ArticleBMC public health2026
Early care in childhood and psychological burden among East and West German adults.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe consequences of external childcare for children are controversially discussed. Many claim that early extrafamilial care is harmful to the child. This article aimed to study the relationship between external childcare at preschool age and psychological burden in adulthood. Given that extrafamilial care followed different norms and regulations depending on the location in East or West Germany during their division, the question was also pursued whether the association between early childcare and psychological burden differed between those regions.
methodsThe analyses are based on a representative sample collected in 2020. A total of 1,796 Germans (1,448 West, 348 East) were divided into three childcare groups: those who first entered external care before the age of three, those who started with or after the age of three, and those who stayed in familial care until school entry. Psychological burden was indicated by the Brief Symptom Inventory-18. Differences in psychological burden according to childcare group and region were tested by ANOVAs, ANCOVAs, and OLS-regressions.
resultsCompared to West Germans in familial care before school entry, West Germans who received full-time external childcare before the age of three tended to report stronger symptoms of depression (std. β = 0.20, p = .050), anxiety (std. β = 0.20, p = .056), and the global score of psychological burden (std. β = 0.19, p = .066). In contrast, extrafamilial childcare was not related to the psychological burden of East Germans. Moreover, East Germans and West Germans differed significantly in terms of their relationship between psychological burden and extrafamilial full-time care before the age of three.
conclusionsThough in the West, full-time care before the age of three was related to greater psychological burden this was not found in the East, indicating external childcare itself might not be harmful. Future research should observe whether selection effects, differing quality in childcare institutions, or differing norms were responsible for this disparity between regions.
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