Survival of the nurtured: A 60-year follow-up study on mortality in institutionalised infants
Patricia Lannen1, Hannah Sand2, Aziz Chaouch3
1Marie Meierhofer Children's Institute, Associated Institute of the University of Zurich, Switzerland; University of Zurich, Zurich, Switzerland; University of Basel, Faculty of Psychology, Basel, Switzerland.
Insights
Severe early childhood institutional care, marked by psychosocial deprivation, significantly increases long-term mortality risk. This life-course study highlights the profound impact of early nurturing on adult health outcomes.
Area of Science:
- Developmental Psychology
- Public Health
- Epidemiology
Background:
- Early childhood institutional placement is hypothesized to impact long-term health and survival.
- This study investigates 60-year mortality in individuals with severe early psychosocial deprivation from institutional care.
Purpose of the Study:
- To examine the long-term mortality outcomes of individuals institutionalized in infancy.
- To compare mortality rates between institutionalized individuals and a community sample.
- To identify predictors of mortality within the institutionalized cohort.
Main Methods:
- A population-based observational study of 431 individuals institutionalized in Zurich, Switzerland (1958-1961).
- Comparison with a representative community sample from the same period and region.
- Mortality tracked over 60 years via population registry linkage, analyzing all-cause mortality, time of death, and causes of death.
Main Results:
- The institutionalized cohort exhibited higher mortality (HR 1.48) and an estimated 12 years of lost life compared to the community sample.
- Deaths before age 40 were twice as common in the institutionalized group.
- Significant differences in causes of death were observed, with fewer natural deaths in the institutionalized cohort. Longer placement duration and more changes trended towards higher mortality.
Conclusions:
- Severe early psychosocial deprivation in institutional settings is linked to increased mortality risk persisting into late adulthood.
- This risk is comparable in magnitude to established risks like smoking.
- The findings underscore the critical importance of early nurturing and social interaction, with global implications for children in institutional care or experiencing psychosocial deprivation.
Background:
Early childhood institutional placements are hypothesised to have long-term consequences for health and survival. This study examined 60-year mortality outcomes in individuals placed in infant institutions marked by severe psychosocial deprivation.
Participants And Setting:
The study includes 431 individuals placed in institutions within their first days of life (1958-1961) in Zurich, Switzerland. While they received adequate physical care, they experienced profound psychosocial deprivation (<1 h cumulative adult-infant interaction per 24 h) due to state care measures before law reform in 1981.
Methods:
This population-based observational study compares the institutionalised cohort with a representative community sample from the same time and geographical area. Mortality was tracked over 60 years through population registry linkage. Main outcomes were all-cause mortality in both cohorts, time of death, cause-of-death, and predictors of mortality within the institutionalised cohort.
Results:
Individuals in the institutionalised cohort showed higher mortality than the community comparison group (Hazard Ratio 1.48; 95% CI = 1.01-2.17; p = .05) and resulted in an estimated 12 years of lost life (reached the 95th survival percentiles 12.4 (95% CI 0.6-24.1) years earlier; p ≤ .04). Deaths before age 40 were twice as common in the institutionalised cohort (22 vs. 9; p = .08). The distribution of causes of death differed significantly between cohorts (p < .001), with fewer deaths from natural causes in the institutionalised group. Within the institutionalised cohort, longer duration of placement and more placement changes all showed trends towards higher mortality.
Conclusions:
Severe psychosocial deprivation during early institutional placement is associated with increased mortality risk persisting into late adulthood, comparable in magnitude to established health risks such as smoking. By eliminating confounding from pre-placement adversity and isolating psychosocial deprivation during the earliest developmental period, this study provides novel long-term evidence on the association between infant institutional care and mortality across the life course. It highlights the risks of insufficient nurturing and social interaction in early childhood and underline the global relevance for the millions of children still growing up under similar institutional care conditions and to children exposed to psychosocial deprivation in other settings.
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