Research Review: Grandparental care and child mental health - a systematic review and meta-analysis.

BACKGROUND: The number of children residing in grandfamilies is growing worldwide, leading to more research attention on grandparental care over the past decades. Grandparental care can influence child well-being in various forms and the effects vary across contexts. In this systematic review and meta-analysis, we synthesize the evidence on the relation between grandparental care and children's mental health status. METHODS: We identified 5,745 records from seven databases, among which 38 articles were included for review. Random effects meta-analyses were used to synthesize evidence from eligible studies. We also examined the variability across study and participant characteristics, including study design, recruitment method, child age, child gender, study region, family type, comparison group, and outcome rater. RESULTS: The meta-analysis consisted of 344,860 children from the included studies, whose average age was 10.29, and of which 51.39% were female. Compared with their counterparts, children being cared for by their grandparents had worse mental health status, including more internalizing problems (d = -0.20, 95% CI [-0.31, -0.09], p = .001), externalizing problems (d = -0.11, 95% CI [-0.21, -0.01], p = .03), overall mental problems (d = -0.37, 95% CI [-0.70, -0.04], p = .03), and poorer socioemotional well-being (d = -0.26, 95% CI [-0.49, -0.03], p = .03). The effects varied by study design and child gender. CONCLUSIONS: The findings highlight that grandparental care is negatively associated with child mental health outcomes with trivial-to-small effect sizes. More supportive programs and interventions should be delivered to grandfamilies, especially in disadvantaged communities.

Regulating the traditional kinship care practice in Ghana: Reflections from young people with kinship care experience.

BACKGROUND: Kinship care has become a favourable alternative care option for orphans and vulnerable children without adequate parental care in Ghana. However, kinship care practices in Ghana are considered informal cultural practices without formal regulations. The absence of formal regulations could have consequences on the health and development of children due to the lack of proper supervision and empirical assessment of children's needs. In line with recent policy discussions on mechanisms to regulate informal kinship care practices, this study aimed to identify how the State could be involved in improving kinship care experience for children. METHODS: Qualitative in-depth interviews were conducted with 22 young persons (aged 18-23) who had been received into kinship care to share their experiences on how the State could be involved in improving kinship care experience for children. Narratives from the young people were analysed following the constructivist grounded theory approach. RESULTS: Introduction of a welfare scheme for kinship caregivers, policy on child care, provision of start-up capital and training for caregivers, were measures suggested by the young people to improve kinship care practice. Providing start-up capital to kinship caregivers was identified to mitigate caregivers' unemployment challenges, which could have ripple effects on the well-being of children by escalating caregiver stress. CONCLUSION: The study's findings suggest that the State has a significant role to ensure that caregivers are equipped with the needed resources to provide adequate care for children. Regulating kinship care practices should embrace a strength-based empowerment model that builds on the capacity of the caregivers to ensure better outcomes for children. Studies that explore the views of policy makers and caregivers in a larger sample may yield promising results to complement the current findings.

Intergenerational support and life satisfaction of young-, old- and oldest-old adults in China.

OBJECTIVES: This study investigated variation across different old-age groups in the association between intergenerational support and elderly life satisfaction in China, taking into account both exchange patterns and different types of support. METHOD: Using the first two waves (2010 and 2012) of China Family Panel Studies, we applied the fixed-effect approach to examine the moderating effect of age separately for exchange patterns and different types of intergenerational support. The sample included 3989 elderly people. RESULTS: There were age differences in the association between intergenerational support and elderly life satisfaction, for both exchange patterns and different types of support. Particularly, there was significant difference between the young-old (61-70) and the oldest-old (85+) in terms of the association. CONCLUSION: Theoretically, this study helps to elaborate on social exchange and equity theories by introducing explanations from socio-emotional selectivity theory. It further highlights how policies for elderly care should be developed considering the diverse needs, characteristics and goals of elderly people rather than treating them as a singular homogenous group, in particular in relation to different old-age groups.

Engaged parenting, gender, and children's time use in transnational families: An assessment spanning three global regions.

Global circuits of migration regularly separate parents from children. How families navigate this separation has changed markedly. The sharp decline in the cost of international communication makes possible new forms of transnational parenting. In many contexts, migrants are now actively engaged parents, involved in decisions, knowledgeable of children's schooling, employment, and activities, and in some cases, even conversant face-to-face with children via videoconferencing. These practices, however, are not universal. We use data from surveys in three countries to document the frequency and variability of intensive, engaged transnational parenting in the diverse global regions of Asia, Africa, and the Americas. We then ask whether the organisation of children's lives-specifically, time allocated to school homework, leisure, and household chores-varies by the degree to which migrant parents stay connected to sending homes. The gender of the migrant parent, stay-behind caregiver, and the gender of the child emerge as explanatory factors for engaged parenting and children's time use. However, and unexpectedly, in the Philippines, migrant mothers are less likely to practice engaged parenting. In sending households, girls in two of the three countries spend more time doing household chores than boys, but parental migration does not mitigate this difference. Although we find some evidence of more traditional gender practices, we also find exceptions that suggest potentially fruitful avenues for future research.

Mental wellbeing amongst younger and older migrant workers in comparison to their urban counterparts in Guangzhou city, China: a cross-sectional study.

BACKGROUND: There has been a dramatic increase in internal migrant workers in China over recent decades, and there is a recent concern of poor mental health particularly amongst younger or "new generation" migrants who were born in 1980 or later. METHODS: A cross-sectional study was conducted in Guangzhou city between May and July in 2012. Mental wellbeing was measured using the World Health Organization Five-item Well-Being Index Scale and the 36 Item Short Form Health Survey mental health scale. Linear and logistic regression models were used to investigate the differences between migrant workers and their urban counterparts and between younger and older migrants. RESULTS: Migrant workers (n = 914) showed a small but significant advantage in mental wellbeing compared to their urban counterparts (n = 814). There was some evidence for age modification effect (p for interaction = 0.055-0.095); better mental wellbeing in migrants than urbanites were mainly seen in the older compared to the younger group, and the difference attenuated somewhat after controlling for income satisfaction. Older migrants showed better mental health than younger migrants. Factors that were independently associated with poor mental health in migrants included being male, longer working hours, and income dissatisfaction, whilst older age, factory job, high income, and increased use of social support resources were associated with reduced risk. CONCLUSIONS: Efforts to promote mental health amongst migrant workers may be usefully targeted on younger migrants and include measures aimed to improve working conditions, strengthen the social support network, and address age-specific needs.

Tanzanian men's gender attitudes, HIV knowledge, and risk behaviours.

This study uses data from the 2004-05 Tanzanian Demographic and Health Survey to examine whether men's traditional gender role attitudes contribute to their sexual risk behaviours for HIV. Logistic regression with random effects were used to analyze effects on risk behaviours at last sex (partners being drunk and condom use) with the three most recent sexual relationships. Men's traditional gender attitudes increased risky sexual behaviours (e.g., not using a condom) even when they had accurate knowledge regarding HIV risks. The impact of men's gender attitudes and HIV knowledge on risky sexual behaviours did not vary by relationship type. Unexpectedly, condom use was more likely when either partner was drunk compared to neither being drunk, though the protective impact of HIV knowledge remained. Overall, these findings suggest that traditional gender attitudes present barriers to preventing HIV/AIDS that even increased knowledge about HIV risks may not overcome.

Continuity in child mental health from preschool years to adolescence in parental migration contexts: Evidence from a longitudinal study in Thailand.

Our analysis employed the life-course approach to examine whether and how mental health during the preschool stage could predict mental health during adolescence in the Thai context, where migration of parents is common. We used the longitudinal data set of the 2008 and 2021 Child Health and Migrant Parents (CHAMPSEA)-Thailand. The baseline survey of CHAMSEA-Thailand gathered data from 1030 households that met the eligibility criteria, each having a child within one of the two specified age ranges (aged 3-5 or 9-11). Our analysis used the baseline data of children aged 3 to 5 years old who were 16 to 18 years old in the subsequent survey (N = 404). In both surveys, the mental health of children was measured using the SDQ (total difficulties scores), a global standard tool for assessing children's mental health. Parental migration measured whether the parent(s) were international migrants when the child was 3 to 5 years old at the baseline. Results showed a significant, positive impact of the SDQ total difficulties scores of children aged 3 to 5 on their SDQ total difficulties scores when they grew up to 16 to 18 years old. Findings also revealed that experiencing parental international migration during the early life stage led to adverse effects on individuals' mental health when they became adolescents.

Expert consensus on a protocol for conducting bibliometric analysis of scientific articles on global migration health (GMH).

BACKGROUND: Migration and health are key priorities in global health and essential for protecting and promoting the health of migrants. To better understand the existing evidence on migration health, it is critical to map the research publication activity and evidence on the health of migrants and mobile populations. This paper presents a search strategy protocol for a bibliometric analysis of scientific articles on global migration health (GMH), leveraging the expertise of a global network of researchers and academics. The protocol aims to facilitate the mapping of research and evidence on the health of international migrants and their families, including studies on human mobility across international borders. METHODS: A systematic search strategy using Scopus will be developed to map scientific articles on GMH. The search strategy will build upon a previous bibliometric study and will have two main search components: (1) 'international migrant population', covering specific movements across international borders, and (2) 'health'. The final search strategy will be implemented to determine the final set of articles to be screened for the bibliometric analysis. Title and abstract screening will exclude irrelevant articles and classify the relevant articles according to predefined themes and subthemes. A combination of the following approaches will be used in screening: applying full automation (ie, DistillerSR's machine learning tool) and/or semiautomation (ie, EndNote, MS Excel) tools, and manual screening. The relevant articles will be analysed using MS Excel, Biblioshiny and VOSviewer, which creates a visual mapping of the research publication activity around GMH. This protocol is developed in collaboration with academic researchers and policymakers from the Global South, and a network of migration health and research experts, with guidance from a bibliometrics expert. ETHICS AND DISSEMINATION: The protocol will use publicly available data and will not directly involve human participants; an ethics review will not be required. The findings from the bibliometric analysis (and other research that can potentially arise from the protocol) will be disseminated through academic publications, conferences and collaboration with relevant stakeholders to inform policies and interventions aimed at improving the health of international migrants and their families.

Does Having a Migrant Parent Reduce the Risk of Undernutrition for Children Who Stay Behind in South-East Asia?

Many parents from South-East Asia who go overseas to work are motivated by a desire to secure a better future for their children, yet the health consequences for children who stay behind are poorly understood. This study is the first cross-country comparison to explore the relationships between parental migration and the risk of undernutrition (stunting) for primary school-aged children. The analysis uses data from the CHAMPSEA Project for children aged 9 to 11 years in the Philippines (N = 480) and Vietnam (N = 482). A series of logistic regression models compares outcomes for children living in transnational households and children living with both parents in non-migrant households in the same communities. We find no general advantage of having a migrant parent. Rather there is a reduced risk of stunting only for some left-behind children in the Philippines, whereas having a caregiver with low educational attainment is a major risk factor for all children. The findings point to a complex set of relationships between parental migration and child nutrition, possibly reflecting differential opportunities for accumulating household wealth through overseas earnings. Moreover, differences between the two countries caution against generalizing across national or cultural groups. We conclude by considering the implications of the findings for theories of transnationalism and for the UN Millennium Development Goal of reducing childhood undernutrition.

Alcohol Use among Very Early Adolescents in Vietnam: What Difference Does Parental Migration Make?

Little is known about the patterns of alcohol use among adolescents and the transmission of alcohol use behaviors from parents to children, including the passage into responsible and problem drinking, in the developing world. The following paper uses primary data from the Child Health and Migrant Parents in South-East Asia (CHAMPSEA) Project for older children aged 9, 10 and 11 to examine the prevalence (16.2 percent) and correlates of alcohol use initiation including parental migration status, caregiving arrangements and exposure to environmental alcohol use (family and friends) in Vietnam. Contrary to expectations, there is no observed migrant 'deficit.' There is some indication that early adolescents in the care of their grandparents are less likely to have a history of experimentation with alcohol use, although it is fully attenuated after controlling for other factors. Peer use is the most powerful explanatory measure of early adolescent drinking, with early adolescents more than five times as likely to have ever drunk alcohol if their friends drink also, and as expected, there is a strong child gender difference with girls much less likely to have a history of alcohol use. "A man without alcohol is like a flag without wind"- Popular Vietnamese saying.

Protective Community Norms and Mental Health Risks for Severe Physical Abuse: Lessons From a Nationally Representative Study of Ghana.

Although it has become axiomatic to quote an African proverb in discussions of child well-being, attempts to draw concrete and positive lessons from how African communities respond to and mitigate child maltreatment are comparatively few. This study tested the hypothesis that the collective value of Abiriwatia in Ghana, which supports legitimate norms of community obligations to care for children, could be protective against physical abuse. It also examined the claim that knowledge of the familial situation of community members, generated through Abiriwatia, may help them to act to mitigate the risk of caregiver's borderline personality disorder (BPD) features. We obtained a nationally representative sample of 1,100 female caregivers from 22 Ghanaian settlements and tested the hypotheses using multilevel models. Controlling for community-level physical abuse, living in a community with high levels of Abiriwatia childcare and community authority values is associated with lower levels of very severe physical abuse, and Abiriwatia childcare may mitigate risk from the caregiver's BPD features. Within Ghana, encouraging positive and protective aspects of traditional Ghanaian values and working to reinstate respect for these values may have positive outcomes for children. Interventions to reduce child maltreatment should be developed with reference to Abiriwatia childcare values.

The protective effects of the collective cultural value of abiriwatia against child neglect: Results from a nationally representative survey.

BACKGROUND: Over the past 20 years, there has been a growing commitment to strengthen community norms-to foster informal support for families and enhance community commitment to protect children from child abuse and neglect. The current study examined the relationship between child neglect and normative interpretations of the dominant cultural value of abiriwatia in Ghana. It was hypothesized that the norms of abiriwatia were associated with lower incidence of child neglect. METHODS: We used a random, stratified four-stage cluster design to select a nationally representative sample of 1100 female caregivers in Ghana. Norms of the cultural value of abiriwatia were measured using a new 11-item Likert scale questionnaire developed by the authors, and child neglect was measured using the Conflict Tactics Scale. RESULTS: Factor analysis of the abiriwatia scale retained three factors, community authority, collective childcare, and lineage, as the core norms of abiriwatia. We found that the abiriwatia norm of community authority was associated with fewer instances of child neglect. Norms of community responsibility for childcare were negatively associated with child neglect frequency (B = -0.31, p < .05). However, the relationship between the abiriwatia norm of lineage and child neglect was positive (B = 0.24, p < .05). CONCLUSION: The protective associations among the norms of community authority and collective childcare and child neglect suggest that traditional practices that strengthen and enforce the collective norms of abiriwatia, including storytelling, family byelaws, community durbars (community meetings), taboos, and reciprocal farming activities (nnoboa) could be protective against neglect.

Gendered Dimensions of Demand for Commercial Sexual Exploitation of Children (CSEC) in Kathmandu, Nepal.

Breaking the demand chain for sex from minors would render supply worthless, contributing to the elimination of commercial sexual exploitation of children (CSEC). Using a novel sampling technique, this study reports on actual and potential adult customers of CSEC in two areas in Kathmandu (n = 466). Controlling for refusal conversion, age, education, and income, higher scores on a new Love-Fantasy Scale (LFS) were associated with increased odds of purchasing sex from young girls, as were patriarchal norms emphasizing the power of men. Further research is needed to design interventions that include aspects related to sexual fantasy for young girls to combat demand for CSEC.

Longitudinal associations between parental migration and children's psychological well-being in Southeast Asia: The roles of caregivers' mental health and caregiving quality.

OBJECTIVE: This study investigates the longer-term effects of parental migration on the psychological well-being of children who stay behind in two major labor-sending countries in Southeast Asia, namely, Indonesia and the Philippines. Adopting the framework of the 'care triangle', we further examine how caregivers' mental health and caregiving quality moderate the associations between parental migration and children's psychological well-being. METHODS: Using longitudinal data collected in 2008 and 2016/17, we assess children's psychological well-being during early childhood (aged 3-5 years) and again in adolescence (aged 11-13 years). We apply both fixed-effects and random-effects models, using the Hausman test to indicate the preferred model. RESULTS: The findings indicate that there is no significant longer-term effect of parental migration on children's psychological well-being, but parental migration tends to show adverse effects on Filipino children's psychological well-being when they are cared for by a caregiver with poor mental health. CONCLUSIONS: The two-country comparison demonstrates the complexities of understanding the gender-based influences of parental migration on children's psychological well-being. The findings also highlight the caregiver's role in maintaining frequent communications with migrant parents within the care triangle, which is crucial to children's well-being.

Resilience and well-being among children of migrant parents in South-East Asia.

There has been little systematic empirical research on the well-being of children in transnational households in South-East Asia-a major sending region for contract migrants. This study uses survey data collected in 2008 from children aged 9, 10, and 11 and their caregivers in Indonesia, the Philippines, and Vietnam (N=1,498). Results indicate that while children of migrant parents, especially migrant mothers, are less likely to be happy compared to children in nonmigrant households, greater resilience in child well-being is associated to longer durations of maternal absence. There is no evidence for a direct parental migration effect on school enjoyment and performance. The analyses highlight the sensitivity of results to the dimension of child well-being measured and who makes the assessment.

Transnational families and the family nexus: perspectives of Indonesian and Filipino children left behind by migrant parent(s).

As a significant supplier of labour migrants, Southeast Asia presents itself as an important site for the study of children in transnational families who are growing up separated from at least one migrant parent and sometimes cared for by 'other mothers'. Through the often-neglected voices of left-behind children, we investigate the impact of parental migration and the resulting reconfiguration of care arrangements on the subjective well-being of migrants' children in two Southeast Asian countries, Indonesia and the Philippines. We theorise the child's position in the transnational family nexus through the framework of the 'care triangle', representing interactions between three subject groups- 'left-behind' children, non-migrant parents/other carers; and migrant parent(s). Using both quantitative (from 1010 households) and qualitative (from 32 children) data from a study of child health and migrant parents in Southeast Asia, we examine relationships within the caring spaces both of home and of transnational spaces. The interrogation of different dimensions of care reveals the importance of contact with parents (both migrant and nonmigrant) to subjective child well-being, and the diversity of experiences and intimacies among children in the two study countries.

Social Norms and Family Child Labor: A Systematic Literature Review.

BACKGROUND: Research has established the family as the predominant context for child labor practices. Decisions to involve children in child labor within the family or by a family member (herein family child labor) is strongly motivated by cultural beliefs that normalize child labor. This systematic review sought to synthesize evidence on the social norms that support child labor practices, and the normative interpretation of international child labor legislation/standards. METHODS: We followed the PRISMA procedure for systematic review by reviewing empirical articles published between 2000 to 2021 and contained within the four key databases: Scopus, ISI Web of Sciences, PubMed and Embase. Findings from 13 articles that met the inclusion criteria were analyzed thematically. RESULTS: The review included studies from three continents: Africa, Asia and Europe. Gender norms, informal apprenticeship norm, norms on succession and sustenance as well as obedience, were key social norms that influenced child labor practices in the family. Parents' decision to involve children in child labor was strongly influenced by the collective acceptance of some occupations (e.g., cocoa farming and fishing) as family occupations, which need to be preserved, undertaken and passed on to children. Child rights and the UNCRC principle of children's participation were considered foreign to most non-western countries and interpreted as contravention to the cherished social norm of obedience. The findings underlie the link between social norms and the common social values of resilience, hard work, and respect. CONCLUSION: The results provide foundations and target to develop normative change intervention programs to re-orient the negative interpretations of common social values and provide alternative pathways that prevent child labor within the social context.

Collective value of Abiriwatia and protective informal social control of child neglect: Findings from a Nationally Representative Survey in Ghana.

Evidence of the protective role of informal social control by community members (family members, friends, and neighbours) in child neglect has received considerable attention. Likewise, the protective effects of informal social control interventions in neglect are theorised to be common and highly efficacious in communities that have sanctioned informal interventions through collective social values and norms. Yet, no research has examined this theoretical postulation within the field of community/neighbourhood research in child maltreatment. We tested the theory-driven hypothesis by examining the interaction effects of protective informal social control of neglect and the collective value of Abiriwatia (a collective value based on lineage with norms on collective childcare duties) against the frequency of child neglect. Data consist of 616 caregivers' self-report of child neglect in the past year, from the Ghana Families and Neighbourhood Study. Hypotheses were tested using random effects regression models with standard errors corrected for settlement/community clusters. Protective informal social control of child neglect was significantly associated with fewer neglect in the past year (B = -0.79, p < 0.05). The interaction between protective informal social control of child neglect and the collective value of Abiriwatia was negative (B = -0.07, p < 0.05). The findings suggest that strengthening the collective normative commitment to childcare would promote family members' intervention to protect against neglect situations, and their intervention can deter further acts of neglect. Community neglect prevention programmes should take advantage of the findings to strengthen community norms that sanction collective childcare duties. Community child protection committees of the Department of Social Welfare should develop social groups and informal associations to strengthen Abiriwatia in Ghana.

Invasive Exploitation and the Multiplicative Hypothesis: Polyvictimization and Adolescent Depression Symptoms in Nepal.

Adverse effects of childhood maltreatment experience and adolescent depression symptoms are theorized to be more profound for adolescents who have suffered multiple maltreatments (polyvictimization). New theoretical insights into the study of polyvictimization suggest that it must be studied using a multiplicative logic, particularly when maltreatment is characterized by invasive exploitation. This study, for the first time, examined the concept of invasive exploitation in the context of polyvictimization and its association with adolescent depression symptoms. The study used a random, three stage probability proportional to size (PPS) cluster sample of 565 mother-adolescent dyads in Kathmandu, Nepal, and also examined the protective effects of maternal empathy. We hypothesized that (a) singly, the empirical categories of maltreatment (neglect, physical abuse, and child sexual abuse) would associate positively with adolescent depressive symptoms and (b) main effects held constant, the interaction effects of a child sexual abuse X neglect and a child sexual abuse X physical abuse would be positive. Regression with clustering corrections found that neglect (B = 3.17, p < .01) and sexual abuse (B = 3.48, p < .05) positively associated with adolescent depression symptoms. Results support the multiplicative invasive exploitation polyvictimization hypothesis (child sexual abuse X neglect interaction; B = 6.14, p < .05). The positive neglect X sexual abuse interaction is consistent with the theory that sexual abuse is distinct as invasive exploitation, and demonstrates that the multiplicative hypothesis can be fruitfully applied to the study of polyvictimization. Interventions targeting polyvictims with experience of invasive exploitation and studies aiming to provide deeper insights into sexual abuse as invasive exploitation are needed.

Filicide as a cultural practice in Ghana: The qualitative understanding of a family tragedy and its implications for child protection practice.

BACKGROUND: Contrary to evidence from the Western literature, cases of filicide in Ghana are mostly unreported because they are rooted in cultural practices and hidden from the general public. OBJECTIVE: The purpose of this study was to explore the cultural context of filicide in a rural community. Particularly, to provide an understanding of the spirit child (SC) phenomenon, how the killing of a SC is performed and to provide a general understanding of filicide within a particular context. PARTICIPANTS AND SETTING: Four relatives of a family that engaged in a filicide incident took part in the study. The interviews were conducted in a rural community in Ghana where the incident occurred. METHODS: Short written narratives were used to explore the experiences and perceptions of relatives whose family engaged in filicide. RESULTS: Children with severe deformities are likely to be associated with matters of divinity which gives way for the conceptualization of the SC and its attendant filicide. The findings highlight the critical role of traditional healers in rural communities and the consequences of strong community beliefs and expectations that influence parents to commit filicide. CONCLUSION: The study provides directions for child protection workers to address the stigma parents face for having children with severe deformities and to provide education on child welfare legislation.