Background: Early childhood institutional placements are hypothesised to have long-term consequences for health and survival. This study examined 60-year mortality outcomes in individuals placed in infant institutions marked by severe psychosocial deprivation.
Participants and setting: The study includes 431 individuals placed in institutions within their first days of life (1958–1961) in Zurich, Switzerland. While they received adequate physical care, they experienced profound psychosocial deprivation (<1 h cumulative adult–infant interaction per 24 h) due to state care measures before law reform in 1981.
Methods: This population-based observational study compares the institutionalised cohort with a representative community sample from the same time and geographical area. Mortality was tracked over 60 years through population registry linkage. Main outcomes were all-cause mortality in both cohorts, time of death, cause-of-death, and predictors of mortality within the institutionalised cohort.
Results: Individuals in the institutionalised cohort showed higher mortality than the community comparison group (Hazard Ratio 1.48; 95% CI = 1.01–2.17; p = .05) and resulted in an estimated 12 years of lost life (reached the 95th survival percentiles 12.4 (95% CI 0.6–24.1) years earlier; p ≤ .04). Deaths before age 40 were twice as common in the institutionalised cohort (22 vs. 9; p = .08). The distribution of causes of death differed significantly between cohorts (p < .001), with fewer deaths from natural causes in the institutionalised group. Within the institutionalised cohort, longer duration of placement and more placement changes all showed trends towards higher mortality.
Conclusions: Severe psychosocial deprivation during early institutional placement is associated with increased mortality risk persisting into late adulthood, comparable in magnitude to established health risks such as smoking. By eliminating confounding from pre-placement adversity and isolating psychosocial deprivation during the earliest developmental period, this study provides novel long-term evidence on the association between infant institutional care and mortality across the life course.
It highlights the risks of insufficient nurturing and social interaction in early childhood and underline the global relevance for the millions of children still growing up under similar institutional care conditions and to children exposed to psychosocial deprivation in other settings.