Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis.

Gracia Fellmeth, Kelly Rose-Clarke, Chenyue Zhao, Laura K Busert, Yunting Zheng, Alessandro Massazza, Hacer Sonmez, Ben Eder, Alice Blewitt, Wachiraya Lertgrai, Miriam Orcutt, Katharina Ricci, Olaa Mohamed-Ahmed, Rachel Burns, Duleeka Knipe, Sally Hargreaves, Therese Hesketh, Charles Opondo, Delan Devakumar

Journal: Lancet (London, England) 2019;392(10164):2567-2582

PMID: 30528471

Free Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Globally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs).

METHODS

For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science, PsychINFO, Global Index Medicus, Scopus, and Popline from inception to April 27, 2017, without language restrictions, for observational studies investigating the effects of parental migration on nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy, and abuse in left-behind children (aged 0-19 years) in LMICs. We excluded studies in which less than 50% of participants were aged 0-19 years, the mean or median age of participants was more than 19 years, fewer than 50% of parents had migrated for more than 6 months, or the mean or median duration of migration was less than 6 months. We screened studies using systematic review software and extracted summary estimates from published reports independently. The main outcomes were risk and prevalence of health outcomes, including nutrition (stunting, wasting, underweight, overweight and obesity, low birthweight, and anaemia), mental health (depressive disorder, anxiety disorder, conduct disorders, self-harm, and suicide), unintentional injuries, substance use, abuse, and infectious disease. We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs) using random-effects models. This study is registered with PROSPERO, number CRD42017064871.

FINDINGS

Our search identified 10 284 records, of which 111 studies were included for analysis, including a total of 264 967 children (n=106 167 left-behind children and adolescents; n=158 800 children and adolescents of non-migrant parents). 91 studies were done in China and focused on effects of internal labour migration. Compared with children of non-migrants, left-behind children had increased risk of depression and higher depression scores (RR 1·52 [95% CI 1·27-1·82]; SMD 0·16 [0·10-0·21]), anxiety (RR 1·85 [1·36-2·53]; SMD 0·18 [0·11-0·26]), suicidal ideation (RR 1·70 [1·28-2·26]), conduct disorder (SMD 0·16 [0·04-0·28]), substance use (RR 1·24 [1·00-1·52]), wasting (RR 1·13 [1·02-1·24]) and stunting (RR 1·12 [1·00-1·26]). No differences were identified between left-behind children and children of non-migrants for other nutrition outcomes, unintentional injury, abuse, or diarrhoea. No studies reported outcomes for other infectious diseases, self-harm, unprotected sex, or early pregnancy. Study quality varied across the included studies, with 43% of studies at high or unclear risk of bias across five or more domains.

INTERPRETATION

Parental migration is detrimental to the health of left-behind children and adolescents, with no evidence of any benefit. Policy makers and health-care professionals need to take action to improve the health of these young people.

FUNDING

Wellcome Trust.

Address: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.; Department of Global Health and Social Medicine, King's College London, London, UK.; Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA.; Great Ormond Street Institute of Child Health, University College London, London, UK.; Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.; Department of Clinical, Educational and Health Psychology, University College London, London, UK.; Faculty of Health Sciences, University of Bristol, Bristol, UK.; Institute for Global Health, University College London, London, UK.; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.; Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany.; Department of Population Science, University of Bristol, Bristol, UK.; Institute for Infection and Immunity, St George's, University of London, London, UK; International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, London, UK.; Institute for Global Health, University College London, London, UK; Centre for Global Health, School of Medicine, Zhejiang University, Hangzhou, China.; National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.; Institute for Global Health, University College London, London, UK. Electronic address: [email protected].

DOI: 10.1016/S0140-6736(18)32558-3

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MeSH Terms: Adolescent, Adolescent Health, Anxiety, Child, Child Health, Child, Abandoned, Conduct Disorder, Depression, Developing Countries, Emigration and Immigration, Humans, Income, Nutrition Disorders, Parents, Substance-Related Disorders, Suicidal Ideation