Association of primary caregiver anxiety and caregiving role with early development of preschool children: a population‑based study

Home caregiving environments are critical to early childhood development (ECD), but evidence on the primary caregiver factors in this link is limited. This study examines associations between primary caregiver anxiety, primary caregiver role, and ECD outcomes. This population-based survey was conducted in January 2024 across all 38 districts of Chongqing, China, using a stratified cluster sampling strategy. The Generalized Anxiety Disorder Questionnaire (GAD-7) and the Chinese Early Human Capacity Index (CHeHCI) were used to assess primary caregivers' anxiety and ECD levels, respectively. The primary caregiver role in the family was self-reported. In fully adjusted regression models (model 4), primary caregivers' anxiety was independently associated with child development delay, with an OR of 1.89 (95% CI: 1.75–2.05). Additionally, fathers’ and grandparents' nurturing were positively associated with child development delay, with ORs of 1.24 (95% CI: 1.05–1.46) and 1.12 (95% CI: 1.01–1.25), respectively. Furthermore, the interaction between only-child status and screen time with anxiety concerning ECD is significant. Similarly, the interaction between only-child status and the primary caregiver role concerning ECD is significant. Primary caregiver anxiety and paternal or grandparental nurturing are significantly associated with delayed ECD, with only-child status and screen time further interacting with these factors. These findings highlight the need for family‑centered interventions targeting primary caregiver mental health.