Isobella looks the picture of health and happiness. She retired just a couple of years ago from her job as a designer with Hats4GoodElves, a job she’d had ever since she migrated here with her two young children almost 30 years ago. Still, few days pass when I wouldn’t see her out and about the woodland.
One day I asked her what was her secret to maintaining her youthfulness. In her nice accent, she said “Oh, you know, I just like to be active and eat my fruits. I must talk more to you again, but I’m off to meet young Claude for lunch as we do every Tuesday.”
I always marvel at how Isobella now speaks the local Elvish dialect better than most of us who grew up here. To think that the day they moved into that cottage was her first day away from her home country.
I thought about our brief conversation. Of course healthy eating and activity are well-known to influence mental wellbeing. Then I thought of her sitting down for lunch for a weekly catch-up with her son. Claude was always so intelligent and hardworking; he even returned to university to get his MBA last year. Could that regular interaction with Claude be contributing to her healthy ageing? I decided to search for recent research about adult children’s influence on their parents’ well-being.
Sure enough, the Journal of Gerontopsychology and Geriatric Psychiatry recently published an article by Sabater and Graham entitled The Role of Children’s Education for the Mental Health of Ageing Migrants in Europe. The study looked at educational attainment of second-generation migrants and how that influenced their parents’ likelihood of experiencing depression. The authors also examined whether effects varied depending on the parents’ own levels of education, or on their level of interaction with their adult children.
The authors gave an overview of past research and theory in two separate areas.
The first is on migrant health. On the one hand, migrants encounter many stressors which might lead to poorer health. Furthermore, migrants can experience both discrimination and social disadvantage in their adopted society which can impede their access to healthcare and compound other stressors.
On the other hand, there is the idea of the ‘healthy migrant’. People with the fortitude to emigrate from their society are likely to be among the healthiest members of that society and therefore are likely to be above average health in the society they migrate to. However, the authors point to evidence from Stronks (2003) and from Nazroo (2006) that while younger migrants may be above average health, with passing years, ageing migrants experience larger declines in health than the general population.
Second, the authors describe ‘health transfers’, the impact of one person’s health advantages on another person; specifically ‘upward intergenerational transfers’ from a child to their parents. The mechanisms through which these transfers might flow include, for example, translation of health information, assistance accessing resources, as well as boosted esteem and satisfaction at witnessing one’s children’s achievements. The authors adopt a novel approach by uniting these two strands of literature.
Methods, data and an important limitation
The data used were from the Survey of Health, Ageing and Retirement in Europe (SHARE) study.
The design was cross-sectional, using the baseline wave of data, collected in 2004.
Analyses are restricted to eight central European countries with long-established migration patterns. The authors justify this decision on the basis that introducing countries such as Spain and Greece where people now retire to would distort the picture they wish to focus on, namely older immigrants who migrated during their youth. Participants with no children were excluded, leaving a study sample of:
- 10,518 people,
- 1,029 foreign-born, and
- 9,489 native to country in which they were surveyed.
The outcome under study was clinical depression as identified by reporting four of the 12 symptoms listed on the Euro-D inventory. SHARE participants were asked for the highest educational qualifications of up to four children, though the researchers chose to focus on the oldest child. Participants also reported on how frequently they interacted with their children. The researchers have adjusted for international variations by using a multilevel design, which is highly appropriate.
A limitation only mentioned briefly in the introduction and revisited in the discussion, is that children’s education and parents’ mental health may be positively associated for many reasons other than a health transfer. A healthy parent like Isobella may be better able to support her children’s learning than someone with poorer health, with the result that better outcomes are experienced by them.
The authors highlight another issue which is that migration may be motivated by opportunities for education, meaning the problem of disentangling a causal direction may be even more difficult for migrants. Similarly, regular interactions with children will be easier to maintain for a healthy person like Isobella. No method to adjust for these sources of confounding are proposed and the authors say as much; therefore I suggest that rather than treat the patterns observed not as protective effects influencing mental health per se, but as factors associated with better mental health.
Notwithstanding the prior caveat, strong relationships are observed between all the variables of interest:
- Immigrants were much more likely to reach the threshold for a depression diagnosis on the Euro-D scale. This relationship remained even after several other factors were adjusted for.
- Immigrants had lower current participation in education, though their overall attainment record was similar to non-immigrants.
- There is a relationship between parents’ educational attainment and children’s, but not a perfect correlation.
- Children’s post-compulsory education is associated with lower incidence of depression. This is independent of the positive association between an individual’s education and better health. This is found for both immigrants and non-immigrants, though it is difficult to say whether the association is stronger for immigrants, as the authors do not show confidence intervals around their estimates, opting instead for standard errors.
- Those with more frequent contact with children are also less likely to be in the depressed range of scores.
The authors make an additional claim for which I don’t see clear evidence (again, in the absence of confidence intervals); namely that the effect of children’s education is stronger for those who see their children more frequently.
This evidence suggests that Isobella’s son Claude having an MBA might benefit her, but does not rule out that Claude may owe some of his educational attainment to his mother’s good health and wellbeing. Furthermore, it may be that Isobella is not the only elder in the woodland benefitting from the education of their younger elves, as both immigrants and non-immigrants have better mental health where their children have better educational attainment.
For policy-makers, more robust evidence in this area should be of interest. Migrants can be a hard-to-reach group for health service providers. If it is shown to be the case that educating migrants will improve family-level health outcomes, then the potential savings accruing from investing in young migrants’ education could yield long-term savings, as well as general societal welfare. However, the current study should, as the authors say, be viewed as exploratory and not as sufficient evidence to support policy change.
Sabater A, Graham E. (2016) The Role of Children’s Education for the Mental Health of Aging Migrants in Europe. Gero-Psych (2016), 29, pp. 81-92. DOI: 10.1024/1662-9647/a000145.
Stronks K. (2003) Public Health research among immigrant populations: Still a long way to go. European Journal of Epidemiology, 18, 841–842.
Nazroo JY. (2006) Ethnicity and old age. In J. A. Vincent, C. Phillipson, M. Downs (), The futures of old age. London: Sage.
very timely piece by @John_ADRC @Mental_Elf
Migrant mental health may improve with children’s educational success https://t.co/ShQvJdtYEq
Today @John_ADRC on the role of children’s education for the mental health of ageing migrants in Europe https://t.co/w9XZO8beSE
@Mental_Elf @John_ADRC @WeCYPnurses @WeNurses @CYPNAUK
Thanks for the top blogs this week!
@dr_know https://t.co/22QOOTquX7… https://t.co/ha21UhnUhm
Migrant #mentalhealth may improve with children’s educational success https://t.co/3svGuSWwbD A look at the #evidence from @Mental_Elf
Migrant mental health may improve with children’s educational success https://t.co/w9XZO8beSE https://t.co/BnnAt1KmDY
https://t.co/0avWDZ9uVI. Migrants #mentalhealth and #education