Abstract
Background Play provides an important foundation for a healthy childhood but longitudinal data exploring how play experiences relate to children's mental health over time is scarce. In this study, data on preschool-aged children's activities and mental health during Covid-19 related restrictions was used to explore how where (inside/outside) and with whom children played related to internalising and externalising problems over time.Methods UK based parents/carers (n = 1028) of preschool-aged children (2-5 years) completed an online survey at four time points between April and July 2020. The survey asked how much time in the previous week their child had spent: Playing inside; Playing outside; Playing alone; Playing with a parent; Playing with another child in their household; and their child's mental health (Strengths and Difficulties Questionnaire internalising and externalising scales). Four hierarchical linear regression analyses were conducted to examine associations between where children play (inside/outside) and (1) internalising and (2) externalising symptoms, and with whom children play (with parent, other child, alone) and (3) internalising and (4) externalising symptoms. Effects of linear and quadratic time, and interactions between play and time were examined. Parent mental health, parent education, contact with nature and physical activity were included as covariates.Results Both inside and outside play was associated with less severe internalising problems (beta = -0.23 [SE = 0.10]; beta -0.54 [SE = 0.19]) and, in statistical interaction with time, less time playing inside was associated with a stronger improvement in externalising problems over time (beta = 0.77 [SE = 0.23]). Further, more time playing with other children was associated with less severe internalising problems (beta = -0.50 [SE = 0.13]) whereas playing alone was associated with more severe internalising problems (beta = 0.28 [SE = 0.10]).Conclusion Varied play opportunities are related to young children's mental health. Even during a pandemic response, children should be given opportunity to play with other children and play outdoors wherever possible.