PURPOSE: To explore the associations between early emotional and behavioral problems, measured by the Strengths and Difficulties Questionnaire (SDQ), and subsequent mental disorders among children in a Swedish context.

METHODS: This cohort study used data on emotional and behavioral problems in children aged 3-5 years old (n = 6,646) from the Focus study in Uppsala Region, Sweden. The data included emotional and behavioral problems using the SDQ rated by mothers (n = 6,616), fathers (n = 6,385) and preschool teachers (n = 5,079). The cohort was followed from 2013 to 2022, with psychiatric diagnoses collected from the National Patient Register. Associations between emotional and behavioral problems and later mental disorders were explored using unadjusted and adjusted Cox regression models.

RESULTS: The proportion of children identified with emotional and behavioral problems, based on the SDQ total difficulties score, was 9.4% according to mothers, 12.2% according to fathers and 7.6% according to teachers. Altogether, 9.2% (n = 611) of the children were diagnosed with a mental disorder during the follow-up period. In unadjusted models, the risk of a mental disorder was significantly higher among children with emotional and behavioral problems, as rated by mothers (HR: 3.59), fathers (HR: 2.67) and teachers (HR: 2.95). This elevated risk remained significant in adjusted models for ratings by mothers (AHR: 3.66), fathers (AHR: 2.66) and teachers (AHR: 3.06). Children with difficulties in the hyperactivity and inattention subscale of the SDQ showed a significantly increased risk of being diagnosed with attention-deficit hyperactivity or conduct disorder when rated by mothers (AHR: 4.19), fathers (AHR: 3.21) and teachers (AHR: 4.88).

CONCLUSION: Early emotional and behavioral problems identified using the SDQ are associated with subsequent mental disorders in children in Sweden. These results reinforce the importance of early assessment of children's emotional and behavioral functioning to enable early identification and intervention for children at risk.

Background: Mental health problems in preschool children are rising in Sweden, yet their economic impact on the health sector remains poorly quantified. This study estimated the incremental healthcare utilization and costs associated with early mental health problems to inform resource allocation and early intervention.

Methods: We analyzed an exact matched sample of 1206 drawn from a cohort of 6957 children aged 3-5 from Uppsala Region, Sweden. Early mental health problems were identified using the Strengths and Difficulties Questionnaire reported by mothers, fathers and teachers. Data were linked to national registers to estimate cumulative healthcare utilization and costs over four years from a health sector perspective. Hurdle models, generalized linear models, and two-part models compared utilization and costs between children with and without early symptoms. Sub-group analyses by sex, symptoms, and raters were performed.

Results: Children with early mental health problems consumed three additional units of medication with an incremental cost of US$ 299, one additional specialized outpatient visit with an incremental cost of US$ 622, and five additional primary care visits with an incremental cost of US$ 376 compared to their healthy peers. Healthcare utilization and costs were higher for boys with externalizing and internalizing symptoms. Findings were consistent across all rater groups.

Conclusions: Early childhood mental health problems represent a substantial economic impact to the healthcare sector. The findings suggest that early identification and intervention in the preschool years may offer significant opportunities for cost-offsetting and improved long-term system efficiency.

Previous research has suggested an association between emotional and behavioral problems and asthma in school-aged children. However, research on the relation between emotional and behavioral problems during preschool years and subsequent asthma is lacking. We aimed to estimate the association between emotional and behavioral problems during preschool years and the risk of subsequent asthma among children in Sweden. In this longitudinal cohort study, we used data on children (n = 6269), 3–5 years of age, whose mothers, fathers and/or preschool teachers had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioral problems, and who were followed for a mean of 7 years with regard to asthma diagnoses collected from the National Patient Register. Children identified with emotional symptoms as rated by mothers (hazard ratio [HR]: 1.65, 95% confidence interval [CI]: 1.21–2.25), fathers (HR: 1.50, 95% CI 1.09–2.07) and preschool teachers (HR: 1.55, 95% CI 1.09–2.23) during the preschool years had an increased risk of asthma, compared to children with no emotional symptoms. Conduct problems, peer-relationship problems, and hyperactivity/inattention were not associated with the risk of asthma. Emotional symptoms during preschool years were associated with an increased risk of subsequent asthma. If our findings are replicated by future studies, children with emotional symptoms during preschool years might benefit from interventions targeting both psychological and somatic aspects of asthma.