Association of Caregiver Mental Health and a Childhood Parenting Intervention in China

OBJECTIVES This study examines whether and how caregiver mental health symptoms influence the impacts of a center-based parenting intervention on child development. METHODS We conducted a clustered randomized controlled trial across 100 rural villages in China between 2016 and 2019. Villages were randomly assigned to a treatment group that received weekly 1-on-1 parenting sessions through parenting centers or to a pure comparison group. A total of 2554 caregiver–child dyads with children aged 6 to 24 months were surveyed at baseline, and 2044 completed the endline survey after 1 year (follow-up rate: 80.0%). Child development was assessed using the Bayley Scales of Infant Development, Third Edition. Caregiver mental health was measured using the Depression Anxiety and Stress Scale-21. Ordinary least squares regressions with interaction terms were used for analysis. RESULTS The intervention significantly improved cognitive (β = 0.17 SD; 95% CI 0.045–0.29) and language development (β = 0.10 SD; 95% CI 0.00–0.21) among children whose caregivers did not exhibit depressive symptoms at baseline. Positive cognitive effects were also observed among children of caregivers with low anxiety (β = 0.13 SD; 95% CI 0.00–0.26) or low stress (β = 0.15 SD; 95% CI 0.03–0.27). In contrast, no significant effects were detected across developmental domains among children whose caregivers exhibited mental health symptoms. Heterogeneous impacts were driven by differences in stimulating parenting practices rather than program attendance or parenting beliefs. CONCLUSIONS The intervention primarily benefited children whose caregivers had no baseline mental health symptoms, suggesting caregiver mental health moderates intervention effects.