Migration of Children and Impact on Depression in Older Parents in Rural Thailand, Southeast Asia

Context: Migration is feared to be associated with abandonment and depression in older parents left behind in rural areas of low- and middle-income countries. Objective: To test for prospective associations between (1) out-migration of all children and subsequent depression in parents and (2) having a child move back and an improvement in parents' depression. Design: A cohort study with a 1-year follow-up. Setting: A population-based study nested in a demographic surveillance site of 100 villages in rural Thailand. Most out-migration is to the capital city. Participants: A stratified random sample of 1111 parents 60 years and older (1 per household) drawn from all 100 villages, of whom 960 (86%) provided depression data at follow-up. Main Outcome Measures: Scoring 6 or more on the Thai version of the EURO-D depression scale at follow-up. Results: Depression prevalence was 22%. At baseline, 155 (16%) had all their children migrated from the district and 806 (84%) had at least 1 child living in the district. Having all children out-migrated at baseline, compared with having none or some children out-migrated, predicted a smaller odds of depression, after controlling for baseline sociodemographic and health measures (odds ratio [OR], 0.43; 95% CI, 0.20-0.92). Having a child move back in the study year was associated with greater odds of depression at follow-up when adjusted for baseline measures (OR, 1.75; 95% CI, 1.04-2.94), although this was no longer significant after adjusting for changes in disability and marital status since baseline (OR, 1.72; 95% CI, 0.99-2.98). Conclusions: Contrary to our hypothesis, parents whose children are not migrants may be at greater risk of depression than those with migrant children. More understanding is needed about the risks for depression in older rural populations and about the effectiveness of interventions. JAMA Psychiatry. 2013;70(2):226-234. Published online December 3, 2012. doi:10.1001/jamapsychiatry.2013.271