The Child 39;s Return Analysis

[Slikk Huisenga]

Weall do. The primary beneficiaries are children and their parents. For example, if a low-income parent is able to secure a place for her child in a high quality daycare program, that child is likely to benefit from exposure to a wider array of learning opportunities than he or she might have at home. Enrolling her child in daycare may also open the door for the parent to take on employment or further her education in order to improve her career prospects. Those individual benefits can be substantial, and life-changing.

While earlier programs may generate the highest potential returns, donors that support children beyond age three nonetheless play an important role in sustaining and extending benefits, and there is good evidence that programs that target older age groups can also generate positive returns.

3 This is a theoretical graph developed by Heckman and LaFontaine (2007), based on their analysis of returns on investment to a range of programs. See also: Cunha, F, Heckman JJ, Lochner, LJ, Masinov JV. Interpreting the Evidence on Life Cycle Skill Formation. In Hanushek, E.F., Welch, F. Editors. Handbook of Economics of Education. North Holland, Amsterdam 2006, pp. 697-812 Chapter 12. Cunha, F. and Heckman, JJ. The Technology of Skill Formation. NBER Paper, 2007. Heckman, JJ. Schools, Skills and Synapses. NIH paper 2008.

4 For more on improving consistency in cost benefit analysis, see: Karoly, Lynn A. Towards Standardization of Benefit-Cost Analysis of Early Childhood Interventions.RAND. Journal of Benefit Cost Analysis, Volume 3, Issue 1, Article 4, 2012.

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The recent rise in maternal workforce participation has led to more research regarding the role of maternal employment for (early) childhood mental health. This systematic review with meta-analysis covers new evidence on the association of both variables. A systematic literature search was conducted. Studies had to compare children 0-7 years of age on the basis of their mothers' employment status, working amount, employment duration, i.e., how long the mother had been back at work after birth, or timing of return to work. Child mental health was operationalized as behavior problems and prosocial behavior. Narrative and meta-analytic syntheses of evidence were conducted. Maternal employment was associated with more conduct problems but less internalizing behavior problems and anxious/depressed behavior in children; full-time employment was linked to more externalizing behavior problems and more hyperactivity/inattention. Longer employment duration was related to less (internalizing) behavior problems and more prosocial behavior but also more externalizing behavior problems. Narrative syntheses indicated early maternal return to work to be associated with more child externalizing behavior problems and less prosocial behavior. Whether maternal employment is associated with child mental health strongly depends on both variables' operationalization. Especially part-time employment, longer employment duration, and return to work only after the first year postpartum may be beneficial for child mental health. Practical implications pertain to an expanded offer of family leave and the endorsement of maternal employment after the first year postpartum. Here, factors that may buffer the negative associations with full-time employment warrant consideration.

Several disciplines address a potential association between maternal employment and child mental health, i.e., developmental psychology, sociology, and economics [18, 19]. The household economics framework for instance postulates that families tend to maximize their well-being based on two resources, i.e., time and money. Parents face the decision whether well-being is maximized by mothers working or staying at home. While maternal employment leads to increased financial resources that can be used to purchase goods and services, e.g., child care, stay-at-home mothers may spend more time with their children, providing attention and emotional support. Maternal employment could lead to poorer child mental health in case goods and services purchased do not sufficiently compensate for lost parental care [see 20].

In light of sociological theories, the mediating role of maternal health seems of importance. The scarcity hypothesis for instance assumes that as time and energy are limited, one could not have enough energy to fulfil several roles equally well, e.g., the role as a mother and the role as an employee. In the end, resulting overload and stress could lead to poorer maternal health [21]. As evidence clearly indicates the positive link between the mental health of mothers and their children [e.g., 22], maternal employment is, therefore, assumed to be associated with poorer child mental health. However, the exact opposite would be expected following the enhancement hypothesis. Here, a fixed amount of time and energy is denied. Instead, it is postulated that every new role adds sources of self-esteem and social support which in the end leads to better health [23, 24].

The extensive body of research on the association of maternal employment and child mental health has so far produced mixed findings leading to different conclusions [see 20, 25]. In recent years, various reviews emphasized that such an association, if any, may arise when early maternal employment is investigated. Especially employment within the first year postpartum has been shown to be adversely related to child mental health in terms of BP [26,27,28], whereas later employment could even be beneficial [26]. Concerning intensity, working very long hours was seen as a potential issue [26]. Further important variables include ethnicity [27] due to possible differences in, e.g., normativity of maternal employment and the home environment [see 18], maternal preferences [26], and working conditions [26], including working schedules [29] and income [26, 27].

Hence, lack of associations between maternal employment and child mental health could be a result of aggregating different health measures that are either positively or negatively linked to employment. Furthermore, mixing results of studies that investigated different age groups could be an explanation. The associations found could also be biased by the same mechanisms. Moreover, it remains unclear whether results can be generalized to more recent findings on the association of maternal employment and child mental health including data generated by newer cohort studies. Beside maternal employment status, other employment characteristics may be important as well.

Initially, three different databases (PsycINFO, PubMed, and Web of Science Core Collection) were searched for relevant literature from 2005 to 2020. The year 2005 was considered as starting point to include recent evidence only [for an analysis of research from 1960 to 2010 please refer to 25]. Evidence published in 2021 and 2022 was not included. In those years, studies often focused on COVID-19. As the pandemic impacted both maternal employment, e.g., by school closures [31], and child mental health [e.g., 32], we would have introduced bias. A comprehensive search string was used consisting of keywords describing the population, treatment and comparison conditions, and the outcomes of interest (for more details please refer to the Online Resource and see Supplementary Box S1). Additionally, reference lists of included studies, the previously published meta-analysis [25], and former reviews [26, 29, 33] were manually screened for further relevant literature. Dissertations and working papers were considered, if available, to cover gray literature.

Concerning study design, observational investigations published in English or German language were considered eligible. Intervention studies, reviews or meta-analyses, case reports, case series studies, commentaries, editorials, and expert opinions were excluded. To be eligible for the meta-analytic part, studies had to additionally report a measure of effect size or present information allowing for its calculation.

Eligibility of studies was examined by screening based on title/abstract first. Afterward, full-texts were retrieved and assessed for inclusion. In both cases, this was done by two reviewers (M.K., M.L.) independently. If consensus could not be reached, a third reviewer (S.G.-N.) was consulted; majority won.

Sample characteristics considered as potential moderators included child age at outcome assessment (in years; if an age range was given the mean was used for analyses), child sex (girls vs. boys vs. mixed), and timing of maternal employment after birth (in years; if a range was given the mean was used for analyses). Ethnicity of mother and/or child was coded as majority White vs. majority Black vs. majority Hispanic (with majority referring to at least 75% of the sample) vs. mixed vs. not reported. Categorization of maternal marital status included majority coupled mothers vs. majority lone mothers (with majority again referring to at least 75% of the sample) vs. mixed vs. not reported.

First, narrative syntheses of evidence for the various outcomes under investigation were conducted. If both unadjusted and adjusted analyses were carried out, only results of the adjusted analyses were considered. In case of various adjusted analyses, we focused on results of the fully-adjusted models.

With duplicates removed, the search process yielded 5,784 results. These were initially screened for eligibility based on title and abstract, resulting in the retrieval of 333 full-texts. Figure 1 depicts the whole process in more detail. In total, 46 studies were considered in the narrative syntheses; 29 studies were included in the meta-analytic syntheses. Please refer to the Online Resource for a corresponding reference list.

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