Parental Migration,Children’s Safety and Psychological Adjustment in Rural China: A Meta-Analysis

Abstract

Studies concerning left-behind children in rural China have shown that parental absence due to migration is associated with greater risk of child victimization and accidental injuries, and a range of psychosocial problems. The authors conducted this meta-analysis to determine the extent to which left-behind children are affected by parental migration, as compared to children in nonmigrant rural families. A comprehensive literature search was conducted, and 90 studies published before 2017 were included in the data synthesis and analysis. The results revealed that compared to non-left-behind children, rural left-behind children are generally more disadvantaged in regard to child safety (d = 0.27) and psychological adjustment (d = 0.25). The effect sizes, though interpreted as small, revealed that children in rural China are significantly affected by parental migration. Children’s educational stage was a significant variable that moderated the effect sizes of child safety and psychological adjustment. The findings of the meta-analysis indicated that mother-only migration may have the most harmful effect on children. In terms of implications for interventions, the results suggest more attention should be given to rural left-behind children and to “mother-absent children” in particular. Future research is warranted to explore the association between left-behind children’s psychological adjustment and their exposure to injury and victimization.

Keywords

left-behind children migration psychological adjustment safety meta-analysis

The left-behind children phenomenon resulting from rural-to-urban migration in China has attracted much public attention and research interest over the last decades (Chen & Sun, 2015; Lu, Lin, Vikse, & Huang, 2016). The understanding of this phenomenon is based mainly on the literature considering the impacts of parental absence on children’s developmental trajectories (Cheng & Sun, 2015; Zhao, Liu, & Wang, 2015). Empirical evidence shows that the separation of parents and their children due to family shifts and crises, such as parental divorce, separation, incarceration, and military deployment, may predict short-term or long-term negative outcomes related to the children’s psychosocial well-being (Amato, 2001; Geller, Cooper, Garfinkel, Schwartz-Soicher, & Mincy, 2012; Paley, Lester, & Mogil, 2013; Rodriguez & Margolin, 2015). In addition, children living with a single parent are more likely to become the victims of violence, abuse, and crime (Chan, 2014; Finkelhor, Vanderminden, Turner, Hamby, & Shattuck, 2014). However, no quantitative synthesis of empirical evidence in the case of left-behind children’s safety and psychological adjustment has been performed. Thus, the aim of this review is to examine the impacts of parental absence on children as a result of internal migration in China.

Massive internal migration has been ongoing in China since the reform and opening up policy was introduced in 1978. In 2014, there were 253 million Chinese internal migrants, a figure comparable to the scale of international migration (244 million) in 2015 (National Health and Family Planning Commission of the People’s Republic of China, 2015; United Nations, 2016). Migration from developing to developed regions has been the main driver of this migration trend in the past decades. In mainland China, people migrate from rural to urban areas and from central (e.g., Henan, Anhui, Hubei, Hunan, Jiangxi) and western (e.g., Guizhou, Sichuan, Chongqing, Yunnan) areas to relatively developed ones, particularly the coastal areas in the southeast (e.g., Shanghai, Jiangsu, Zhejiang, Fujian, and Guangdong). This massive internal migration over the past three decades has been accompanied by dramatic shifts within Chinese families, which have considerably altered child-rearing arrangements in rural areas. Today, one person in six in China is a migrant; however, most migrant workers face difficulties when moving their families to the cities in which they work. Many migrant workers have low incomes and live in poor accommodation (Wen & Lin, 2012). In addition, the institutional segregation caused by the household registration system between rural and urban areas restricts migrants’ access to public services such as compulsory education and medical care (Biao, 2007). As childcare in big cities is barely affordable for migrant workers, parents have no choice but to leave their children in their rural hometown. Nationwide, over 61 million children are left behind, meaning that one in every five children in China is a left-behind child (All-China Women’s Federation, 2013).

Empirical studies on single-parent families demonstrated that children of divorced parents or born to unmarried mothers experience more challenges in their lives compared to their counterparts residing with married parents in regard to academic achievement, conduct, psychological adjustment, self-concept, social adjustment, and parent–child relations (Amato & Keith, 1991; Demuth & Brown, 2004). Similarly, parental absence due to migration may also have negative impacts on the well-being of children. Children left behind are placed in a vulnerable position and are at greater risk of experiencing violations of human rights (e.g., physical protection, health care, and education), psychosocial problems, and other well-being issues. For example, in the Caribbean, parental migration adversely affects the psychological well-being, health, and education opportunities of left-behind children (Dillon & Walsh, 2012; Smith, Lalonde, & Johnson, 2004). Children in Indonesia and Thailand who have a migrant father are at higher risk of poor psychological well-being compared to children residing with both parents (Graham & Jordan, 2011). In addition, the effects of maternal absence and the effects of paternal absence might be different. In the Philippines, compared to children with migrant fathers, the children of migrant mothers are more likely to fall behind in school, even when remittances are controlled (Cortes, 2015).

Although migrant parents try to improve the living standard of their children left behind in the rural hometown by providing more economic resources, their absence significantly affects family life and child-rearing (Fan, Su, Gill, & Birmaher, 2010). As one result of internal migration, family structure in China is varied today, with a decreased number of nuclear households and more skipped generation families (Y. Wang, 2013). With one or both parents migrating elsewhere, left-behind children can be taken care of by a single parent, grandparents, other relatives, or even themselves. This change of child-rearing arrangement can affect child well-being across a range of domains, especially with regard to child safety and psychological adjustment.

Chinese Left-Behind Children’s Well-Being: Mixed and Unsynthesized Findings

The present meta-analysis of evidence related to left-behind children’s safety issues and psychological adjustment is needed for three reasons. First, during the past decade, an increasing amount of research has been done in China to quantify the effects of parental internal migration on left-behind children’s well-being, including their traumatic experiences (e.g., child abuse and neglect, bullying, injury, and suicide ideation) and psychosocial problems (anxiety, depression, loneliness, etc.). However, there is still a lack of research synthesis of these traumatic experiences of left-behind children. The rich evidence in this field has allowed us to obtain a more comprehensive picture of left-behind children by conducting this meta-analytic review.

Second, previous studies have compared the differences between left-behind children and non-left-behind children with respect to a range of outcomes; however, they have produced a wide range of results. For example, some studies found that left-behind children were not different from, or were even better than, their counterparts in regard to educational outcomes, physical health, and daily activities (Guo, 2012; Yao & Mao, 2008); such findings seem to contradict mainstream theories that left-behind children are disadvantaged.

Third, several factors that can affect left-behind children’s well-being remain unknown. For example, previous studies have found that male rural left-behind children have the highest injury rate and that children left behind at a younger age are at a higher risk of psychopathology (Fan et al., 2010; Shen et al., 2009). The living place of left-behind children, which has not been studied before, may also be associated with children’s well-being. Parental migration status, which includes mother-only migration, father-only migration, and both-parent migration, is also a potential factor that affects research findings.

Aims of the Study

Understanding the magnitude of probable negative effects caused by parental migration is key to preventing the trauma suffered by left-behind children. The major objective of the current meta-analysis was to provide a quantitative synthesis of the existing findings on the differences between left-behind children and non-left-behind children in regard to psychological adjustment (depression, anxiety, loneliness, poor mental health, and low self-concept) and child safety (accidental injury, child abuse and neglect, bullying, general victimization, suicide ideation, and sense of security). We hypothesized that compared to non-left-behind children, rural left-behind children are more disadvantaged in terms of these well-being outcomes (Hypothesis 1).

The second objective was to examine factors that moderate the impacts of parental migration. We examined the full texts of the included studies and retrieved the characteristics of the samples. Finally, three variables were tested via this meta-analysis: parental migration status, children’s educational stage, and the place where data were collected. We hypothesized that these factors contribute to the differences within the population of left-behind children (Hypothesis 2).

Method

Study Selection

Studies were retrieved by searches in Applied Social Sciences Index and Abstracts, ERIC, PsycINFO, Social Services Abstracts, Family & Society Studies Worldwide, MEDLINE, and the Chinese database CNKI. The studies were published between 1979 (when internal migration due to major economic reform began in China) and December 2016. The following terms were searched through titles, key words, and abstracts in varying combinations: (a) left-behind, migration, migrant, migrate; (b) child, student, teen, adolescent; and (c) China, Chinese.

Inclusion and Exclusion Criteria

Next, a selection was made from the articles retrieved from the electronic databases. Studies had to meet the following inclusion criteria: (a) they focused on children who had been left behind in rural China due to parents’ internal migration from rural to urban settings; (b) they examined the well-being of rural left-behind children, particularly focusing on psychological adjustment and safety issues; (c) they had a quantitative research design and included children whose parents were not migrants as the comparison group; (d) articles were based on different studies (articles based on one study were combined); and (e) they were published in English or Chinese, and Chinese articles were published in a core journal in China.

Studies were excluded from the meta-analysis if they met the following criteria: (a) they were nonempirical, qualitative, or narrative studies; (b) the research targets were other populations affected by internal migration, such as left-behind women, left-behind elderly people, and migrant children; (c) they focused on children affected by international migration; (d) they examined other outcomes only (e.g., education, behavior, physical health, nutrition); and (e) the data were not convertible, available, or sufficient.

Data Extraction and Quality Assessment

All eligible studies were coded using a detailed coding sheet. Child safety issues were further classified into six subgroups after scanning the full texts of the included studies: accidental injuries, physical child abuse and child neglect by caregivers, school bullying, general victimization, suicide ideation, and sense of security. Psychological well-being refers to loneliness and feeling of loss, anxiety and depression, lower self-concept, and general mental health status. We also coded the characteristics of participants. For instance, some studies used single-parent and both-parent migration to classify parental migration status, and some studies used father-only migration, mother-only migration, and both-parent migration as three categories; thus, in this meta-analysis, we employed both classification methods. Child participants were divided into age ranges according to their educational attainment level (e.g., preschool, primary school, and secondary school). Additionally, the economic region where data were collected was coded as a moderator variable.

Regarding the quality characteristics, the first and second authors independently assessed the quality of each identified study. We calculated the methodological quality score on the basis of a checklist comprised of 8 items pertaining to the research method (Online Appendix A). We obtained a high level of agreement in assessing the interrater reliability (Cohen’s k = .90), and disagreements were resolved by further discussion.

Statistical Analysis

We examined the differences between left-behind children and their counterparts who had not been left behind by calculating effect size using Cohen’s d, which refers to a standardized mean difference (Borenstein, Hedges, Higgins, & Rothstein, 2009). An average effect for each study was calculated in terms of psychological adjustment and safety issues, respectively. Random effects models were used for combining studies and attaining a pooled overall effect size. We used a Q statistic to test the heterogeneity, which measures if there were differences between the included studies. We further tested the probable variables that could moderate the effects of being left behind. Studies were grouped by a few available study characteristics, including parental migration status, educational stage of children, and data collection place. The Q statistic was also used to test the differences between and within groups of studies.

Publication bias was examined using a funnel plot. The asymmetry of a funnel plot usually implies that publication bias exists. We also estimated the unbiased effect size using the Trim and Fill test, a compensation technique of publication bias, and then compared it to the original effect size (Duval & Tweedie, 2000). Effect size calculations of Cohen’s d, the test of heterogeneity, moderator analyses, and the test of publication bias were completed using the Comprehensive Meta-Analysis program.

Results

Study Characteristics

A total of 90 studies that met the inclusion and exclusion criteria were selected: Nineteen studies published in English and 71 studies published in Chinese. A flow diagram describes the study selection process (Figure 1). Across the 90 studies, the sample sizes ranged from 200 to 12,938. The total number of participants was 148,568, constituting a very considerable sample, and the average number of participants included in the research was 1,651. The studies were conducted in 19 provinces covering Eastern China (Fujian, Guangdong, Jiangsu, and Shandong), Central China (Anhui, Henan, Hubei, Hunan, Jiangxi, and Liaoning), and Western China (Chongqing, Gansu, Guizhou, Shaanxi, Sichuan, Yunnan, Guangxi Zhuang autonomous region, Ningxia Hui autonomous region, and Xinjiang Uighur autonomous region). Participants were mainly recruited from schools at different educational stages. Twenty-six studies examined well-being outcomes regarding child safety, and 71 studies examined children’s psychological adjustment, with seven studies focusing on both problems (for study characteristics, see Online Appendix B). Although a number of the included studies did not report participant characteristics in detail, the majority of the identified studies achieved a high-quality score, which had clear research design and sampling method and used appropriate measurements and statistical method.

Figure 1.
Flow diagram of study selection.

Safety and Psychological Adjustment of Left-Behind Children

Various instruments were used in the selected studies to measure the above outcomes. For example, some studies specifically focused on depression and anxiety among left-behind children using the Children’s Depression Inventory, the Center for Epidemiological Studies Depression Scale for Children, the Social Anxiety Scale for Children, and the Self-Rating Depression Scale and Self-Rating Anxiety Scale; some studies used the mental health test, a scale widely used in Chinese schools that covers several mental health problems among school-age children. Regarding child victimization, the Juvenile Victimization Questionnaire was used to measure a wide range of violence, abuse, and crime against children. In some studies, child neglect was measured using a validated Chinese scale—the Chinese Rural Children Neglect Evaluation Model (Yang, Pan, Yang, Wang, & Ma, 2014; Zhong et al., 2015). In addition, self-constructed questionnaires were used to measure children’s exposure to abuse or neglect. Thus, we divided the outcomes into subgroups, and subanalyses were conducted in order to calculate the effect sizes. Significant differences were found between left-behind children and non-left-behind children with regard to child safety and psychological adjustment (Table 1).

Table 1.
Comparison of Outcome Variables Related to Child Safety and Psychological Adjustment.

Outcome k d SE 95% CI [LL, UL] Z Q

Child safety 26 0.27 0.03 [0.22, 0.33] 10.14* 135.45*

Accidental injuries 12 0.30 0.05 [0.19, 0.40] 5.58* 71.40*

Abuse and neglect 9 0.24 0.05 [0.15, 0.34] 5.04* 61.30*

Bullying 1 0.23 0.03 [0.18, 0.28] 8.58*** 0

Victimization 1 0.17 0.12 [−0.06, 0.40] 1.48 0

Suicide ideation 2 0.29 0.12 [0.05, 0.54] 2.25* 4.06*

Sense of security 2 0.33 0.05 [0.22, 0.43] 6.18* 0.54

Psychological adjustment 71 0.25 0.02 [0.21, 0.29] 11.87* 616.50*

Depression and anxiety 23 0.27 0.06 [0.16, 0.38] 4.92* 380.63*

Loneliness 19 0.29 0.03 [0.23, 0.35] 9.01* 60.27*

Poor mental health 27 0.23 0.03 [0.17, 0.29] 7.59* 185.34*

Lower self-concept 14 0.28 0.06 [0.17, 0.39] 4.93* 178.76***

*p < .05. ***p < .001.

As shown in Table 1, 26 studies explored the effects of parental migration on child safety. The pooled effect size was 0.27 under the random effects model. On the basis of the Cohen’s U3 index, this means that over 60% of left-behind children had more adverse experiences than their counterparts. In addition, all of the studies reported effect sizes larger than zero, indicating that left-behind children were at a greater risk of experiencing safety problems. On the basis of the effect sizes of specific child safety outcomes, left-behind children were exposed to more accidental injuries (d = 0.30), abuse and neglect (d = 0.24), school bullying (d = 0.23), and victimization (d = 0.17) and had a higher level of suicidal ideation (d = 0.29) and less sense of security (d = 0.33).

Seventy-one studies examined the impact of parental migration on children’s psychological well-being, including depression and anxiety (d = 0.27), loneliness (d = 0.29), poor mental health (d = 0.23), and low levels of self-concept (d = 0.28). Over 90% of the studies reported a pooled effect size larger than zero, indicating that left-behind children were at a higher risk of experiencing psychological adjustment issues (n = 64).

Effects of Moderator Variables

Because of the large degree of between-study heterogeneity of the effect sizes of child safety (Q = 133.45, p < .001) and psychological adjustment (Q = 616.50, p < .001), we further examined the probable moderator variables. The studies on the two major outcomes were further divided into subgroups on the basis of participant and study characteristics. We used two classification methods to categorize parental migration status: (a) one-parent migration and both-parent migration and (b) mother-only migration, father-only migration, and both-parent migration. As shown in Table 2, regarding child psychological adjustment, parental migration status could contribute to the significant between-group variance as a moderator variable when using either of the classification methods. In this meta-analysis, both-parent migration was found to be more harmful than one-parent migration (Q_b = 3.94, p < .05), and compared to mother-only migration and both-parent migration, father-only migration exerted a very small effect on the well-being of left-behind children (d = 0.11, Q_b = 24.00, p < .001).

Table 2.
Moderator Variable Analysis.

Moderator Group Subgroup Child Safety Psychological Adjustment

k d 95% CI [LL, UL] Q_b k d 95% CI [LL, UL] Q_b

Parental migration status (a) One-parent migration 1 0.09 [−0.11, 0.28] 1.82 7 0.13 [0.07, 0.18] 3.94*

Both-parent migration 4 0.23 [0.15, 0.32] 19 0.18 [0.16, 0.21]

Parental migration status (b) Father-only migration 3 0.16 [0.06, 0.26] 1.34 12 0.11 [0.08, 0.14] 24.00*

Mother-only migration 3 0.20 [0.05, 0.36 10 0.24 [0.19, 0.30]

Both-parent migration 4 0.23 [0.15, 0.31] 19 0.18 [0.16, 0.21]

Education Preschool and primary school 13 0.31 [0.28, 0.35] 12.35* 19 0.23 [0.21, 0.26] 7.41**

Secondary school and above 10 0.22 [0.18, 0.26] 20 0.18 [0.15, 0.21]

Economic region Eastern/coastal 1 0.36 [0.15, 0.56] 1.13 7 0.26 [0.20, 0.31] 6.47*

Western 17 0.25 [0.20, 0.30] 25 0.20 [0.17, 0.22]

Central 9 0.24 [0.20, 0.28] 29 0.18 [0.16, 0.20]

Note. In this study, Eastern/coastal China includes Fujian, Guangdong, Jiangsu, and Shandong province; Western China includes Chongqing, Gansu, Guizhou, Shaanxi, Sichuan, Yunnan province, Guangxi Zhuang autonomous region, Ningxia Hui autonomous region, and Xinjiang Uighur autonomous region; Central China includes Anhui, Henan, Hubei, Hunan, Jiangxi, and Liaoning province.p < .05. p < .01. p < .001.

Participants in the included studies were mainly selected from preschools, primary schools, and secondary schools. The educational stage of children was a significant moderator of child safety outcome (Q_b = 12.35, p < .001) and children’s psychological adjustment (Q_b = 7.41, p < .01). Left-behind children at preschools or primary schools demonstrated more psychological adjustment and safety problems. In addition, economic region (Q_b = 6.47, p < .05) was a significant moderator for the between-group variance regarding the outcome of psychological adjustment. It appears that left-behind children from eastern/coastal China were much more disadvantaged on psychological adjustment compared with their counterparts.

Testing for Publication Bias

We used funnel plots to examine the publication bias. For both child safety and psychological adjustment, the majority of the included studies were distributed symmetrically around the combined effect size (Figures 2 and 3). However, the presence of bias should be noted because there are some small studies (which may have low methodological quality), especially child psychological well-being studies, that published larger effect sizes (Figure 3). More studies concentrated on the right side of the mean effect size; thus, the calculated effect size might be larger than the unbiased effect size. The Trim and Fill test also estimated that the unbiased effect sizes should be smaller than the calculated values. This result indicated that some studies with insignificant or smaller effect sizes were not published.

Figure 2.
Funnel plot of standard error by standard difference in means—child safety.

Figure 3.
Funnel plot of standard error by standard difference in means—child psychological adjustment.

Discussion

A meta-analytic review of the impacts of migration on left-behind children in China in terms of their safety and psychological adjustment has been missing to date. This meta-analysis examined the extent to which left-behind children are more disadvantaged than their counterparts who are not left behind. Moreover, moderator analyses were performed in order to identify variables that may affect the effects parental migration has on children. The study synthesized the results of 90 studies published in English or Chinese with a very large sample size.

In general, consistent with the first hypothesis, the findings of this meta-analysis demonstrate that left-behind children have lower levels of well-being, including a greater prevalence of safety issues (d = 0.27) and psychological adjustment issues (d = 0.25). Thus, the results indicate that parental migration is associated with reduced child well-being, although it is regarded as a type of temporary parental absence (Rodriguez & Margolin, 2015). Parental absence means generally decreased contact between children and parents and also decreased support and resources for children’s development (Brown, 2010). The migration situation usually hampers parents from providing childcare effectively and efficiently, and the lack of adequate parental care and supervision can result in children experiencing developmental and behavior problems (Black et al., 2017).

It should be noted that the effect sizes for child safety issues and psychological adjustment issues are interpreted as small on the basis of the criteria for effect size interpretation (Cohen, 1992). A few points can explain the small overall effect sizes. First, many migrant parents in China often try to create good living arrangements in order to minimize the negative effects on left-behind children; for example, to ensure sufficient care for their children, migrant parent(s) will appoint responsible guardians, such as the nonmigrant mother and grandparents (Chen & Sun, 2015). Second, migrant parents try to make phone calls and send remittances regularly in order to reduce their children’s feelings of loss (Ye & Pan, 2011). Therefore, the absence of parents may be compensated to some extent.

However, the negative impacts of parental migration cannot be ignored. Left-behind children have a higher prevalence of safety problems according to the pooled effect size of 26 studies. Compared to children who live with both parents, left-behind children usually have a lower sense of security and higher levels of suicide ideation. Supportive parenting can reduce children’s adverse childhood experiences and prevent internalizing behaviors (Gini & Espelage, 2014). However, left-behind children often have less parental supervision, which increases their suicide risk. Left-behind children are also at higher risk of injuries, farm-related injuries in particular; this may be because left-behind children are regarded as an important labor force when the adults are working outside (Shen et al., 2013). Parental absence due to migration also increases the risk of child abuse and neglect among left-behind children as left-behind children have less parental supervision and support. This increased risk of child abuse and neglect may also be due to the fact that left-behind women and elderly, as the caregivers of left-behind children, often suffer from parenting stress and bear the burden of life (Mu & Van de Walle, 2011). It should be noted that there was wide variance across the group of studies that measured child safety; for example, the heterogeneity was highly significant in the studies on abuse and neglect among rural children (Q = 61.30, p < .001), perhaps reflecting the inconsistency in the measurements of child abuse and neglect across different studies.

This study finds that left-behind children experience a higher degree of depression, anxiety, loneliness, stress, and other mental health problems. In addition to this, left-behind children have lower levels of self-concept and self-esteem, both of which are associated with higher risks of mental health problems. This result is consistent with previous reviews (i.e., X. Wang et al., 2015; L. Wang & Mesman, 2015). In addition, previous individual studies (i.e., Chan, 2013; Cole et al., 2016) have identified an association between child victimization and mental health issues, which is consistent with the finding of one study of left-behind children (Chen & Chan, 2016) included in the meta-analysis.

The findings of the meta-analysis also provide support for the second hypothesis that several factors could moderate the impacts of parental migration on left-behind children’s well-being. A few factors that seemed to explain some of the differences between the subgroups of left-behind children were found. For example, children’s educational stage was a significant moderator in regard to both child safety issues and psychological issues; this implies that children who are left behind at a younger age are more affected by their parents’ migration. Parental migration status was another significant moderator of children’s psychological adjustment. Specifically, the meta-analysis indicated that mother-only migration is more harmful than father-only migration; this is because mothers are usually the dedicated caregiver. It is interesting to note that mother-only migration was found to be even more harmful for children than both-parent migration. This finding may reflect a selection bias among the studies (Wen & Lin, 2012). Compared to mothers who are forced to work in distant and big cities, fathers who are willing to be left behind may be less able or motivated to become the breadwinner in the family. Consequently, they may be less responsible for and capable of taking care of left-behind children. One-parent migration is found to be less harmful compared to both-parent migration; this may be because mother-only migration was the least common type in the studies included in this meta-analysis. This is consistent with the sixth population census in China, in which mother-only migration (16.87%) was less common compared to both-parent migration (46.74%) and father-only migration (36.39%). Economic region also significantly moderated the effects of parental migration on left-behind children, with children from eastern/coastal China being affected more. The smaller effect sizes in western and central areas of China reflect smaller differences between left-behind children and non-left-behind children in these areas compared to in eastern/coastal China; however, they could also indicate that rural children in less developed areas are generally living in unfavorable situations.

Strengths and Limitations

This meta-analysis has several strengths. The present study is the first meta-analytic review synthesizing the evidence on child safety and psychological adjustment among left-behind children in rural China. This study quantitatively describes the risks of left-behind children facing a range of problems and identifies the factors that could moderate children’s negative experiences as a result of parental migration.

The limitations of this study should also be noted. First, the number of studies focusing on child safety was relatively small, which prevented the exploration of moderator variables to some extent. Second, unpublished studies were not included in the present study, and although we used compensation technique, publication bias should be considered when interpreting the findings. Third, wide variation in the effect sizes was found, and thus further moderator analysis is necessary to identify risk factors for the poor well-being of left-behind children. However, most of the studies did not provide sufficient information about the profiles of left-behind children, their parents and caregivers, or more complicated family dynamics (e.g., sibling information, duration of parental migration, social support, parental marital status, socioeconomic status). We therefore could not conduct further nuanced analyses. Fourth, the causal impacts of parental migration on children’s well-being are still unclear because the vast majority of studies included in the meta-analysis were cross-sectional studies comparing the differences between left-behind children and non-left-behind children. Also, we could not examine whether children are less (or more) affected as they grow older.

Implications for Research

This study indicates that the absence of parents (especially mothers) due to migration adversely affects the children who are left behind. However, because the well-being of children is affected by a range of factors at multiple levels, it will be meaningful to explore how other factors (such as the caregivers’ parenting practice, peer influence, school environment, and public services) influence left-behind children’s well-being and to investigate protective factors that could help compensate for the absence of parents. Also, because almost all of the studies included in the meta-analysis were cross-sectional studies, longitudinal research regarding left-behind children’s well-being is strongly recommended to investigate the causality between parental migration and child well-being.

While the left-behind children phenomenon has been thoroughly recognized in China, with considerable empirical research evidence, the issue of left-behind children is just beginning to attract attention in the European Union (EU), with sparse and mixed evidence (Bélorgey et al., 2012). Additionally, according to our search, the evidence regarding the well-being of left-behind children in other Asian countries is limited. Future research regarding the impacts on the well-being of left-behind children in the EU or developing countries in Southeast Asia is suggested.

Implications for Policy

This review of the existing research addresses the first step that should be taken in regard to the provision of public services to rural children affected by migration; it finds that left-behind children are living in more disadvantaged situations compared with those who have not been left behind. Left-behind children in rural China suffer from the separation from their parents, feel lonely and stressed, and are at risk of a range of safety problems. To mitigate these effects, policy makers should consider a more flexible household registration system in China that would encourage families to reunite. Understanding the challenges in left-behind children’s lives, we should provide more quality social services that meet the needs of left-behind children to improve their well-being and living environments; for example, child protection agencies could provide nonmigrant parents (especially the fathers) and other caregivers with parent education services, thereby improving their capabilities in taking care of their children.

Conclusion

Along with the expanding migrant population in China, the number of left-behind children may even increase over the next decade. The issues of rural left-behind children are long term, complex, and urgent. Parental presence is important for children’s socialization and development. The current review shows that children of migrant parents are more disadvantaged with regard to child safety issues and psychological well-being. When addressing the negative effects on children caused by parental migration, local governments, rural communities, schools, and relatives need to work together to create a supportive network.

Supplemental Material

Supplemental Material, 6._Appendixes_-_revision_2 - Parental Migration, Children’s Safety and Psychological Adjustment in Rural China: A Meta-Analysis

Supplemental Material, 6._Appendixes_-_revision_2 for Parental Migration, Children’s Safety and Psychological Adjustment in Rural China: A Meta-Analysis by Mengtong Chen, Xiaoyue Sun, Qiqi Chen and Ko Ling Chan in Trauma, Violence, & Abuse

Outcome	k	d	SE	95% CI [LL, UL]	Z	Q
Child safety	26	0.27	0.03	[0.22, 0.33]	10.14***	135.45***
Accidental injuries	12	0.30	0.05	[0.19, 0.40]	5.58***	71.40***
Abuse and neglect	9	0.24	0.05	[0.15, 0.34]	5.04***	61.30***
Bullying	1	0.23	0.03	[0.18, 0.28]	8.58***	0
Victimization	1	0.17	0.12	[−0.06, 0.40]	1.48	0
Suicide ideation	2	0.29	0.12	[0.05, 0.54]	2.25*	4.06*
Sense of security	2	0.33	0.05	[0.22, 0.43]	6.18***	0.54
Psychological adjustment	71	0.25	0.02	[0.21, 0.29]	11.87***	616.50***
Depression and anxiety	23	0.27	0.06	[0.16, 0.38]	4.92***	380.63***
Loneliness	19	0.29	0.03	[0.23, 0.35]	9.01***	60.27***
Poor mental health	27	0.23	0.03	[0.17, 0.29]	7.59***	185.34***
Lower self-concept	14	0.28	0.06	[0.17, 0.39]	4.93***	178.76***

Moderator Group	Subgroup	Child Safety	Psychological Adjustment
Parental migration status (a)	One-parent migration	1	0.09	[−0.11, 0.28]	1.82	7	0.13	[0.07, 0.18]	3.94*
Both-parent migration	4	0.23	[0.15, 0.32]		19	0.18	[0.16, 0.21]
Parental migration status (b)	Father-only migration	3	0.16	[0.06, 0.26]	1.34	12	0.11	[0.08, 0.14]	24.00***
Mother-only migration	3	0.20	[0.05, 0.36		10	0.24	[0.19, 0.30]
Both-parent migration	4	0.23	[0.15, 0.31]		19	0.18	[0.16, 0.21]
Education	Preschool and primary school	13	0.31	[0.28, 0.35]	12.35***	19	0.23	[0.21, 0.26]	7.41**
Secondary school and above	10	0.22	[0.18, 0.26]		20	0.18	[0.15, 0.21]
Economic region	Eastern/coastal	1	0.36	[0.15, 0.56]	1.13	7	0.26	[0.20, 0.31]	6.47*
Western	17	0.25	[0.20, 0.30]		25	0.20	[0.17, 0.22]
Central	9	0.24	[0.20, 0.28]		29	0.18	[0.16, 0.20]

Footnotes

Declaration of Conflicting Interests

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

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work described in this article was fully supported by a grant from the Central Policy Unit of the Government of the Hong Kong Special Administrative Region and the Research Grants Council of the Hong Kong Special Administrative Region, China [HKU 7001-SPPR-12].

Supplemental Material

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