Grandparents caring for grandchildren has increased globally in the past two decades, but we have a limited understanding of its effects on custodial grandchildren’s mental/behavioral health and educational outcomes. This mixed-methods systematic review aims to synthesize mental/behavioral health and educational outcomes of custodial grandchildren within custodial grandparent-headed families and with comparison to other types of household structure, and further examine factors associated with these outcomes.
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a comprehensive literature search in seven databases, including ERIC, Family Studies Abstracts, PsycINFO, PubMed, Scopus, Social Work Abstract, and SocINDEX, in March 2021. Key search concepts used for literature searches were custodial grandparents, education, and behavioral health outcomes. The search yielded 14,515 articles, and screening was facilitated by COVIDENCE. The inclusion criteria were (1) articles that examined mental/behavioral health or educational outcomes of custodial grandchildren (i.e., those who were raised by grandparents with no biological parents in the household); (2) were observational studies; (3) were empirical studies; and (4) were published since 2000 in peer-reviewed journals in English. The mixed-methods appraisal tool was used for the quality assessment of included studies (Hong et al., 2018).
A final set of 42 articles, including 33 quantitative, seven qualitative, and two mixed-methods studies, were included for review. These 42 studies examined mental/behavioral health and educational outcomes of custodial grandchildren in 10 countries, including Australia (N=1), China (N=1), Kenya (N=1), Korea (N=1), Indonesia (N=1), Malawi (N=1), Philippines (N=1), Spain (N =1), Thailand (N=2), and the United States (N=32). Regarding mental/behavioral health outcomes, this review included 38 studies that covered a wide range of mental/behavioral health outcomes, including internalizing and externalizing behavioral problems, social-emotional skills, delayed developmental outcomes, mental disorders, substance use, risky sexual behaviors, bullying, and delinquent behaviors. Regarding educational outcomes, this review included 15 studies that examined custodial grandchildren’s academic performance (e.g., grade, writing, reading, and math skills), attitude toward school, and school bonding. Multi-level factors associated with mental/behavioral and educational outcomes of custodial grandchildren both within custodial grandparent-headed families and in comparison with other household structures/care were identified. Regarding factors associated with children’s mental/behavioral health, child and grandparent level factors (e.g., demographics, parenting, depression, family environment) were the most significant predictors. Grandchildren’s academic performance was related to challenges facing grandparents themselves (e.g., poverty, low education, declined physical and mental health condition, parenting stress, lack of school engagement and communication, lack of understanding of new educational expectations and curriculum) and grandchildren’s mental/behavioral problems.
Conclusions and implications
This review provides new insight into mental/behavioral health and educational outcomes of custodial grandchildren by synthesizing research evidence in 10 countries. Our findings reveal that custodial grandchildren have worse mental/behavioral problems and educational outcomes compared to those who are raised by parents but may fare better than or the same as those who stay in institutional care and foster care. This review also highlights the need to develop and examine interventions that aim to improve grandchildren’s mental/behavioral health and educational outcomes across the world.