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.

Feasibility and Acceptability of an ABCD Program for Child Development Among Skipped Families in Rural Thailand: A Pilot Study

Introduction

The study aimed to develop and examine the aesthetic, bedtime story, connecting with nature, and drawing (ABCD), community based, program for grandparents to help them promote their grandchildren's development.

Methods

The action research was conducted in two phases. In the first phase, semi-structured interviews and focus group discussions were utilized to gather information from healthcare providers, teachers, and community leaders to develop the ABCD program. This was followed by a critical evaluation of the program's activities, materials, and contents. The second phase was to examine the program's effectiveness. A one-group pretest-posttest design was used to study the effectiveness of the program among 20 dyads of grandparents and grandchildren.

Results

All grandparents attended and completed the program. The grandparents' knowledge increased significantly (p = 0.024), and satisfaction with the program was high (X = 9, SD = 0.93) while children's development was not statistically different (p = 0.317).

Conclusion

The ABCD program was found to be feasible and acceptable to grandparents of skipped families to promote their grandchildren's development. The importance of healthcare providers, teachers, and community leaders in providing ABCD programs must also be recognized.

Nurses' Work-Family Strategies during COVID-19 Lockdown and Their Association with Individual Health and Family Relations

The COVID-19 lockdown forced people to stay at home and address their family duties more equally. However, since nurses themselves were involved in the closed-loop management in hospitals and unable to return home, there was also an increased likelihood of non-traditional work-family strategies emerging. To ascertain the extant and implications of this phenomenon, this cross-sectional study explores work-family management strategies among nurses during the COVID-19 lockdown and their association with nurses' individual health, family relationships, and job performance. Survey data were collected from 287 nurses who were involved in the closed-loop management in Shanghai hospitals from March to June 2022. Latent Class Analysis of seven categorical variables of nurses' work-family status (e.g., the division of childcare labor) produced a best-fit solution of five strategies (BLRT (p) < 0.001, LMR (p) = 0.79, AIC = 5611.34, BIC = 6302.39, SSA-BIC = 5703.65, Entropy = 0.938): (1) fully outsourcing to grandparents, (2) partially outsourcing to grandparents, with the husband filling in the gap, (3) the husband does it all, (4) egalitarian remote workers, and (5) a neo-traditional strategy. Nurses who applied the egalitarian strategy had less psychological distress and relationship tension and better performance than those who applied the neo-traditional strategy and performed most of the childcare. The "husband does it all" strategy and the outsourcing strategies seem to have double-edged effects, with better job performance and family relations but also more distress and fewer sleeping hours among nurses. Overall, with a view to future risk mitigation, policymakers and practitioners should be aware of the diversity of the work-family strategies among nurse families during the lockdown period, and their association with individual and family outcomes, and provide tailored support.

Early and continuing grandparental care and middle school students' educational and mental health outcomes in China

Several recent studies have examined the relationship between grandparents and grandchildren, but few have examined the effects of early and continuing grandparental care on children's development in China. Using data from the China Education Panel Survey, this study examines the effects of early and continuing care, in which grandparents serve as primary caregivers on middle school students' educational (measured by academic performance and cognitive scores) and mental health (depression score) outcomes. Using multilevel analyses and robustness tests, the results show that for urban and rural students, students cared for by their grandparents showed no disadvantages in their educational outcomes. For rural students who received grandparental care in early childhood or adolescence academically outperformed those who received only parental care. Urban and rural students who received only grandparental care in early childhood and adolescence show worse mental health outcomes. These results challenge the prevailing belief that grandparent caregiving can harm grandchildren's school preparation and cognitive abilities.

Interparental and Intergenerational Co-parenting Conflict and Adolescent Academic Performance: The Mediating Roles of Adolescent Academic Engagement and Depression

While a link between co-parenting conflict and academic performance is frequently assumed, studies on this association have shown inconsistent results. In addition, academic engagement and depression can potentially mediate the association between co-parenting conflict and academic performance. However, studies have not tested this proposition. This paper examined the direct effect of co-parenting conflict on adolescent academic performance and the mediating effect of academic engagement and depression. Using data from a nationally representative survey, the 2020 China Family Panel Studies (CFPS), we constructed a sample of 1989 dyads of adolescents (aged 10 to 15) and their primary caregivers in China. The structural equation model analysis revealed that co-parenting conflict was not directly linked with academic performance but was indirectly associated with adolescent academic performance through academic engagement and depression. The findings provide empirical support that academic engagement and depression play important mediating roles in the relationship between co-parenting conflict and adolescent academic performance. Future intervention programs aimed at promoting adolescent academic performance may consider a family-oriented approach to identify adolescents from families with co-parenting conflict and provide them with professional support.

A qualitative study on the perspectives of Turkish mothers and grandmothers in the Netherlands regarding the influence of grandmothers on health related practices in the first 1000 days of a child's life

BACKGROUND

Given the importance of the first 1000 days of a child's life in terms of laying the foundations for healthy growth and development, parents are a logical target group for supporting health-related practices with regard to young children. However, little attention is paid to the influence of the wider social community on the health and development of young children during this crucial period. This includes grandmothers, who often have a significant influence on health-related practices of their grandchildren. The aim of this study was therefore to explore the influence of grandmothers on health related practices of their grandchildren during the first 1000 days, from the perspectives of both grandmothers and mothers with a Turkish background.

METHOD

This qualitative study in the Netherlands collected data during focus group discussions with grandmothers (N = 3), interviews with grandmothers (N = 18) and interviews with mothers (N = 16), all with a Turkish background. Data was collected in the period between June 2019 and April 2021 and analysed using a thematic content analysis.

RESULTS

The influence of grandmothers and the wider social community on health related practices during the first 1000 days of a child's life is substantial and self-evident. The support of grandmothers is often rooted in various socio-cultural norms and practices. The mothers of young children can experience the guidance and pressure they receive from grandmothers and the wider social community as quite stressful. Conflicting views and practices tend to arise between grandmothers and mothers when a grandmother babysits. Both mothers and grandmothers often find it difficult to discuss these differences openly, for fear this might lead to a family conflict.

CONCLUSION

This study shows that grandmothers and the wider social community play an influential role in supporting a healthy first 1000 days of a child's life. The strong involvement of grandmothers may lead to tension between the mothers and grandmothers when their ideas about healthy practices are not in agreement and may lead to unhealthy practices. In targeting this wider social community, it is important to consider the various socio-cultural factors that underlie the advice, support, practices and beliefs of the individuals involved.

Long-Term Impact of Grandchild Caregiving Trajectories on Depression in Middle-Aged and Older Chinese People: A Longitudinal Study

There has been little research investigating the effects of caregiving for grandchildren on grandparents' mental health from a dynamic perspective. The aim of this study was to evaluate the effects on caregivers' depression of changes in grandparenting intensity. The study population included 8,157 respondents obtained from the China Health and Retirement Longitudinal Study (CHARLS). Latent growth mixture modeling was used to group respondents into five classes of trajectory of caregiving intensity as follows: "sharply decreasing", "never or rarely", "slowly decreasing", "increasing", and "continuously high". A generalized additive mixed model (GAMM) and a marginal structural model (MSM) both associated the "continuously high" and "sharply decreasing" intensities with depression. "Continuously high" intensity significantly increased the risk of depression in the male group only. Further research should be conducted to analyze the deep-seated mechanisms of association between grandparenting and mental health, in different cultural contexts and among subgroups with different characteristics.

Research on grandchild care and depression of chinese older adults based on CHARLS2018: the mediating role of intergenerational support from children

BACKGROUND

There may be differences in gender and marital status in the impact of grandchild care on the depression of the Chinese older adults. This research explores the effect of grandchild care on the depression of Chinese older adults of different genders and marital status, and explores the mediating role of intergenerational support from children between grandchild care and depression.

METHODS

This research uses the data of 3540 Chinese older adults from the China Health and Retirement Longitudinal Study (CHARLS) in 2018. The OLS model is used to analyze the effect of grandchild care on the depression of the older adults. and the older adults are classified according to gender and marital status, and the differences in the effect of grandchild care on the depression of the elderly of different genders and marital status is explored. Finally, the bootstrap method is used to test the mediating effect of intergenerational support from children.

RESULTS

The research finds that grandchild care has a significant impact on the depression of the older adults in China, and providing grandchild care can significantly reduce the depression of the older adults. The effect of grandchild care on the depression of the older adults is different between different genders and marital status. After categorizing the older adults by gender, the grandchild care only has a significant impact on the depression of female older adults; after classified by marital status, grandchild care only has a significant impact on the depression of the older adults who don't have a spouse. The mediating effect analysis shows that both children's emotional support and children's economic support have a mediating effect between grandchild care and depression of the older adults.

CONCLUSION

The depression of the Chinese older adults is affected by grandchild care, and this effect is more prominent in female older adults and the older adults who don't have a spouse. The society should support and encourage capable older adults to participate in grandchild care, and children should also provide more intergenerational support to the older adults who provide grandchild care, so as to further play the role of grandchild care in relieving depression of the older adults.

Reasoning Talk at Chinese Families' Dinner Table: Across Three Generations and Different Communicative Contexts

This study examines the feature of reasoning talk used by 37 Chinese families at the dinner table across three generations with the background of co-parenting and in consideration of different communicative contexts. Drawing upon Hasan’s semantic framework, reasons were mainly coded as logical or social types. We categorize the communicative context of reasoning talk into contextualized (meal-related) and decontextualized topics. When the proportion of social reasoning was found slightly higher than that of logical reasoning, the families’ reasoning talk account for only 3.85% of the total language. Specifically, the count of mothers’ total reasoning talk was significantly above other family members, while there were no significant differences among the other participants. The effect of the communicative contexts on family members’ social reasoning was found. The reasoning talk grounded on local rules (family-made rules) and coercive power occurred significantly more frequently in contextualized than decontextualized context. A higher rate of local-rule grounded reasoning talk of all family members appeared in contextualized than decontextualized context, and this gap was particularly obvious among mothers. These findings reveal the significant role of mothers in family communications and confirm the pedagogical values of decontextualized communicative context for promoting children’s learning opportunities at the dinner table.

Domestic Generative Acts and Life Satisfaction among Supplementary Grandparent Caregivers in Urban China: Mediated by Social Support and Moderated by Hukou Status

Urban China is witnessing a growth of migrant grandparents apart from the prevalent local grandparent caregiving. However, the health consequences and influencing factors of grandparent caregiving remain largely unknown among migrant and local grandparent caregivers. This study examined informal and formal social support's mediation roles between domestic generative acts and life satisfaction, as well as investigating Hukou's (household registration system) moderation effect. Our sample compromised 1013 grandparent caregivers (Migrant = 508, Local = 505) from 12 kindergartens with a multistage clustered random sampling from Eastern China. Migrant grandparent caregivers had significant lower informal social support (M = 4.000, L = 4.355, p < 0.001), formal social support (M = 1.787, L = 2.111, p < 0.001), and life satisfaction (M = 3.323, L = 3.574, p < 0.001) than local ones. Structural equation modeling results indicated that domestic generative acts positively associated with life satisfaction (b = 0.085, p < 0.05), informal (b = 0.223, p < 0.001) and formal social support (b = 0.080, p < 0.05); informal (b = 0.379, p < 0.001) and formal social support (b = 0.138, p < 0.001) positively associated with life satisfaction. In addition, both informal (β = 0.084, CI [0.039, 0.101], p < 0.001) and formal social support (β = 0.011, CI [0.001, 0.018], p < 0.05) mediated the relationship between domestic generative acts and life satisfaction. Furthermore, Hukou status moderated the indirect path from domestic generative acts to life satisfaction via informal social support (p < 0.01), but not formal social support (p > 0.05). Migrant grandparent caregivers, with limited formal social support resources, were found to be more dependent on informal social support than locals. The findings revealed social support and wellbeing disparities among migrant and local grandparent caregivers in urban China. Theoretical contributions and practical implications are also discussed.

Language Development in Early Childhood: Quality of Teacher-Child Interaction and Children's Receptive Vocabulary Competency

High-quality teacher-child interactions in early learning environments have been regarded as a key contributor to children's early language and cognitive development in international scholarships. Little is known, however, about the longitudinal effects of children's receptive vocabularies in the Chinese context. In this study, we addressed the question of such longitudinal effects by examining the predictive effect of preschool teacher-child interaction quality on children's subsequent receptive vocabulary development in 42 kindergartens in Guangdong Province China. The results in a nested design showed that except for the factor of Emotional Support, the other two factors (Classroom Management and Instructional Support) were positive predictors to children's vocabulary competency from K2 (T1) to K3 (T2) at preschools. Findings contribute to the growing international literature on the critical role teacher-child interaction quality plays in children's language and literacy learning and development. Implications for enhancing communication channels between early childhood (EC) educators and decision-makers, and the strategies of the improvement of language and literacy teachers' professional development are also discussed.

Family Well-being in Grandparent- Versus Parent-Headed Households

BACKGROUND AND OBJECTIVES

Little is known about the 2% of US children being raised by their grandparents. We sought to characterize and compare grandparent- and parent-headed households with respect to adverse childhood experiences (ACEs), child temperament, attention-deficit/hyperactivity disorder (ADHD), and caregiver aggravation and coping.

METHODS

Using a combined data set of children ages 3 to 17 from the 2016, 2017, and 2018 National Survey of Children's Health, we applied survey regression procedures, adjusted for sociodemographic confounders, to compare grandparent- and parent-headed households on composite and single-item outcome measures of ACEs; ADHD; preschool inattention and restlessness; child temperament; and caregiver aggravation, coping, support, and interactions with children.

RESULTS

Among 80 646 households (2407 grandparent-headed, 78 239 parent-headed), children in grandparent-headed households experienced more ACEs (β = 1.22, 95% confidence interval [CI]: 1.07 to 1.38). Preschool-aged and school-aged children in grandparent-headed households were more likely to have ADHD (adjusted odds ratio = 4.29, 95% CI: 2.22 to 8.28; adjusted odds ratio = 1.72, 95% CI: 1.34 to 2.20). School-aged children in these households had poorer temperament (β_adj = .25, 95% CI: -0.63 to 1.14), and their caregivers experienced greater aggravation (β_adj = .29, 95% CI: 0.08 to 0.49). However, these differences were not detected after excluding children with ADHD from the sample. No differences were noted between grandparent- and parent-headed households for caregiver coping, emotional support, or interactions with children.

CONCLUSIONS

Despite caring for children with greater developmental problems and poorer temperaments, grandparent caregivers seem to cope with parenting about as well as parents.

Left behind, not alone: feeling, function and neurophysiological markers of self-expansion among left-behind children and not left-behind peers

Four in 10 young rural Chinese children are ‘left behind’ by parents migrating for economic opportunities. Left-behind children do as well academically and imagine as many possible futures for themselves as their peers, implying that they must compensate in some ways for loss of everyday contact with their parents. Three studies test and find support for the prediction that compensation entails self-expansion to include a caregiving grandmother rather than one’s mother in self-concept, as is typical in Chinese culture. We measured self-expansion with feeling, function and neurophysiological variables. Twelve-year-old middle school left-behind children (Study 1, N = 66) and 20-year-old formerly left-behind children (now in college, Studies 2 and 3, N = 162) felt closer to their grandmothers and not as close to their mothers as their peers. Self-expansion had functional consequence (spontaneous depth-of-processing) and left a neurophysiological trace (event-related potential, Study 3). Left-behind participants had enhanced recall for information incidentally connected to grandmothers (Studies 1 and 3, not Study 2). Our results provide important insights into how left-behind children cope with the loss of parental presence: they include their grandmother in their sense of self. Future studies are needed to test downstream consequences for emotional and motivational resilience.

Influence of Grandparental Child Care on Childhood Obesity: A Systematic Review and Meta-Analysis

Objective: This study systematically reviewed the scientific literature on the relationship between grandparental child care and childhood obesity. Methods: Keyword/reference search was performed in CINAHL, PsycINFO, PubMed, and Web of Science. Meta-analysis was conducted to estimate the pooled effect of grandparental child care on children's weight outcomes. Results: A total of 23 studies were identified, including 9 longitudinal, 9 cross-sectional, 2 case-control, and 3 qualitative studies. Eight studies were conducted in China, five in Japan, three in the United Kingdom, two in the United States, and one in five other countries each. Twelve studies focused on grandparents' roles as a main caregiver in the family, and seven on grandparents' co-residence. Data from 14 studies were used in meta-analysis, 10 focusing on childhood overweight/obesity and the other 4 on children's BMI z-scores. Meta-analysis found that grandparental child care was associated with a 30% (95% confidence interval = 21-40) increase in childhood overweight/obesity risk. Grandparental child care was not associated with children's BMI z-scores after correcting for publication bias. Meta-regressions revealed no difference in the estimated effect of grandparental child care on children's weight outcomes by country or grandparents' specific roles (main caregiver in the family vs. co-residence). Conclusions: Preliminary evidence links grandparental child care to elevated risk of childhood overweight/obesity, but not BMI z-scores. Future research should focus on a specific child age group within a country, adopt systematic and field-validated measures on grandparental child care, and elucidate the pathways linking grandparental child care to children's weight outcomes.

How do grandparents influence child health and development? A systematic review

Grandparents are often a key source of care provision for their grandchildren, yet they are sidelined in caregiving research and policy decisions. We conducted a global, systematic review of the literature to examine the scope and quality of studies to date (PROSPERO database CRD42019133894). We screened 12,699 abstracts across 7 databases, and identified 206 studies that examined how grandparents influence child health and development. Indicators of grandparent involvement were contact, caregiving behaviors, and financial support. Our review focused on two research questions: how do grandparents influence child health and development outcomes, and what range of child outcomes is reported globally? We examined study design, sample characteristics, key findings, and outcomes pertaining to grandchildren's physical health, socio-emotional and behavioral health, and cognitive and educational development.  Our search captured studies featuring grandparent custodial care (n = 35), multigenerational care (n = 154), and both types of care (n = 17). We found substantial heterogeneity in the data provided on co-residence, caregiving roles, resources invested, outcomes, and mechanisms through which "grandparent effects" are manifested. We identified two important issues, related to operationalizing indicators of grandparent involvement and conceptualizing potential mechanisms, leading to gaps in the evidence base. Currently, our understanding of the pathways through which grandparents exert their influence is constrained by limited data on what grandparents actually do and insufficient attention given to interpersonal and structural contexts. We present a conceptual framework to explicitly measure and theorize pathways of care, with a view to inform research design and policy implementation. We underscore the need for more robust data on three indicators of caregiver involvement-contact, behavior, and support-and for careful description of structural and interpersonal contexts in caregiving research.