Early stimulation and responsive care: a mediator of caregivers’ depression on the suspected developmental delay of left-behind children in China

Abstract Purpose: Due to multiple factors, children left behind in rural areas suffer from delayed neurodevelopment (suspected developmental delay, SDD). This study aimed to analyze the effect of caregivers’ depression on left-behind children’s SDD, with early stimulation and responsive care mediating. Methods: A cross-sectional survey was conducted in villages of five Chinese counties. A total of 904 left-behind children and their primary family caregivers were enrolled. Information on the children and their caregivers were collected through face-to-face interviews. The Zung Self-rating Depression Scale (ZSDS) was used to measure caregivers’ depressive symptoms. The Ages and Stages questionnaires, third edition (ASQ-3) was used to screen children for SDD, which contains five domains: communication (CM), gross motor (GM), fine motor (FM), problem-solving (CG), and personal social (PS). Results: Of left-behind children’s caregivers, 39.7% experienced varying symptoms of depression. The prevalence of total SDD among left-behind children under three years was 31.4%. Caregivers’ ZSDS scores were positively correlated with the FM, GM, CG, and PS of the left-behind children. Caregivers’ early stimulation & responsive care was positively correlated with the CM, FM, CG, and PS of the left-behind children. Conclusion: Left-behind children under three years in rural China were at high risk of SDD and their caregivers’ mental health was not good. Caregivers’ depressive symptoms may negatively affect the suspected developmental delay of left-behind children through caregivers providing less early stimulation and responsive care. A comprehensive intervention should be conducted to promote the health of left-behind children and their caregivers.