Increasing Trends and Persistent Inequalities in Preschool Social-Emotional Problems in Sweden

Background

Despite early childhood being a foundational developmental period, the evidence on temporal trends in preschool social-emotional problems remains limited. This study examines trends over time in the prevalence and sociodemographic patterning of social-emotional problems among three-year-old children in a Swedish county and assesses the impact of the COVID-19 pandemic.

Methods

This was a repeated, cross-sectional and population-based study with data collection spanning 2014-2022. The parent-reported Ages & Stages Social-Emotional (ASQ:SE) 36-month questionnaire from routine child health services in Västerbotten County was linked to national register data on parents’ sociodemographic characteristics. Model-based prevalence, prevalence ratios and the interaction between time and sociodemographic characteristics were estimated by fitting regression models. The impact of the pandemic was investigated using interrupted time series analysis.

Results

A statistically significant linear trend in social-emotional problems was found, with model-based prevalence increasing from 7.9% (95% CI 6.8 – 9.3%) in 2014 to 12.3% (95% CI 10.9 – 13.9%) in 2022. There also appeared to be persisting sociodemographic differences. The impact of the COVID-19 pandemic was not found to be statistically significant, although an initial decrease in prevalence was observed in addition to increasing differences in social-emotional problems in boys and children with immigrant backgrounds in the year following the pandemic.

Conclusions

An increasing trend in preschool social-emotional problems alongside persisting social inequalities is concerning as well as notable in northern Sweden, a high-income context with comprehensive social security. Potential explanations include changing social environments or increased awareness and reporting. Future research should use longitudinal and mixed-methods approaches to examine these trends, informing context-sensitive interventions in early childhood.

Key messages

• Social-emotional problems in 3-year-olds appear to have increased in Västerbotten, Sweden (2014–2022), suggesting a need for precision-oriented approaches to guide targeted and effective prevention.

• The presence of sociodemographic differences in the prevalence of preschool social-emotional problems over time indicates a need for early interventions addressing the social determinants of health.