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Child Psychiatrist /Adult Psychiatrist

Grandparental Care Linked to Worse Child Mental Health Outcomes

Grandparent care is associated with increased internalizing, externalizing, and overall mental health problems among children, according to study results published in the Journal of Child Psychology and Psychiatry. These findings indicate that grandparental care may be a risk factor for children’s mental health.


Worse Child Mental Health

Previous research has demonstrated that parental characteristics exert a major impact on children’s mental health outcomes. Given the global increase in the number of children residing in grandfamilies, investigators conducted a systematic review and meta-analysis to characterize and evaluate the effect of grandparental care on children’s mental health.

The investigators searched publication databases in November 2021 and a second-round search in June 2023 for studies that focused on grandparental care and reported at least 1 mental health outcome for grandchildren. The primary outcome of interest was children’s mental health outcomes, including internalizing problems, externalizing problems, overall mental problems, and socioemotional well-being. Additionally, the investigators evaluated potential moderators in the effects of grandparental care.


A total of 38 studies (cross-sectional: k =27; longitudinal, k =11) were included for analyses, for a pooled sample size of 344,860 children. On average, children were 10.29 years of age and there was a generally balanced gender distribution. Most studies evaluated internalizing problems (k =18), followed by externalizing problems (k =14), overall mental problems (k =10), and socioemotional well-being (k =7). Additionally, mental health outcomes were reported through child self-report (k =17), caregiver report (k =11), mental health professional report (k =3), and teacher report (k =3).


Our findings also call for more supportive preventions and early mental health interventions for children living in grandfamilies.


The investigators found that children who were cared for by their grandparents had more internalizing (d = -.20; 95% CI, -0.31, -.09; P=.001), externalizing (d = -.11; 95% CI, -0.21 to -.01; P =.03), and overall mental problems (d = -.37; 95% CI, -.70 to -.04; P =.03) and poorer socioemotional well-being (d = -.26; 95% CI, -.49 to -.03; P = -.03), relative to children without parental care. However, the wide confidence intervals suggest variability in the association between grandparental care and child mental health across populations.


When evaluating potential moderators to this relationship, the investigators observed that study design (Q =4.97; P =.03) and child gender (Q =5.96; P =.02) contributed significantly to effect size variance. Specifically, there were larger negative effects of grandparental care associated with longitudinal studies (d = -.08; 95% CI, -.53 to -.19) relative to cross-sectional studies (d = -.29; 95% CI, -.41 to -.18) and for girls (d = -.10; 95% CI, -.25 to .04) compared with boys (d = -.10; 95% CI, -.25 to .04). Recruitment setting, child age group, study region, cultural context, living area, and family type did not significantly moderate the effects of grandparental care.


“These results underscore the need for additional research on grandparental care with more nuanced and comprehensive measurements of the context and extent of grandparental care,” the investigators noted. “Our findings also call for more supportive preventions and early mental health interventions for children living in grandfamilies,” study authors concluded.


These findings may be limited by the lack of information on parental factors and family dynamics, inability to establish causal relationships, and small sample size.


Note: This article originally appeared on Psychiatry Advisor

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