Caregivers’ depressive symptoms and social–emotional development of left-behind children under 3 years old in poor rural China: The mediating role of home environment

We explored the influence of caregivers’ depressive symptoms on the social–emotional development of left-behind children in rural China through a cross-sectional study in five counties from five provinces in middle-western China. We visited 847 left-behind children aged under 3 years and their primary caregivers at home, collecting demographic and anthropometric data of children and caregivers through face-to-face interviews. Depressive symptoms of caregivers were measured using the Zung Self-rating Depression Scale (ZSDS). Home environment was assessed using the Infant-Toddler Home Observation for Measurement of the Environment inventory (IT-HOME). Children’s social–emotional development was evaluated using the Chinese version of Ages & Stages Questionnaires: Social–Emotional (ASQ:SE-C). Of the left-behind children, 37.19% had social–emotional problems, and 40.02% of caregivers reported depressive symptoms. Caregivers’ depressive symptoms were positively correlated with social–emotional problems in left-behind children. This association was mediated by home environment, which explained 15.62% of the total effect. Among the six domains of the IT-HOME, responsivity, acceptance, involvement, and variety mediated the relationship between caregivers’ depressive symptoms and children’s social–emotional problems. The social–emotional development of left-behind children under 3 years old in the surveyed area of rural China was poor, especially in children whose caregivers exhibited depressive symptoms. Comprehensive intervention addressing caregivers’ mental health and the home environment could benefit left-behind children and their families.