Is being a 'left-behind' child associated with an increased risk of self-poisoning in adulthood? Findings from a case–control study in Sri Lanka

Abstract

PurposeThe long-term consequences of parental emigration on offspring self-harm risk is unknown.MethodsWe investigated the association between experiencing parental emigration in childhood with hospital presentations for self-poisoning in adulthood using a hospital case–control study. Cases were adult self-poisoning patients (≥18 year olds) admitted to the medical toxicology ward Teaching Hospital Peradeniya, Sri Lanka. Sex and age frequency matched controls were recruited from the outpatient department or nearby specialist clinics at the same hospital. Details of parental emigration were collected using a pre-piloted questionnaire. The relationship between parental emigration and self-poisoning in adulthood was estimated using logistic regression models.Results298 cases, and 500 hospital controls were interviewed for the study. We estimate that one in five adults experienced parental emmigration as children (95% CI 17% to 24%). We find limited evidence that children from households with emigrating parents were more likely to experience adverse childhood experiences than those with non-emigrating parents. We found no statistical evidence of an increased risk of self-poisoning in adulthood in individuals who experienced parental emigration (maternal or paternal) during childhood. There was no statistical evidence that the impact differed by the sex of the participant.ConclusionAdults who experienced parental emigration as children were no more likely to self-poison than adults with non-emigrating parents. Further research using longitudinal data are needed to understand whether any adverse outcomes observed in 'left-behind' children are a consequence of parental emigration or due to factors associated but predate the emigration. Prospective data are also important to investigate whether there are any lasting effects on children who experience parental emigration.

Association of the Labor Migration of Parents With Nonsuicidal Self-injury and Suicidality Among Their Offspring in China

“…To our knowledge, only 1 existing study investigated sex differences in the association of parental migration with NSSI. Knipe and colleagues 8 conducted a hospital-based case-control study and found no sex differences in self-poisoning behavior (the most common method of NSSI in Sri Lanka) between boys and girls with at least 1 parent who migrated, consistent with the findings of our study. Nonsuicidal self-injury for emotional regulation is closely associated with coping strategies, 38 and no sex differences have been detected for coping strategies.…”

“…Four existing studies 8 , 9 , 10 , 11 have examined the association of parental migration with NSSI in children and adolescents with mixed conclusions or less convincing findings due to the use of an ambiguous definition of NSSI 8 or the failure to adjust for potential confounders. 9 , 10 , 11 In the present study, we used a validated diagnostic criterion for NSSI 19 , 28 , 29 and adjusted for up to 13 potential confounders, providing robust evidence that parental migration is independently associated with increased risk of less frequent NSSI among Chinese children, adolescents, and young adults and that those offspring who were left behind are at high risk for less frequent NSSI engagement.…”

“…6,7 A recent meta-analysis suggested that, compared with children of parents who did not migrate, children left behind by parents who migrated for employment had increased risk of depression, anxiety, suicidal ideation, conduct disorder, substance use, wasting, and stunting. 7 Despite these findings, few studies have specifically focused on the the health outcomes of NSSI, [8][9][10][11] suicidal ideation, or suicide attempt. [12][13][14][15] Moreover, findings that do exist are mixed and inconclusive.…”

“…Although some studies have found that parental migration was associated with increased risk of NSSI 9,11 and suicidal ideation [12][13][14] among children, other studies indicated null or even inverse associations of parental migration with risk of NSSI, 8,10 suicidal ideation, 15 and suicide attempt. 12,15 In addition, most studies comparing the risk of NSSI between children who were and children who were not left behind did not adjust for potential confounders, [9][10][11]13 such as socioeconomic status and emotional regulation factors (eg, loneliness, emotional management ability, and psychological resilience) 16 ; therefore, the independent association between parental migration and NSSI remains uncertain.…”