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Key Points Question Is the labor migration of parents in China associated with nonsuicidal self-injury (NSSI) or suicidality among children, adolescents, and young adults who were left behind, and are there sex differences in any association? Findings In this cross-sectional study in China of 15 312 participants, labor migration of the father or of both parents was associated with 1 to 4 (but not ≥5) episodes of NSSI in 1 year and with suicidality among offspring, whereas differential associations by sex were minimal. In addition, higher odds of experiencing 1 to 4 episodes of NSSI were found for offspring who were initially separated from 1 or both parents at preschool age. Meaning These findings suggest that interventions to address NSSI should consider potential associations with parental migration., Importance The labor migration of parents in China often leaves children behind, which may be adversely associated with children’s health. However, few studies have assessed the association of parental migration with nonsuicidal self-injury (NSSI) or with suicidality among their offspring. Objective To examine the associations of parental labor migration with NSSI and with suicidality as well as potential differential associations by sex among offspring left behind. Design, Setting, and Participants This nationwide cross-sectional study was conducted from February to October 2015 among individuals aged 11 to 20 years from 45 public middle and high schools across 5 provinces of China. Data analysis was performed from November 1, 2020, to March 1, 2021. Exposures Parental labor migration, including parental migration status (yes vs no), migration pattern (father, mother, or both), and the child’s age at the initial parent-child separation. Main Outcomes and Measures Less frequent (1-4 episodes) NSSI, more frequent (≥5 episodes) NSSI, suicidal ideation, and suicide attempt in the past year were measured using validated questionnaires. Multinomial or binomial logistic regression analyses were used separately to estimate adjusted odds ratios (aORs) and 95% CIs of the associations between parental migration and NSSI, suicidal ideation, or suicide attempt. Potential covariates (demographic, family-level, and psychological characteristics) were adjusted for in 3 sequential models. Results A total of 15 312 participants (7904 male [51.6%] and 7408 female [48.4%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) were included. Of those participants, 5963 (23.3%) experienced parental migration. The 12-month prevalence of less frequent NSSI was 17.2% (2635 of 15 312), the 12-month prevalence of more frequent NSSI was 11.6% (1783 of 15 312), the 12-month prevalence of suicidal ideation was 15.2% (2335 of 15 312), and the 12-month prevalence of suicide attempt was 3.5% (535 of 15 312). Parental migration was associated with less frequent NSSI (adjusted odds ratio [aOR], 1.13; 95% CI, 1.03-1.24); no significant association of parental migration with more frequent NSSI (aOR, 1.01; 95% CI, 0.90-1.13), suicidal ideation (aOR, 1.00; 95% CI, 0.90-1.10), or suicide attempt (aOR, 1.09; 95% CI, 0.90-1.33) was identified. Compared with children whose parents did not migrate, the aOR for less frequent NSSI for participants whose father migrated was 1.18 (95% CI, 1.06-1.31), and the aOR for less frequent NSSI for participants having both parents migrate was 1.12 (95% CI, 1.01-1.28). Compared with children whose parents did not migrate, participants who experienced initial separation from 1 or both parents at preschool age had an aOR for less frequent NSSI of 1.16 (95% CI, 1.03-1.31). No sex disparities were found in these associations except for participants who experienced initial separation from 1 or both migrant parents at preschool age, for which the aOR for more frequent NSSI was higher among male (aOR, 1.27; 95% CI, 1.04-1.55) than female (aOR, 0.96; 95% CI, 0.77-1.19) participants. Conclusions and Relevance This cross-sectional study found that parental migration, mainly of the father or of both parents, or an initial separation of children at preschool age from 1 or both parents who migrated was associated with higher odds of experiencing 1 to 4 NSSI episodes in 1 year among offspring. Overall, the associations of parental migration with NSSI and suicidality were similar between male and female participants., This cross-sectional study examines whether migration of 1 or both parents is associated with risk of nonsuicidal self-injury or suicidality and whether the risk differs by sex among the children, adolescents, and young adult offspring left behind in China.

Prolonged separation from migrant parents may lead to child development risks, despite the potential benefits from improved financial circumstances. Within the substantial literature on the health and well-being of the so-called left-behind children, the cognitive impact of parental migration has been inconclusive across different settings globally. In this issue, Hou et al.'s study in rural China focused on school-age children who experience persistent absence of both migrant parents since infancy, and revealed disadvantages in language comprehension outcomes among these children, despite the mitigating effect of higher household income. While results from this study are limited to the ongoing parent-child separation, previous absence of migrant parents has been suggested to have long-lasting negative effects in studies of adolescents in reunited families. Findings from Hou and colleagues' study highlight the needs to better understand migration-related parent-child separation during sensitive developmental periods in infancy and early childhood. A spectrum of risk due to parental migration should be established, accounting for the timing and duration of migration and care arrangements, in order to better identify the at-risk children in communities affected by out-migration. Future research should further explore the mediating and moderating factors in child's environments, and evaluate post-separation adjustment among reunited families after parents' return migration. Research evidence on these aspects will inform the development of tailored intervention programs for left-behind children, and strengthen the abilities of families and communities in best serving the needs of children affected by prolonged parental absence.

Purpose Prolonged separation from migrant parents raises concerns for the well-being of 60 million left behind children (LBC) in rural China. This study aimed to investigate the impact of current and previous parental migration on child psychosocial well-being, with a focus on emotional and behavioral outcomes, while considering factors in family care and support. Methods Children were recruited from schools in migrant-sending rural areas in Zhejiang and Guizhou provinces by random stratified sampling. A self-administered questionnaire measured children’s psychosocial well-being, demographics, household characteristics, and social support. Multiple linear regression models examined the effects of parental migration and other factors on psychosocial difficulties. Results Data from 1930 current, 907 previous, and 701 never LBC were included (mean age 12.4, SD 2.1). Adjusted models showed both previous and current parental migration was associated with significantly higher overall psychosocial difficulties, involving aspects of emotion, conduct, peer relationships, hyperactivity, and pro-social behaviors. Parental divorce and lack of available support demonstrated a strong association with greater total difficulties. While children in Guizhou had much worse psychosocial outcomes than those in Zhejiang, adjusted subgroup analysis showed similar magnitude of between-province disparities regardless of parental migration status. However, having divorced parents and lack of support were greater psychosocial risk factors for current and previous-LBC than for never LBC. Conclusions Parental migration has an independent, long-lasting adverse effect on children. Psychosocial well-being of LBC depends more on the relationship bonds between nuclear family members and the availability of support, rather than socioeconomic status.

Internal and international migration impacts family structure, parent–child relationships, and child care arrangements for the world’s ∼1 billion migrants.1 When parents migrate without their children, this experience of prolonged separation has profound repercussions on children’s development and well-being. Because international migration disrupts family systems globally, internal migration, such as rural-to-urban migration in low- and middle-income countries, also has massive impacts. In China alone, 61 million rural children are living apart from their parents who have migrated to urban areas.2 These so-called “left-behind children” comprise 34% of all rural children and 22% of the total child population in China.2 The well-being of children who are affected by parental migration has raised concerns worldwide. Although labor-related migration tends to improve a family’s socioeconomic circumstances, a prolonged separation from migrant parents can place children at an increased risk for psychosocial disorders.3 Even reunification with parents may lead to additional distress because of an abrupt restructuring of family dynamics.4,5 Despite the many clinical implications of parental migration and family separation, little information is available to help clinicians understand how parental migration may affect mental and behavioral development in children. Migrant parents often leave their children behind in the pursuit of employment even in Asian cultures, in which family connection is emphasized as the major source of identity and protection. Factors that prevent migrant parents from bringing their children along include residence permit policies, a high cost of living, and a lack of access to child care and education. … Address correspondence to Chenyue Zhao, PhD, Department of Child and Adolescent Psychiatry, School of Medicine, New York University, 1 Park Ave, 7th Floor, New York, NY 10016. E-mail: chenyue.zhao{at}nyumc.org