Childhood Emotional Neglect and Cognitive Function Among Middle-Aged and Older Adults: Mediating Role of Social Engagement

Abstract

Studies have demonstrated that childhood maltreatment and adverse experiences lead to impaired cognitive function. However, relatively few studies have examined the independent effect of childhood emotional neglect on cognitive function in middle-aged and older adults, and the role of social engagement in this relationship. Using a sample from the China Health and Retirement Longitudinal Study, the current study examined the mediating role of social engagement in the association between childhood emotional neglect and cognitive function among middle-aged and older adults. Participants were 32,540 middle-aged and older adults (M_age = 63.45, SD = 8.83). Data were analyzed using a fixed effects model for panel data and bootstrap resampling method. Results showed that participants who experienced emotional neglect had poorer cognitive function (β = −.068, p < .001). Social engagement mediated 7.55% of the association between emotional neglect and cognitive function (β = −.004, 95% CI [−0.006, −0.002], p < .05). The results indicated that interventions are required to improve awareness of emotional neglect and facilitate healthy parenting practices. Further research on how to motivate adults who experienced emotional neglect to engage in social activities is necessary.

Keywords

childhood emotional neglect social engagement cognitive function middle-aged adult older adult childhood maltreatment

Childhood emotional neglect is a distinct form of maltreatment that affects the long-term well-being of children worldwide (Zhang & Li, 2022). Emotional neglect is the failure to provide for fundamental emotional needs, being emotionally unresponsive to children’s distress, and their emotional needs being consistently disregarded, ignored, invalidated, or unappreciated by caregivers (Ludwig & Rostain, 2009). Compared with physical, emotional, and sexual abuse, emotional neglect has a higher prevalence but has received much less empirical attention (Grummitt et al., 2022). Children who are emotionally neglected may develop a sense of insecurity and feel that they are not accepted or worthy of love by others (Fung et al., 2020), which has similar effects to physical and emotional abuse (Strathearn et al., 2020). For instance, a longitudinal study conducted in the United States demonstrated that deprivation-related adverse childhood experiences represented by neglect cause more lasting damage to adult cognitive function than threat-related adverse childhood experiences represented by physical abuse (Hawkins et al., 2021).

With the rapid aging of the global population, age-related health conditions have become critical public health issues. Cognitive function, which is one of the most important health indicators, is associated with an individual’s well-being in later life and imposes severe challenges to healthcare systems and society (Muir et al., 2012; Tochel et al., 2019). It encompasses multiple mental abilities and skills in reasoning, perception, memory, verbal and mathematical ability, and problem solving (George et al., 2022). Although evidence supports the association between emotional neglect or child maltreatment and impaired cognitive function (Irigaray et al., 2013), research gaps remain.

First, studies on this theme have usually combined emotional neglect with child maltreatment or adverse childhood experiences using a cumulative risk model (Ding & He, 2021; Lin et al., 2022). Research that treats emotional neglect as an independent variable is scarce. Second, several investigations attempting to identify the underlying mechanisms that may buffer the impact of childhood maltreatment on impaired cognitive function have focused mainly on biological pathways and psychosocial factors (Juster et al., 2010; Ringle et al., 2020). Limited social resources such as poor social support and engagement have been reported as risk factors for cognitive impairment and are increasingly common among older adults (Krueger et al., 2009; Zhou et al., 2020). However, the understanding of the mediating role of social engagement in the association between childhood emotional neglect and cognitive function in later life is limited.

Childhood Emotional Neglect and Cognitive Function

Accumulating evidence have demonstrated the associations between childhood maltreatment and the cognitive function of victims (Ding & He, 2021; Halpin et al., 2022; Malarbi et al., 2017). Some of these studies found that neglect is correlated significantly with poorer cognitive function than with abuse (Hawkins et al., 2021; Mills et al., 2011). For instance, Mills et al. (2011) found that neglect was generally a stronger predictor of a lower reading ability and perceptual reasoning compared with abuse. However, the number of studies that explore the separate effects of emotional neglect on cognitive function remains small. Separating emotional neglect from child maltreatment allows an in-depth study of the specific effects of emotional neglect and helps raise social awareness of this problem, which could promote the development of appropriate protective and intervention measures. In addition, neglect has short-and/or long-term impacts on cognitive function. Previous studies found neglect can affect individuals’ reading ability, perceptual reasoning, and receptive verbal intelligence at a young age (Mills et al., 2011, 2019), and cognitive deficits (such as poorer memory and executive function) observed in neglected children which could persist into adulthood (Gould et al., 2012). However, most of those studies have limited sample of adolescents and middle-aged adults (Majer et al., 2010; Pluck et al., 2011; Zheng et al., 2022), and whether this effect will persist into old age deserves further examination. Identifying the independent effect of emotional neglect on mid-to-late life cognitive function is crucial for a comprehensive understanding of the long-term benefits of interventions.

The relationship between emotional neglect and cognitive function can be explained by several pathways. First, emotional neglect can have detrimental effects on the structural and functional development of the brain (Juster et al., 2010). The lack of emotional interaction and parental care may result in alterations to neural circuits involved in cognitive processes, leading to potential impairments in cognitive function. Second, emotionally neglected children may feel unloved and unwanted, fear emotional closeness, and shun intimacy in relationships, which puts them at risk of low self-esteem and emotional problems, such as depression and anxiety throughout their lives (Strathearn et al., 2020; Zhang et al., 2022). Third, research has shown that individuals with these psychosocial factors may experience lower learning motivation and poorer self-perception (Zhang et al., 2020), which further affect their cognitive function, including attention, motivation, and information processing. Therefore, we hypothesized that childhood emotional neglect can predict poorer cognitive function in middle-aged and older adults.

Role of Social Engagement

The literature asserts that childhood neglect alters brain structures and affects psychosocial functioning (Teicher et al., 2016). Social engagement, which is an important indicator of psychosocial functioning (Berkman et al., 2000), refers to the maintenance of social connections and participation in social activities (Bassuk et al., 1999). Several studies have shown that social engagement is positively associated with cognitive function (Du et al., 2023; Kelly et al., 2017). There are two main theories to explain the relationship between social engagement and cognitive function. First, “the disuse hypothesis” suggests that low participation in social activities and everyday experiences can result in “atrophy” of cognitive processes and skills (Fratiglioni et al., 2004). Second, social identity theory argues that social engagement can enable individuals to acquire the identity of being members of a certain organization (Jetten et al., 2014). This identity can affect their values, psychological and emotional health, as well as provide them with social resources and emotional support, thereby contributing to maintaining cognitive function in old age (Xue, 2018).

Although there is less direct evidence on the association between childhood emotional neglect and social engagement in late life, studies indicate that child adverse experiences lead to greater stress in relationships later in life and increase social isolation (Arslan, 2018). Social isolation refers to objective absence or deficit in social connections and social engagement (Nicholson, 2009). The attachment theory (Bowlby, 1969) may explain the relationship between childhood emotional neglect and social engagement in adulthood. Individuals with a history of neglect have higher levels of avoidant attachment (Hillman et al., 2020). Those with avoidant attachment, in turn, generally perceive others as unavailable, unresponsive, or punitive (Weber et al., 2022), which may cause social isolation and reduces social participation and engagement. Therefore, childhood emotional neglect may be positively associated with poorer cognitive function through decreased social engagement.

The Present Study

The independent consequences of childhood emotional neglect on cognitive function in middle- and older-aged adults have been seldom explored. In addition, there is a dearth of evidence on whether social engagement plays a role in the association between childhood emotional neglect and cognitive function. Understanding this association is necessary for developing interventions to prevent cognitive decline among middle-aged and older adults who had experienced childhood emotional neglect.

Using a nationally representative sample from China, this study investigated the role of social engagement in the association between childhood emotional neglect and cognitive function among middle-aged and older adults. We made the following hypotheses (H).

H1: Middle-aged and older adults who were emotionally neglected during childhood would report a lower level of cognitive function.

H2: Childhood emotional neglect would be associated with poorer cognitive function through a decreased social engagement.

Methods

Participants

This study used data from the China Health and Retirement Longitudinal Study (CHARLS), which is an ongoing nationally representative sample of Chinese residents aged 45 and older. CHARLS sampled 150 counties/districts and 450 villages/urban communities across 28 provinces using multistage stratified probability-proportionate-to-size sampling (Zhao et al., 2014). The baseline national wave of CHARLS was conducted in 2011, the participants were followed up every 2 years, and new participants were added to compensate for the loss to follow-up. In addition, a Life History Survey was conducted in 2014 to provide information on childhood experiences (China Center for Economic Research Institute of Social Science Survey, 2014). A more detailed description of the study design and sampling procedure is available in the CHARLS cohort profile (Chen et al., 2021; Zhao et al., 2014). Ethical approval for the CHARLS was obtained from the institutional review board at Peking University. Each participant who agreed to participate in the survey provided written informed consent.

As Figure 1 illustrates, data from four waves of biennial surveys (2011, 2013, 2015, and 2018) were pooled to obtain a panel dataset. Childhood experience data reported in the 2014 Life History Survey were matched based on participant ID. In total, 11,109 participants with no missing data for childhood experiences, adulthood characteristics, social engagement, and cognitive function were included in this study. A total of 32,540 observations were included in the final analyses, comprising 3,546 participants surveyed four times (14,184 total), 4,069 participants surveyed three times (12,207 total), 2,655 participants surveyed twice (5,310 total), and 839 participants surveyed once (839 total). The characteristics of participants with incomplete data are available upon request.

Figure 1.

Study flow.

Measures

Childhood Emotional Neglect

In line with previous studies (Ding & He, 2021; Zheng et al., 2022), childhood emotional neglect was measured using two items: “How much love and affection did your female guardian give you while you were growing up?” (often, sometimes, rarely, never) and “How much effort did your female guardian put into watching over you while you were growing up?” (a lot, some, a little, not at all). Emotional neglect was defined as 1 (“Yes”) if the participants responded “rarely/a little” or “never/not at all” to either or both of the two questions; otherwise, 0 (“No”) was recorded.

Cognitive Function

Cognitive function was measured into two dimensions: episodic memory and executive function (Lin et al., 2022; Yao et al., 2022). Episodic memory was divided into immediate word recall (score range: 0–10 points) and delayed word recall (score range: 0–10 points). Executive function was assessed using orientation, calculation, and vision construction. Orientation (score range: 0–5 points) was evaluated by asking the participants to name the date (month, day, year), current season, and day of the week. Calculation (score range: 0–5 points) was assessed using serial subtraction of seven from 100 five times. Vision-spatial ability (score range: 0–1 point) was evaluated by asking participants to draw a previously displayed figure. The total score for cognitive function was the sum of these two dimensions, with a scale ranging from 0 to 31 points, with higher scores indicating better cognitive functioning. Raw cognitive function scores were standardized to z-scores. The scale has internal consistency and a reliability coefficient of .86.

Social Engagement

In line with a previous study (Zhou et al., 2020), to measure social engagement, the participants were asked whether they had taken part in social activities in the preceding month using a multiple-choice question that encompassed 11 activities: (a) interacting with friends; (b) playing Ma-Jong, chess, and cards, or going to community clubs; (c) providing help to family, friends, or neighbors who do not live with the participant; (d) going to a sports, social, or other type of club; (e) taking part in a community-related organization; (f) doing voluntary or charitable work; (g) caring for a sick or disabled adult who does not live with the participant; (h) attending an educational or training course; (i) stock investment; (j) using the Internet; and (k) other. Each item was scored as 0 (No) or 1 (Yes). The scores across the 11 items were summed to generate the total score ranging from 0 to 11. Higher scores indicated a higher level of social engagement.

Covariates

Covariates were selected based on previous studies and divided into three groups: childhood factors, adulthood sociodemographic characteristics, and lifestyle (Roberts et al., 2022; Zheng et al., 2022). Childhood factors were parental education (both parents being literate = 1), parental occupation (both parents being farmers = 1), childhood financial situation (same as or better than others = 1), and childhood adversities (score range: 0–11 point). Based on previous studies (Ding & He, 2021; Li et al., 2020) and the indicators measured by life history questionnaire, we selected 11 indicators as childhood adversities: (a) bedridden parent; (b) parent suffering from mental illness; (c) serious physical disability of a parent; (d) being physically abused by a parent; (e) witnessing domestic violence; (f) being bullied by kids in the neighborhood; (g) being bullied by kids at school; (h) being abused by a sibling; (i) parental drug abuse; (j) parental alcohol abuse; (k) parental gambling; and (l) parent involved in criminal activities. A total score for childhood adversities, ranging from 0 to 11, was obtained by summing these indicators, with higher values representing greater adversities.

Adulthood sociodemographic characteristics were gender (female = 1), age, marital status (married = 1), residential area (rural = 1), educational attainment (upper secondary school and above = 1), and household registration status (rural hukou = 1). The nationwide household registration system, also known as the “Hukou” system, provides citizens with a legal document and divided Chinese residents into two categories: rural hukou and urban hukou (Liu, 2005). Hukou can determine access to housing, education, medical treatment, and other social welfare rights (Wu et al., 2023). Citizens with rural hukou have limited access to the above public service compared to those with urban hukou. Lifestyle factors considered were health (good or fair = 1), alcohol consumption (yes = 1), and smoking (yes = 1).

Statistical Analyses

Group comparisons, association analyses, and moderating effect analyses were conducted. First, descriptive statistical analysis and bivariate analysis were utilized to summarize sample characteristics and analyze differences between groups with and without emotional neglect. Second, fixed effects models were employed to investigate the associations between childhood emotional neglect and cognitive function, social engagement and cognitive function, and emotional neglect and social engagement. Community fixed effects models were used to reduce time-invariant confounding heterogeneity. Third, the bootstrap resampling method was applied using 10,000 re-samples of the data, and bootstrap percentile confidence intervals were computed. Relationships were considered significant if 0 was outside these intervals.

To account for possible selection bias due to missing data, bivariate attrition analyses were conducted (i.e., the chi-square test). Participants lost to follow-up and with missing values were more likely to be female (χ² = 106.49, p < .000), older (r = .11, p < .000), have rural hukou (χ² = 251.74, p < .000), unmarried (χ² = 341.44, p < .000), and have lower levels of education (χ² = 1,200, p < .000). Supplemental Table A1 displays the number of participants with missing data for the key study variables.

Robustness checks were conducted to examine the sensitivity of the main findings. First, we generated 50 imputed datasets using the multiple imputation method with chained equations to reanalyze the results. To mitigate potential self-selection bias and balance the baseline characteristics between the treatment (with emotional neglect) and control (without emotional neglect) groups, propensity score matching (PSM) with the nearest neighbor approach was used. Mediation analyses utilized the Karlson-Holm-Breen (KHB) method (Karlson & Holm, 2011).

All analyses were performed using Stata 15.0 (StataCorp). Two-tailed p < .05 indicated statistical significance.

Results

Sample Characteristics

Table 1 presents the descriptive statistics of the sample based on emotional neglect. There were 49.4% (n = 16,075) men, with a mean age of 63.45 (SD = 8.83). Moreover, 32.6% (n = 10,597) of participants experienced emotional neglect. Average scores of cognitive function and social engagement were 15.18 (SD = 5.48) and 0.98 (SD = 1.16), respectively.

Table 1.

Participant Characteristics Based on Childhood Emotional Neglect.

Participant characteristics	Total Observation	Not Neglected	Neglected	p Value
Participant characteristics	N = 32,540	N = 21,943	N = 10,597	p Value
Gender
Male	16,075 (49.40)	11,012 (50.18)	5,063 (47.78)	.000
Female	16,465 (50.60)	10,931 (49.82)	5,534 (52.22)
Current hukou
Urban hukou	6,948 (21.35)	4,488 (20.44)	2,460 (23.21)	.000
Rural hukou	25,592 (78.65)	17,455 (79.55)	8,137 (76.79)
Marital status
Married	29,802 (91.59)	20,097 (91.59)	9,705 (91.58)	.988
Single or divorced	2,738 (8.41)	1,846 (8.41)	892 (8.42)
Education
Primary school or below	19,506 (59.94)	12,921 (58.88)	6,585 (62.14)	.000
Secondary school or above	13,034 (40.06)	9,022 (41.12)	4,012 (37.86)
Current residence
Urban	7,142 (21.95)	4,547 (20.72)	2,595 (24.49)	.000
Rural	25,398 (78.05)	17,396 (79.28)	8,002 (75.51)
Health
Poor	8,101 (24.90)	5,342 (24.34)	2,759 (26.04)	.001
Good or fair	24,439 (71.10)	16,601 (75.66)	7,838 (73.96)
Alcohol consumption
Yes	8,157 (25.07)	5,477 (24.96)	2,680 (25.29)	.520
No	24,383 (74.93)	16,466 (75.04)	7,917 (74.71)
Smoking
Yes	13,012 (39.99)	8,888 (40.50)	4,124 (38.92)	.006
No	19,528 (60.01)	13,055 (59.50)	6,473 (61.08)
Parents’ occupation
Non-farmer	6,792 (20.87)	4,398 (20.04)	2,394 (22.59)	.000
Farmer	25,748 (79.13)	17,545 (79.96)	8,203 (77.41)
Parents’ education
Illiterate	17,178 (52.79)	11,750 (53.55)	5,428 (51.22)	.000
Literate	15,362 (47.21)	10,193 (46.45)	5,169 (48.78)
Childhood SES^a
Worse than others	11,954 (36.74)	7,799 (35.54)	4,155 (39.21)	.000
Better than others	20,586 (63.26)	14,144 (64.46)	6,442 (60.79)
Childhood adversities	3.96 (1.67)	3.93 (1.68)	4.04 (1.67)	.000
Age^b	63.45 (8.83)	63.33 (8.77)	63.71 (8.95)	.003
Cognitive function^b	15.18 (5.48)	15.32 (5.40)	14.89 (5.62)	.000
Social engagement^b	0.98 (1.16)	0.99 (1.17)	0.95 (1.15)	.002

p-Value was based on the chi-squared test or analyisis of variance where appropriate.

Values are means ± standard deviations.

SES = socioeconomic status.

There were significant differences in childhood emotional neglect by gender (χ² = 16.56, p = .000), hukou status (χ² = 32.44, p = .000), education attainment (χ² = 31.55, p = .000), residential area (χ² = 59.17, p = .000), health status (χ² = 24.07, p = .000), smoking (χ² = 7.51, p = .006), parental education (χ² = 15.51, p = .000), parental occupation (χ² = 28.10, p = .000), and childhood financial status (χ2 = 41.35, p = .000). The t-test results indicated that participants who experienced emotional neglect had poorer cognitive function (t = 6.64, p = .000), lower social engagement (t = 3.55, p = .0002), and more childhood adversities (t = −5.47, p = .000) than those that did not experience emotional neglect.

Relationship Between Emotional Neglect, Social Engagement, and Cognitive Function

Table 2 presents the fixed effects models for the associations between childhood emotional neglect, social engagement, and cognitive function. Participants who experienced childhood emotional neglect were more likely to have poorer cognitive function (β = −.068, p < .001) and lower levels of social engagement (β = −.061, p < .001) after controlling for childhood factors, adulthood sociodemographic characteristics, and lifestyle factors. After adjusting for social engagement, childhood emotional neglect was still negatively associated with cognitive function (β = −.063, p < .001), whereas the association was slightly weakened by the inclusion of social engagement. Social engagement was positively correlated with cognitive function (β = .076, p < .001) after adjusting for childhood factors, adulthood sociodemographic characteristics, and lifestyle factors.

Table 2.

Association of Emotional Neglect, Social Engagement, and Adult Cognitive Function: Fixed Effects Model Estimates.

Variables	Neglect and Cognitive Function	Engagement and Cognitive Function	Neglect, Engagement, and Cognitive Function	Neglect and Engagement
Variables	β (SE)	β (SE)	β (SE)	β (SE)
Emotional neglect	−.068*** (0.010)	NA	−.063*** (0.010)	−.061*** (0.013)
Social engagement	NA	.076*** (0.004)	.075*** (0.004)	NA
Control variables
Female	−.212*** (0.013)	−.217*** (0.013)	−.216*** (0.013)	.045** (0.001)
Age	−.023*** (0.005)	−.022*** (0.001)	−.022*** (0.000)	−.012*** (0.024)
Rural hukou	−.229*** (0.018)	−.207***(0.019)	−.205*** (0.019)	−.316*** (0.022)
Married	.115*** (0.017)	.122*** (0.017)	.122*** (0.017)	−.090*** (0.015)
Secondary education	.486*** (0.011)	.471*** (0.011)	.468*** (0.012)	.228*** (0.505)
Living in rural area	−.005 (0.038)	−.004 (0.038)	−.002 (0.038)	−.049 (0.007)
Good or fair health	−.053*** (0.005)	−.047*** (0.005)	−.005*** (0.005)	−.082*** (0.015)
Alcohol consumption	.011 (0.011)	−.001 (0.011)	.000 (0.011)	.142*** (0.017)
Smoking	.028* (0.013)	.034* (0.013)	.003* (0.013)	−.083*** (0.017)
Parents are farmers	−.052*** (0.013)	−.041 (0.013)	−.042** (0.013)	−.142*** (0.017)
Parents are literate	.110*** (0.010)	.010* (0.010)	.101*** (0.010)	.121*** (0.013)
Good financial status	.040*** (0.010)	.041*** (0.010)	.038*** (0.010)	.242 (0.013)
Childhood adversities	−.006* (0.003)	−.006* (0.003)	−.005 (0.003)	−.015*** (0.004)
2013	.153*** (0.013)	.134*** (0.013)	.134*** (0.013)	.247*** (0.017)
2015	−.163*** (0.012)	−.177*** (0.012)	−.178*** (0.012)	.190*** (0.016)
2018	.084*** (0.013)	.071*** (0.013)	.071*** (0.013)	.172*** (0.018)
Constant	1.56*** (0.064)	1.386*** (0.064)	1.401*** (0.064)	2.173*** (0.085)
R²	.28	.29	.29	.11

p < .05.

p < .01.

***

p < .001.

Mediating Role of Social Engagement

As Table 3 reveals, social engagement mediated the association between childhood emotional neglect and cognitive function (β = −.004, 95% CI [−0.006, −0.002], p < .05), and the mediating effects account for 7.55%.

Table 3.

Mediating Effect of Social Engagement on the Relationship Between Emotional Neglect and Cognitive Function.

Effect	β (SE)	[95% CI]
Indirect effect	−.004^* (0.001)	[−0.006, −0.002]
Direct effect	−.053^*** (0.010)	[−0.072, −0.034]
Total effect	−.057^*** (0.010)	[−0.076, −0.038]
Proportion of indirect to total effect, %	7.55%

p < .05.

***

p < .001.

Robustness Checks

A multiple imputation sensitivity analysis was performed, and the results remained unchanged (Supplemental Tables A2 and A3). As Supplemental Table A4 denotes, there was no significant difference (p < .05) in covariates between the neglected and non-neglected groups after PSM, and the standardized bias across covariates was near zero, thereby suggesting that the self-selection bias was corrected. In line with the results of the fixed effects models, the PSM estimates indicated that childhood emotional neglect predicted poorer cognitive function and lower levels of social engagement after controlling for covariates (Supplemental Table A5). After PSM, the KHB method demonstrated that social engagement mediated the association between childhood emotional neglect and cognitive function (Supplemental Table A6).

Discussion

Using a nationally representative sample of Chinese middle-aged and older adults, this study revealed that social engagement mediated the relationship between childhood emotional neglect and adult cognitive function. Overall, emotional neglect significantly predicted a higher level of cognitive impairment, with 7.6% of the association significantly mediated by social engagement.

This study extends existing knowledge by demonstrating that middle-aged and older adults who are emotionally neglected in childhood had poorer cognitive function, which is consistent with previous research using adolescent and middle-aged samples (Mills et al., 2011; Zheng et al., 2022). From a life course perspective, this finding supports the evidence that childhood emotional neglect has long-term effects on lifetime mental health and neurobiological processes (Hanson et al., 2015; Salokangas, 2022). Moreover, this study indicates that social engagement partially mediates the association between childhood emotional neglect and cognitive function. These results are in line with the attachment theory regarding individual development (Bowlby, 1969). The literature has established that neglected children are more likely to develop insecure and disorganized attachment styles (Cyr et al., 2010). Growing up without a sensitive and responsive caregiver to provide emotional support and security negatively affects social functioning and networks (Müller et al., 2019; Raby et al., 2013).

Furthermore, the findings show that middle-aged and older adults with lower social engagement are at higher risk of cognitive decline, which is in line with previous cohort studies in high-income countries (Bourassa et al., 2017; Krueger et al., 2009) and low- and middle-income countries (Oh et al., 2021; Zhou et al., 2020). These findings suggest that promoting social engagement could alleviate the harmful effects of childhood emotional neglect on cognitive impairment in middle- and older-aged adults. There are several possible explanations for the buffering effects of social engagement. First, social engagement allows middle-aged and older adults to interact and communicate with each other, which could reduce negative emotions such as loneliness, depression, or anxiety associated with cognitive impairment (Seeman et al., 2001; Zhong et al., 2017). In addition, according to the stress-buffering hypothesis proposed by Cohen and Wills (1985), social engagement reduces the effects of stress from adverse childhood experiences on health outcomes. A reduction in stress can preserve hippocampal neurons and reduce neurotoxicity, which are important factors in maintaining cognitive function during aging (Lin et al., 2022; McEwen & Sapolsky, 1995).

This study has implications for future research, policies, and interventions. The findings call for focus, awareness, and attention to emotional neglect and its prevention in developing countries, such as China. In China, many Chinese parents are less likely to show love through open communication and warm emotional expressions due to the influence of Chinese traditional culture (Wang et al., 2022). Some of them do not realize that their failure to express love and care for their children is a form of maltreatment (Li et al., 2014). Therefore, children may experience the negative effects of emotional neglect, and the effects can persist into adulthood. Studies have shown that evidence-based parenting programs can be implemented at a low cost to reduce emotional neglect in developing countries (McCoy et al., 2021). Therefore, it is necessary to provide preventative parenting programs that improve parents’ awareness and teach positive parenting practices to reduce emotional neglect among Chinese parents. Furthermore, it is important to improve the social engagement of emotionally neglected middle-aged and older adults. At present, the government, associations and societies for the elderly are in a joint effort to create a better social environment by providing platforms for learning and actively participating in social programs (Zhou et al., 2020). However, as individuals with a history of emotional neglect are reluctant to engage in social activities, how to deliver services and motivate them to participate is critical. As such, more studies are required to explore the mechanisms underlying the relationship between childhood emotional neglect and social engagement and identify methods to improve social engagement among neglected populations.

This study had several limitations. First, the measurement of childhood emotional neglect was rough and assessed using a retrospective self-report. The possibilities of recall bias and unintentional errors cannot be ruled out. Therefore, multiple data collection approaches should be adopted to improve the validity. Secondly, the CHARLS database only measured maternal emotional neglect and did not include information on paternal emotional neglect. Emotional neglect is a complex concept involving interactions and influences among multiple family members. The absence of data on paternal emotional neglect may lead to an incomplete understanding of emotional interactions, family dynamic, and their effects on children. Therefore, it is essential to include data on paternal emotional neglect, as it can offer a more comprehensive perspective and help us better comprehend the impact of the family environment on child development. Third, emotional neglect is often accompanied by other forms of neglectful behavior by parents, such as physical neglect, supervisory neglect, and medical neglect, and unmeasured variables of other forms of neglect may confound our research findings. Future research could build on the present study to control or isolate those confounding factors to explore the truly independent effect of emotional neglect on late-in-life cognitive function. Fourth, a large proportion of participants were excluded from this study due to the lack of follow-up and missing data. Those participants were mostly older people, women, living in rural areas, unmarried, and less educated, which could compromise the generalizability of the findings and introduce some potential selection bias.

Conclusions and Implications

Despite these limitations, this study has contributed to our understanding of the long-term consequences of childhood emotional neglect in the Chinese context and the role of social engagement as a mediator. The present study indicates that childhood emotional neglect is negatively associated with poorer cognitive function among middle-aged and older adults, and this association was mediated through decreased social engagement. This study suggests that policies and interventions should raise parental awareness of neglect and improve parenting skills to prevent emotional neglect. Moreover, social engagement is an effective element that could be incorporated into interventions to improve middle-aged and older adults’ cognitive function with childhood emotional neglect experience.

Supplemental Material

sj-docx-1-jiv-10.1177_08862605231198245 – Supplemental material for Childhood Emotional Neglect and Cognitive Function Among Middle-Aged and Older Adults: Mediating Role of Social Engagement

Supplemental material, sj-docx-1-jiv-10.1177_08862605231198245 for Childhood Emotional Neglect and Cognitive Function Among Middle-Aged and Older Adults: Mediating Role of Social Engagement by Weiwei Wang, Xinger Xia and Huiping Zhang in Journal of Interpersonal Violence

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This study has been supported by Public Health & Disease Control and Prevention, Major Innovation & Planning Interdisciplinary Platform for the “Double-First Class” Initiative, Renmin University of China (2023PDPC).

ORCID iD

Huiping Zhang

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Weiwei Wang, MSW, is a PhD student in Center for Studies of Sociological Theory and Method, and Department of Social Work and Social policy, Renmin University of China. Her research focuses on child maltreatment prevention and intervention, especially in rural areas.

Xinger Xia, BSW, is an MSW student in Department of Social Work and Social policy, Renmin University of China. Her research focuses on child protection and family intervention. She is the co-first author of this manuscript.

Huiping Zhang, PhD, is a professor in Center for Studies of Sociological Theory and Method, and Department of Social Work and Social Policy, Renmin University of China. Her research interests include vulnerable children and family intervention, and child protection in rural China.

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