Caregiver Depression and Early Child Development: A Mixed-Methods Study From Rural China

Abstract

Half of rural toddlers aged 0–3 years in China's Qinling Mountainous region are cognitively delayed. While recent studies have linked poor child development measures to the absence of positive parenting behaviors, much less is known about the role that caregiver depression might play in shaping child development. In this paper, a mixed methods analysis is used to explore the prevalence of depression; measure the association between caregiver depression and children's developmental delays, correlates of depression, and the potential reasons for caregiver depression among women in rural China. The analysis brings together results from a large-scale survey of 1,787 caregivers across 118 villages in one northwestern province, as well as information from in-depth interviews with 55 female caregivers from these same study sites. Participants were asked to respond to the Depression, Anxiety and Stress Scale-21 (DASS-21) as well as a scale to measure children's social-emotional development, the Ages and Stages Questionnaire: Social-Emotional (ASQ-SE). We also administered a test of early childhood development, the Bayley Scales of Infant and Toddler Development (BSID-III), to all of the study household's infants and toddlers. The results show that the prevalence of depression may be as high as 23.5 percent among all female caregivers (defined as scoring in the mild or higher category of the DASS-21). Grandmothers have higher prevalence of depression than mother caregivers (p < 0.01). Caregiver depression also is significantly associated with a 0.53 SD worsening of children's social-emotional development (p < 0.01) and a 0.12 SD decrease in children's language development (p < 0.05). Our qualitative findings reveal six predominant reasons for caregiver depression: lack of social support from family and friends; the burden of caregiving; lack of control and agency within the household; within-family conflict; poverty; the perception of material wealth as a measure of self-worth. Our findings show a serious lack of understanding of mental health issues among rural women, and suggest that rural communities could benefit greatly from an educational program concerning mental health and its influence on child development. Our findings confirm the need for a comprehensive approach toward rural health, with particular attention paid to mental health awareness and support to elderly caregivers.

Incidence and risk factors of depressive symptoms in 4 years of follow-up among mid-aged and elderly community-dwelling Chinese adults: findings from the China Health and Retirement Longitudinal Study

“…Depressed caregivers were more likely to show negative parenting interactions (eg, limited facial and behavioural affect) with their children, and these interactions were directly relevant for children’s development 29 30. A strong negative correlation has been reported between the levels of depression of grandmothers and the levels of developmental outcomes of the grandchildren in their care, including cognitive, language, social-emotional and motor functions 31 32. Taken together, changes in social policies and intervention programmes should be developed to address timely diagnosis and treatment of depression for these people, which will help improve young children’s developmental outcomes in rural China.…”

Maternal Mental Health, Handwashing Practices, and Infant Illness in Rural China

“…These rates are comparable to, and in some cases even higher than, other developing countries, where rates of illness in any given two-week period tend to be around 40-50% for diarrhea [20,21], 10-50% for fever, and 10-20% for coughing spells [22,23]. Research on maternal mental health in China has also discovered rates of depression to be around 20-25% [24][25][26], which is higher than both the 13% global rate of maternal mental disorders and similar to the rate of mental disorders among women in other LMICs (20%) [27].…”

Mental Health Issues among Caregivers of Young Children in Rural China: Prevalence, Risk Factors, and Links to Child Developmental Outcomes

“…According to recent studies, the prevalence of mental health issues among caregivers is higher in rural areas of China compared to many other developing countries [ 27 , 28 ]. Previous studies demonstrated that mental health problems affect between 23% and 40% of caregivers of young children in rural China [ 29 , 30 , 31 , 32 ]. This is higher than rates of caregiver mental health issues in other LMICs such as India (23%) [ 33 ] or Vietnam (21%) [ 34 ].…”

“…The existing literature has identified, as well, several risk factors for mental health issues among mothers and caregivers in rural China. Qualitative evidence points to poverty-related factors as potential risk factors for depression among rural caregivers [ 30 , 35 ]. In addition, factors such as poor physical health [ 36 ], raising multiple children [ 37 ], and a husband’s not living at home [ 38 ] have been found to be potential risk factors for mental health issues among rural mothers in China.…”

“…Recent studies in rural China also have found that maternal mental health is associated with developmental delays among young children. Two studies have found that caregiver depressive symptoms are linked with significantly lower developmental scores among young children in rural communities [ 30 , 39 ]. An additional study of depression, anxiety and stress among caregivers across rural China found significant associations between mental health issues and lower ECD outcomes [ 31 ].…”