parental number, gender, accumulated separation period, and present separation status at preschool age were collected. The parent version of the Strengths and Difficulties Questionnaire (SDQ) was adopted to assess outcomes of interest, including children's total difficulties, internalizing problems, externalizing problems, and pro-social behaviors. RESULTS: A total of 7487 children from eighty-one kindergartens were included, with a mean (SD) age of 4.2 (0.92) years, and 52.3 % were male. After adjusting for socio-demographic characteristics, compared to non-separation, parent-child separation within the first three years was significantly and positively associated with preschool-aged children's internalizing problems (β = 0.19, [95 % CI, 0.10-0.28]), externalizing problems (β = 0.24, [95 % CI, 0.12- 0.35]), and total difficulties (β = 0.42, [95 % CI, 0.25-0.59]), but not with pro-social behavior. The associations were significant when separated from either one parent or both parents, whether the separation lasted for less than or more than three years in total, and whether the separation occurred previously or persisted into preschool age. CONCLUSIONS: Our findings illustrated the association between early parent-child separation and developing mental health in early childhood, indicating potential opportunities for cost-efficient prevention and intervention for the health and development of vulnerable children separated in the highly mobile society to achieve sustainable development.