Evaluating the impact of free access to early childhood education on mental distress in adolescence: evidence from Europe

Background Few studies have assessed the impact of large-scale early childhood education and care (ECEC) programmes. In this study, we evaluated the impact of national-level policy changes providing access to free ECEC during children’s preschool years on symptoms of mental distress during early adolescence. Methods We used data from nine European countries that participated in five waves of the Health Behaviour in School-aged Children (HBSC) Study conducted between 2002 and 2018, including 165 656 participants who were born between 1988 and 2003, and surveyed when they were 11–15 years old. Primary outcomes were feeling low, feeling irritable, feeling nervous and having difficulty sleeping more than once per week in the past 6 months. Our difference-in-differences design compared outcomes across birth cohorts in five treated countries that expanded access to free ECEC to changes in control countries that did not. We examined heterogeneity by gender and family affluence. Results One year of access to free ECEC reduced the prevalence of feeling low by 1.3 percentage-points (95% CI 2.5 to −0.1), feeling irritable by 2.1 percentage-points (95% CI −4.0 to −0.3) and feeling nervous by 1.8 percentage-points (95% CI −2.7 to −0.9) and did not appreciably affect the prevalence of having difficulty sleeping. We did not observe evidence of a marked beneficial effect across all treated countries, and stratified analyses did not show heterogeneity in these associations by gender or family affluence. Our main results were robust to alternative control groups. Conclusion Our findings suggest that the effects of free ECEC policies on adolescent mental health are context-specific.