Birth Cohort Study On The Trajectory And Influencing Factors Of Emotional And Behavioral Problems In Preschool Children

Objective: To describe the current situation of emotional and behavioral problems in preschool children,fit the dynamic development trajectory of preschool children’s emotional and behavioral problems,identify the differences of different demographic characteristic trajectories,comprehensively analyze the factors affecting preschool children’s emotional and behavioral problems,and explore the effects,paths,and continuous prediction of biological,family and social environmental factors on preschool children’s emotional and behavioral problems and the internal structural relationship among these factors.Methods: Using the prospective birth cohort design,the live births born in 2015 in three streets of Kaifu District of Changsha City were selected as the research object.The children were followed up at the age of1 month,3 months,6 months,8 months,1,1.5,2,3,3.5,4,4.5 and 5 years old,and finally 636 children were included in the analysis.The strength and difficulty questionnaire was used to assess children’s emotional and behavioral problems.Generalized linear model and generalized estimating equation were used to explore the factors affecting the prevalence rate of emotional and behavioral problems in preschool children.Latent growth curve model and latent growth mixture model were used to fit the trajectory.Structural equation model(SEM)was used to explore the effects and paths of each factor and the internal structure relationship,and SEM combined with cross-lag analysis was used to explore the continuous prediction of each factor.Results:(1)The prevalence rates of emotional and behavioral problems at 3.5,4,4.5 and 5 years old were 30.3%,26.0%,23.1% and 29.9%,respectively.The general development trajectories of the score and prevalence rate of the emotional and behavioral problems at 3.5 to 5 years old decreased at first and then increased.Based on group heterogeneity,the score trajectories of the emotional and behavioral problems at 3.5 to 5 years old can be divided into four categories: “high score decreasing group”,“high score stable group”,“low score rising group” and “low score stable group”.The prevalence rate trajectories of the emotional and behavioral problems at 3.5 to 5 years old can be divided into four categories: “abnormal to normal group”,“most abnormal to all abnormal group”,“a few abnormal to all normal group” and “normal to abnormal group”.After adjusting other demographic characteristics,only the influence of maternal occupation on the score and prevalence rate trajectories of emotional and behavioral problems at 3.5 to 5 years old was statistically significant.(2)Multi-factor generalized linear model showed that father drinking in half a year before pregnancy(RR=1.462,95%CI:1.156 ～1.849),boys(RR=1.310,95%CI:1.045 ～1.643),colds ≥ 3 times at 8 to 12 months old(RR=1.820,95%CI:1.086 ～ 3.050),iron deficiency at 1 year old(RR=1.335,95%CI:1.044 ～1.706),sometimes finger sucking at 1 year old(RR=1.380,95%CI:1.083～1.759),mother’s occupation as businessman or enterprise worker at 1 month old(RR=1.960,95%CI:1.384 ～ 2.774),mother’s occupation as freelance work or others at 1 month old(RR=1.667,95%CI:1.139 ～ 2.440),poor language/cognition environment at 2 years old(RR=1.643,95%CI:1.064 ～ 2.536),and indoor noise at 2 years old(RR=1.744,95%CI:1.076 ～ 2.828)were risk factors for emotional and behavior problems at 3.5 years old.Folic acid supplementation for 3 months before and after pregnancy was protective factor for emotional and behavior problems at 3.5 years old(RR=0.729,95%CI:0.548 ～ 0.969).(3)Multi-factor generalized estimating equation showed that abnormal head circumference(RR=1.532,95%CI:1.281～1.834),mother’s occupation as businessman or enterprise worker(RR=1.864,95%CI:1.482 ～ 2.344),mother’s occupation as freelance work or others(RR=1.376,95%CI:1.075 ～1.761),weekend children’s screen time ≥ 1hour(RR=1.340,95%CI:1.107 ～1.622),bad(RR=1.621,95%CI:1.190 ～ 2.209)and medium(RR=1.392,95%CI:1.065 ～ 1.819)family rearing environment,the problem of slow eating(RR=1.184,95%CI:1.031 ～ 1.360),food response problem(RR=1.254,95%CI:1.098 ～ 1.433),and cognitive retardation(RR=1.614,95%CI:1.241 ～ 2.100)were the risk factors for emotional and behavioral problems in preschool children.Calcium supplementation was protective factor for emotional and behavior problems at 3.5 years old(RR=0.842,95%CI: 0.735 ～ 0.965).(4)Multi-factor SEM showed that maternal postpartum depression(β =0.220,P=0.001),children’s dietary behavior problems at 3 years old(β =0.271,P=0.002),parents as main caregivers at 1 month old(β =0.120,P=0.045),outdoor activity time <2 hours at 1.5 years old(β =0.150,P=0.013)had positive effects on children’s emotional and behavioral problems at 3.5 years old,while calcium and vitamin D supplementation at 3 years old(β =-0.184,P=0.019)and higher cognitive development at 3 years old(β =-0.166,P=0.007)had negative effects.The direct effects of the above factors on emotional and behavioral problems at 3.5 years old were as follows: children’s dietary behavior problems at 3 years old,maternal postpartum depression,calcium and vitamin D supplementation at 3 years old,cognitive development at 3years old,outdoor activity time at 1.5 years old,and main caregivers at 1month old.The indirect effect of father’s age on emotional and behavioral problems at 3.5 years old through maternal postpartum depression wasβ =-0.025,P=0.025.The indirect effect of family rearing environment at 3 years old on emotional and behavioral problems at 3.5 years old through children’s dietary behavior problems at 3 years old wasβ =-0.082,P=0.019.(5)The interaction effect between father drinking in half a year before pregnancy and maternal postpartum depression,outdoor activity time at1.5 years old and screen time at 2 years old,family rearing environment at2 years old and family rearing environment at 3 years old on children’s emotional and behavioral problems at 3.5 years old were 0.730,0.454,and-0.143 respectively.Cross-lagged SEM showed that dietary behavior problems and better family rearing environment at 3.5,4 years old had positive and negative effects on emotional and behavioral problems at 4,4.5 years old respectively,while higher cognitive development at 4.5 years old had a negative effect on emotional and behavioral problems at 5 years old.Conclusion:(1)Children’s emotional and behavioral problems were not stable in the preschool period,and the mother’s occupation can continuously affect their development.(2)Family factors affecting preschool children’s emotional and behavioral problems include father’s pre-pregnancy drinking,maternal postpartum depression,mother’s occupation,main caregivers,outdoor activity time and family rearing environment.Biological factors include folic acid supplementation for 3 months before and after pregnancy,children’s calcium and vitamin D supplementation,iron deficiency,colds,abnormal head circumference,screen time,cognitive development and dietary behavior,and environmental factors include indoor noise.(3)Father’s age and family rearing environment have indirect effects on preschool children’s emotional and behavioral problems through the mediation of maternal postpartum depression and children’s dietary behavior,respectively.Father’s pre-pregnancy drinking and maternal postpartum depression,outdoor activity time and screen time,and family rearing environment of different ages had interactive effects on preschool children’s emotional and behavioral problems.(4)Children’s dietary behavior,family rearing environment,and children’s cognitive development can continuously predict the emotional and behavioral problems of preschool children.