Preschool children who frequently play outdoors tend to have better mental health in middle childhoodAmidst rising concerns for children’s mental health, an expanding body of research suggests that outdoor play provides key developmental opportunities that are central to the prevention of mental health difficulties, particularly internalizing problems such as anxiety and depression. However, existing studies have largely used cross-sectional designs that examined data collected at a single point in time, and there is a paucity of longitudinal research investigating the long-term relationship between early outdoor play and mental health throughout childhood. This study, therefore, aimed to clarify whether outdoor play in early childhood may offer “a low-cost, enjoyable, and developmentally appropriate strategy for reducing children's risk of later mental health difficulties.” The study used data from a nationally representative cohort in Scotland to examine whether outdoor play in the preschool years (age 2-4) predicted children’s mental health trajectories into middle childhood (age 4–8).
The study was conducted utilizing caregiver-reported data for 4,151 children. The data were obtained from the Growing Up in Scotland (GUS) dataset, a nationally representative, population-based birth cohort study that followed children born between June 2004 and May 2005. The data examined in the study were reported by primary caregivers beginning when children were two years old, with subsequent data collection sweeps continuing until age eight. Parents reported how many days per week their child played outdoors (during the week before the survey) at ages two, three, and four. Four repeated assessments of mental health outcomes were conducted when the children were between the ages of four and eight using the Strengths and Difficulties Questionnaire (SDQ). The SDQ included five subscales to evaluate internalizing symptoms (emotional symptoms and peer problems) and externalizing problems (conduct problems, hyperactivity and inattention). Statistical analysis evaluated whether preschoolers’ outdoor play predicted internalizing symptoms and externalizing problems in middle childhood. Analysis incorporated a range of demographic factors that may influence the relationship between outdoor play and mental health outcomes, including child sex, ethnicity (categorized as white or not white), and physical health conditions; caregiver education level and mental health symptoms; area-level deprivation; and access to a nearby park or garden.
Analysis first examined shifts in internalizing and externalizing symptoms to group children based on their symptom trajectories over time. For both internalizing and externalizing symptoms, three trajectories were identified. For both symptom types, the far majority of children were grouped into the normative trajectory, which showed a stable course of minimal symptoms through middle childhood. Smaller percentages of children showed trajectories of increasing symptoms or decreasing symptoms through middle childhood. Children with increasing or decreasing symptom trajectories showed elevated mental health symptoms compared to children in the normative trajectory group. Next, the analysis examined the relationship between outdoor play and internalizing and externalizing symptoms while controlling for demographic factors. Results revealed that outdoor play frequency significantly predicted trajectory groups for both internalizing and externalizing symptoms. Specifically, children who played outdoors more often as preschoolers were less likely to belong to the increasing or decreasing trajectory groups for both internalizing and externalizing symptoms in middle childhood than those who played outdoors less often. This finding suggests that “children who played outdoors more frequently were more likely to follow a trajectory of minimal symptoms, demonstrating good mental health over time.” Lastly, analysis examined whether outdoor play was a predictor of increasing versus decreasing trajectory groups. For externalizing symptoms, outdoor play was not significantly related to increasing or decreasing trajectories. However, for internalizing symptoms, more frequent play was surprisingly linked to a greater likelihood that children would follow a trajectory of increasing symptoms over time (indicating poorer mental health), rather than a trajectory in which symptoms decreased.
According to the researchers, this is the first study to demonstrate that outdoor play during the preschool years is related to how children's mental health develops over time. Findings suggest that preschool children who play outdoors more frequently may have better mental health throughout middle childhood. While previous research has identified relationships between play and internalizing symptoms (such as anxiety and depression), this study makes a noteworthy contribution to the literature by identifying previously undocumented links between play and externalizing problems. The researchers conclude that “given rising concerns about children’s mental health and declining play opportunities, these findings highlight the need to incorporate outdoor play into the preventative public mental health agenda.” In particular, efforts to boost play should aim to ensure equitable access, which is essential for reducing disparities in both outdoor play opportunities and health outcomes. The study’s lack of racial and ethnic diversity among participants may limit the generalizability of the findings. Future research employing experimental designs is needed to establish a causal relationship between outdoor play and improved mental health.
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