The impacts of parent-child communication on left-behind children’s mental health and suicidal ideation: A cross sectional study in Anhui

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Abstract

This study aimed to investigate the impact of previous maternal migration experiences on left-behind children’s (LBC) mental health status and suicidal ideation, and the possible mediating role of parent-child communication. A cross-sectional study among rural children was conducted in Anhui, China, in 2018. LBC who self-reported that (a) their fathers were migrants and (b) they were living with their mothers at the time of the survey were included in this study. The participants were then divided into two subgroups by previous maternal migration experience. Previous maternal migration was associated with worse mental health and a higher prevalence of suicidal ideation among LBC compared with their peers. Healthy communication between children and parents fully mediates the adverse effects caused by previous maternal migration experiences on mental health among LBC, and communication with mother partially mediates the association with suicidal ideation. Communication classes for returning parents offered jointly by governments and schools could be an effective way to mitigate the impacts of maternal migration on child mental health and should be studied.

Introduction

Although large-scale labour migrations to urban environments significantly contribute to the Chinese economy, they have also caused long-term parental absences in their original--rural residential areas, resulting in the societal phenomenon of left-behind children (LBC). While, in the international context, LBC refers to children whose parents migrate into another country, in China, LBC generally refers to rural children whose fathers or mothers or both migrate to another city outside of their original residence area as recorded on the hukou system, for at least 6 months (Duan & Zhou, 2005). The hukou system is a government system based on household registration required by law in China. The hukou is issued per family, and officially identifies a person as a resident of an area and includes identifying information such as name, parents, spouse, and date of birth. Many social welfare policies are assigned by this hukou system, including health insurance and education. In China, one is identified as “migrant” if he/she moves out of his/her original residence area recorded on the hukou, and thus may not be able to receive social welfare in their new place of residence.

In 2014, the Chinese Women’s Federation, the largest Chinese non-governmental organization playing a decisive role in women and children’s welfare protection, estimated there were 61 million LBC in rural areas, accounting for 38% of rural children and 22% of the total youth population in China (All-China Women’s Federation, 2013). Being left behind by both parents and taken care by other relatives in the family (e.g. grandparents) is the predominant form of separation, followed by being left behind by only their fathers (Guang et al., 2017). Maternal migration, specifically, exerts adverse effects on child development, including fewer educational opportunities (Yang & Duan, 2008), and poorer nutritional status (Li & Su, 2014).

Parental absences also result in a range of psycho-social and developmental risks to LBC due to lack of parental monitoring, supervision, and support (Ding & Bao, 2014). Compared to their rural counterparts whose parents do not migrate, LBC reported more symptoms of anxiety and depression (Fang, Su, Gill, & Birmaher, 2010), poorer health-related quality of life (Hao & Cui, 2007), lower self-esteem (Jia, 2012), and fewer pro-social behaviors (Liu, Li, & Ge, 2009). However, none of these studies was able to tell how would these mental health problems of LBC evolve according to family environment changes like reunion with their parents.

Suicide has become one of the top causes of children and adolescents worldwide (Nock et al., 2008a). And as one widely accepted model for suicidality accentuates that suicidal ideation is the first stage of suicide (de Wilde, 2002). One recent systematic review suggested that globally, LBC had a 70% increased risk of suicidal ideation compared with their peers (Fellmeth, Clarke, & Zhao, 2018). It has also been estimated that between 12.9% and 20.0% rural LBC reported suicidal ideation (Deng & Li, 2014), much higher than that of the observed rate of non-LBC in China (10.9%) (Fu, Xue, Zhou, & Yuan, 2017). However, while parental absence has been identified as a risk factor for LBC’s suicidal ideation, the effect of reunion with parents remains unexplored among LBC in China.

As most migrant workers stay within China, it is not uncommon for migrant parents to return home (staying with children for months or permanently) when family needs or problems arise. In families where both parents migrate, typically the mother will be the first to return home, while the father will continue to work away from home (Qiu, 2016). However, the limited available evidence suggests that reunions do not relieve the problems resulting from previous separation. One study conducted in rural China found that the adverse effects of a previous parental migration experience (single or both parents) on a child’s mental health were as significant as the effects of an ongoing parental migration (Zhao, Wang, Li, Zhou, & Hesketh, 2017). However, the authors did not explore potential remedies for adverse effects of parent-child separation on children’s mental health. We wish to further explore the impact of maternal reunions on LBC’s mental health, and reflect on possible interventions to mitigate and remedy the adverse consequences of parental migration.

While research regarding the impact of reunions on LBC in China is scant, reports on the US military families’ parental deployments and returns can provide us with instructive evidence. Reunions between children and parents who were deployed have many similarities with parental reunions with LBC; they are both major stressors, and in both scenarios, family members have to renegotiate roles, as returned parents may not recognize how their children have changed during their absence, and children may worry that their parents may be redeployed again (Mmari et al., 2009, Wilson et al., 2011). For these military families, communication processes such as age-appropriate disclosure (e.g., parents’ talking with their children about topics in ways that are appropriate for their age and development), social support, and shared decision-making can help mitigate children’s deployment-related stress and promote adaptation to new circumstances (Walsh, 2003).

The parent-child relationship and communication between parents and children are of extreme importance for child development. Families are central to the well-being of their children, with strong parent-child relationships and communication playing a critical role in the promotion of children’s mental health (Loon, Ven, Doesum, Hosman, & Witteman, 2015). Several studies with small samples in China (Niu et al., 2019, Zhang et al., 2018) showed that LBC generally communicate with their migrating parents via mobile phone or/and instant-messaging software like Wechat. As noted, the majority of LBC (50–60%) communicated with their migrating parents at a relatively low frequency, about less than once a week. Open and positive communication with parents was found to be related to better mental health status and fewer risky behaviors among children with different backgrounds (Tasopoulos-Chan, Smetana, & Yau, 2009); however, this approach is seldom used in China.

This study aims to investigate the impact of previous maternal migration experiences on mental health status and suicidal ideation, and the possible protective role of parent-child communication of LBC in Anhui. Anhui, located in southeastern China, is a relatively underdeveloped province with around 16 million migrant workers and 4.5 million LBC (Duan, Lu, Guo, & Wang, 2013). Based on the aforementioned review of the literature, two major hypotheses were examined in the present study: first, previous maternal migrant experiences can exert adverse effects on LBC’s mental health and likelihood of suicidal ideation; second, parent-child communication may play a mediating role between previous maternal migration and mental health and suicidal ideation among LBC.

Section snippets

Data collection

Data for this study come from a cross-sectional study which focused on rural left-behind children’s mental health status and was conducted in Anhui Province, in May 2018.

This study was conducted in two counties within the Anhui Province, Wuwei and Nanling. Within each county, two towns were randomly selected. Then, one primary school and one middle school were randomly selected from the school roster of the Town Education Bureau. Thus, eight schools were included in the present study, from

Results

We included 471 LBC with a migrant father in this study. Among these participants, 276 (58.60%) reported their mothers had previously migrated (LBC-MP), while 195 (41.40%) had mothers who never migrated (LBC-MN). There were no differences in gender, grade, family economic status, siblings, number of friends, total difficulties of SDQ, or communication status with fathers (openness and problem) between LBC who reported their mothers had previously been migrants and those who had mothers who

Discussion

To our knowledge, this is the first study to investigate the potential protective role of parent-child communication on the effect of maternal migration on LBC’s mental health and suicidal ideation. This study has produced two major findings: firstly, previous maternal migration was found to be related to poorer mental health and a higher prevalence of suicidal ideation among LBC, and; secondly, healthy communication between children and parents fully mediated the association between previous

Conclusion

Healthy communication between children and parents mediates the association between experiencing maternal migration and mental health symptoms among left behind children and partially mediates the association between maternal migration and suicidality. Future research using experimental design should test whether interventions, including a family service packages of parenting skills for returning parents and emotional adjustment for children, can promote children’s mental health and avoids

Implication and contribution

Our findings highlight the mediating role of parent-child communication between previous maternal migration and LBC’s mental health and suicidal ideation. Interventions including parenting skills for returning parents and emotional adjustment for children to promote children’s mental health and avoid suicides can be creditable attempts.

CRediT authorship contribution statement

Jingjing Lu: Conceptualization, Formal analysis, Investigation, Writing - original draft. Leesa Lin: Methodology, Writing - review & editing. Brita Roy: Methodology, Writing - review & editing. Carley Riley: Methodology, Writing - review & editing. Emily Wang: Methodology, Writing - review & editing. Karen Wang: Methodology, Writing - review & editing. Lu Li: Conceptualization, Supervision, Writing - review & editing. Feng Wang: Conceptualization, Methodology, Investigation, Resources, Project

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgement

We gratefully acknowledge the schools’ coordinators, staffs who supported the study. This study was funded by Zhejiang University Zijin Talent Programme.

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