Impact of Infant Institutionalization. A 60-year Follow-up Study

• In Event: The Relevance of Typical and At-Risk Development for Adult Outcomes

Abstract

Early childhood is a crucial period for human development across the life span. Proper stimulation and a responsive caregiver during the early years are essential for healthy development. A child raised in institutional care in a high-income country in Europe under the legal context before 1981 and the historic care practices at the time, was typically deprived of such supportive, intensive, one-to-one relationship with a primary caregiver. The main reasons to have a child placed in an institution was either being a single mother or having a migrant background, foremost migrant workers.

In a pioneering study and consistent with current global scientific data on the detrimental effects of institutionalization, a population-based study found significant developmental delays due to psychosocial deprivation in a population-based survey of 431 infants placed in infant care institutions in the 1950-ies compared to a community sample not affected by institutionalization (N= 445). Different starting conditions – as would have shown in differences in birth weight for example – were ruled out as an explanation.

In a 60-year follow-up study, 96% of individuals residing in the country were found through population registry and 52% of eligible individuals (N = 127) participated. In a mixed-method design, they were assessed with questionnaires, neuropsychological assessments and biographical narrative interviews on health, abilities and life trajectories. The community sample participants were followed-up in parallel and were available again as a comparison group. Preliminary analyses showed that participation in the 60-year follow-up was not selective in terms of gender or developmental quotient assessed during infancy. Initial survival analysis showed that individuals placed in institutions were more likely to have already passed away, particularly males (HR, 95% CI [0.88, 7.52], B = 0.94, p = .085). We also found that formerly institutionalized individuals scored lower on a range of outcomes compared to non-institutionalized individuals such as socio-economic indicators (B=0.43, p<.001), physical health (B=0.21, p=0.03), mental health (B=-0.09, p=0.01), satisfaction with life (B=0.3, p=0.01) and cognitive abilities (e.g. working memory B=0.89, p<.001).

Initial linear regression model analyses showed that longer duration of institutionalization was associated with worse outcomes (satisfaction with life: B=-1.69, p<.001; health: B=-0.79, p=0.068). On the other hand, individuals who received more family visits reported a higher income (B=0.94, p=0.011), had better cognitive abilities (e.g. similarities B=4.54, p=0.013) and higher satisfaction with life (B=0.73, p=0.053).

Qualitative findings from interviews suggest that not only the individuals placed in the institutions themselves, but the family system as a whole was impacted by the placement, including the parents and siblings, and that the next generation offspring.

This globally unique study is expected to contribute to the societal reconciliation and rehabilitation process of social and compulsory measures before law reform in 1981. Using a population-based, longitudinal design with a non-affected comparison cohort from the same geographic location this study undoubtedly is able to shed light on the secrets of long-term adaptation after infant institutionalization, a practice that is still very common around the world.

Authors

• Patricia Lannen, Marie Meierhofer Children's Institute
  Presenting Author

• Hannah Sand, Marie Meierhofer Children's Institute

• Clara Bombach, Marie Meierhofer Children's Institute

• Fabio Sticca, Marie Meierhofer Institut für das Kind

• Heidi Simoni, Marie Meierhofer Children's Institute

• Flavia M Wehrle, University Children's Hospital Zurich

• Oskar G. Jenni, University Children’s Hospital