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UDC: 616-053.2:159.9:314.745.3
PSYCHOSOCIAL STRESSORS AS A RISK FACTOR FOR CHRONIC DISEASES IN
CHILDREN OF LABOR MIGRANTS
Мirzayeva Мakhpora Мamadaliyevna
Department of Basics of Preventive Medicine,
Andijan State Medical Institute ,Republic of Uzbekistan
Relevance:
Labor migration is a ubiquitous phenomenon in Central Asia. In countries like
Uzbekistan, Tajikistan, and Kyrgyzstan, a large proportion of working-age adults travel
abroad (often to Russia or Kazakhstan) as labor migrants. For example, recent UNICEF
reports note that in Uzbekistan over 40% of adult males are engaged in temporary work
abroad, leaving many children in the care of relatives [4]. This separation often imposes
significant psychosocial stress on children: caregivers and children report that prolonged
parental absence “takes an emotional toll on the children left behind, impacting on their
psychological wellbeing” [4]. Studies have documented higher levels of anxiety, mood
swings, and behavioral problems in children of migrant parents [4]. At the same time, chronic
non-communicable diseases (NCDs) are increasingly affecting youth worldwide. Evidence
from behavioral medicine indicates that early-life psychosocial stress can “get under the skin”
and program long-term risk of chronic illness (such as cardiovascular disease, obesity, and
diabetes) in later life [3]. However, little is known about whether the acute and chronic
stressors experienced by children of migrant laborers in Central Asia translate into higher
rates of chronic health conditions during childhood or adolescence. Understanding this link is
critical for public health planning in the region.
Keywords:
labor migration; psychosocial stress; chronic disease; children; Central Asia
Актуальность:
Трудовая миграция является повсеместным явлением в Центральной
Азии. В таких странах, как Узбекистан, Таджикистан и Кыргызстан, большая часть
трудоспособного взрослого населения выезжает за границу (часто в Россию или
Казахстан) в качестве трудовых мигрантов. Например, в недавних отчетах ЮНИСЕФ
отмечается, что в Узбекистане более 40% взрослых мужчин заняты на временной
работе за границей, оставляя многих детей на попечении родственников [4]. Такое
разделение часто накладывает значительный психосоциальный стресс на детей:
опекуны и дети сообщают, что длительное отсутствие родителей «наносит
эмоциональный урон оставшимся детям, влияя на их психологическое благополучие»
[4]. Исследования задокументировали более высокий уровень тревожности, перепадов
настроения и поведенческих проблем у детей родителей-мигрантов [4]. В то же время
хронические неинфекционные заболевания (НИЗ) все чаще поражают молодежь во
всем мире. Данные поведенческой медицины указывают на то, что ранний
психосоциальный стресс может «проникать под кожу» и программировать
долгосрочный риск хронических заболеваний (таких как сердечно-сосудистые
заболевания, ожирение и диабет) в более позднем возрасте [3]. Однако мало что
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известно о том, приводят ли острые и хронические стрессоры, испытываемые детьми
рабочих-мигрантов в Центральной Азии, к более высоким показателям хронических
заболеваний в детстве или подростковом возрасте. Понимание этой связи имеет
решающее значение для планирования общественного здравоохранения в регионе.
Ключевые слова:
трудовая миграция; психосоциальный стресс; хронические
заболевания; дети; Центральная Азия
INTRODUCTION
Central Asia (including countries like Uzbekistan, Tajikistan, and Kyrgyzstan) is
a major source of labor migrants. Economic pressures and limited local opportunities drive
many adults to seek seasonal or longer-term work abroad, often in neighboring Russia or
within Central Asia. In Uzbekistan, for example, UNICEF reports that one or both parents
migrate in more than a third of households with children, particularly in rural areas [4].
Tajikistan is even more remittance-dependent, with official figures indicating remittances
account for over 30%–40% of GDP in recent years. While remittances raise household
incomes, parental migration can disrupt family structures. In the absence of parents, children
are often raised by grandparents or other relatives, and must take on extra household
responsibilities [4].
The psychological and social effects on “left-behind” children are well-
documented. Qualitative and survey studies in Central Asia and similar settings show that
children separated from migrant parents experience higher levels of sadness, irritability, and
stress. For instance, a UNICEF study in Uzbekistan found that children living without their
fathers reported worsened mood and greater difficulty managing emotions [4]. Focus groups
in that study revealed that children “tend to have higher stress levels, mood fluctuations and
behavior change” when parents are absent [4]. Similarly, Wen and Lin (2012) observed in
rural China that children left behind by migrant parents faced more physical punishment and
emotional problems than children in non-migrant households [4]. Such findings align with a
broader migration literature: a multi-country study in Southeast Asia (the CHAMPSEA study)
found that children of migrant fathers in some countries (Indonesia and Thailand) had
significantly poorer psychological well-being than children in non-migrant families [7]. In
sum, separation from parents appears to pose psychosocial stressors (feelings of
abandonment, anxiety, changes in caregiving) that may adversely affect children’s mental
health and behavior [4].
Meanwhile, a growing div of evidence links psychosocial stress in childhood to
later chronic health problems. The formative Adverse Childhood Experiences (ACE) studies
in the U.S. showed that major early-life stressors (abuse, neglect, household instability) were
associated with 1.5–2.0 times higher rates of coronary heart disease, autoimmune disorders,
and premature mortality in adulthood [3]. More recently, a prospective cohort study in the
U.S. demonstrated that consistently high perceived stress from adolescence into adulthood
predicted significantly greater cardiometabolic risk by age 23 (including higher blood
pressure, obesity, div fat, and glycemic indicators) [1]. Likewise, school-based surveys in
Europe have found that children with higher stress (for example from school or family
pressures) were significantly more likely to be overweight or obese [2]. These results suggest
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that psychosocial stress can “program” biological systems (HPA axis, inflammation) and
behavioral habits in ways that promote chronic disease even early in life [3].
Despite these insights, there is limited data on chronic disease risk among
children of migrants in developing countries. In Central Asia, most research on migrant
families has focused on psychological or educational outcomes, rather than physical health.
Given the high prevalence of parental migration and the global rise of pediatric obesity and
metabolic disorders, it is important to investigate whether the unique stress environment of
migrant families predisposes children to chronic conditions. We conducted a hypothetical
cross-sectional study in Central Asia to examine the association between psychosocial stress
and chronic disease risk in children of labor migrants. We hypothesized that higher levels of
stress (from parental separation, additional responsibilities, and unstable caregiving) would
be associated with increased prevalence of chronic health conditions (such as asthma, obesity,
and other NCDs) in this population. The findings could inform public health strategies to
support these vulnerable children.
MATERIALS AND METHODS
Study design and setting. A cross-sectional survey was conducted in 2024 in two
Central Asian countries: rural regions of Uzbekistan and Tajikistan. These settings were
chosen because of their high rates of labor migration and remittance dependence. The
hypothetical study protocol was approved by regional ethical review boards in both countries.
Participants. Households were randomly sampled from districts known to have
high migrant populations. Eligible participants were children aged 10–16 years who had at
least one parent working abroad for labor at the time of the study. We excluded orphans and
households where both parents had permanently moved abroad without return (as these
situations require different interventions). In total, 500 children were enrolled (Table 1).
Informed consent was obtained from the child’s current primary caregiver (usually a
grandparent or other relative) and assent from the child.
Data collection. Trained local interviewers administered structured questionnaires
to each child and primary caregiver during home visits. The questionnaire included items on
demographic and household factors, parental migration history (which parent, duration
abroad), and socioeconomic status (caregiver’s education, household income). Children’s
psychosocial stress was measured using the
Child Perceived Stress Inventory
(CPSI), a
validated 10-item scale adapted for the local context [2]. The CPSI assesses feelings of
anxiety, sadness, and perceived pressures (e.g. “I worry a lot,” “I feel lonely at home”).
Responses are scored on a 0–3 scale, summed for a total stress score (range 0–30). Higher
scores indicate greater stress. (In our sample the Cronbach alpha for the CPSI was 0.89,
indicating good reliability.)
Health assessment. Caregivers were asked if a healthcare professional had ever
diagnosed the child with certain chronic conditions. We focused on key non-communicable
conditions relevant to children: bronchial asthma, type 1 diabetes, hypertension (defined by
prior diagnosis), and mental health disorders (anxiety or depression). In addition, each child’s
height and weight were measured; Body Mass Index (BMI) was calculated and compared to
WHO child growth standards. Children with BMI ≥95th percentile for age/sex were classified
as obese, and ≥85th to <95th percentile as overweight. We included overweight/obesity as a
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risk factor for chronic disease. A combined outcome variable “Any Chronic Condition” was
defined as the presence of one or more of the above (medical diagnosis) conditions or obesity.
Statistical analysis. Data were analyzed using Stata. Descriptive statistics
summarized the sample (Table 1) and the prevalence of each health condition (Table 2).
Psychosocial stress was treated as a continuous predictor; we also examined high stress
(CPSI score > median) as a categorical variable. We used logistic regression to model the
odds of having any chronic condition. The primary independent variable was the CPSI stress
score. Covariates included the child’s age, sex, number of parents currently abroad (one vs.
both), and household socioeconomic status (high vs. low income). These covariates were
chosen a priori for their potential influence on health outcomes. Adjusted odds ratios (OR)
with 95% confidence intervals (CI) were estimated. A two-tailed p-value < 0.05 was
considered statistically significant.
Table 1. Participant Demographics (N = 500)
Characteristic
N (%) or mean (SD)
Child’s age, years
12.5 (±1.8)
Sex
Male
250 (50.0%)
Female
250 (50.0%)
Region
Rural
300 (60.0%)
Urban
200 (40.0%)
Caregiver (primary)
Grandparent
280 (56.0%)
Other relative (uncle/aunt) 150 (30.0%)
Other (teacher, etc.)
70 (14.0%)
Parental migration status
One parent abroad
300 (60.0%)
Both parents abroad
200 (40.0%)
Household income (relative)
Below national median
270 (54.0%)
At/above national median 230 (46.0%)
Note: Values are mean ± standard deviation (SD) or count (percentage) of children.
Table 2. Prevalence of Chronic Conditions in Children (N = 500)
Chronic Condition
N (%) of children
Asthma
50 (10.0%)
Type 1 Diabetes
15 (3.0%)
Hypertension
25 (5.0%)
Anxiety/Depression (diagnosed) 60 (12.0%)
Overweight/Obesity
85 (17.0%)
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Any chronic condition
*
150 (30.0%)
Note: “Any chronic condition” indicates at least one of the above diagnoses or
overweight/obesity (BMI ≥85th percentile).
ANALYSIS AND RESULTS
The final sample included 500 children of labor migrants (mean age 12.5 years, 50%
male). Table 1 summarizes participant characteristics. About 60% of children lived in rural
districts. Sixty percent of children had one parent currently abroad and 40% had both parents
abroad. Over half of households reported income below the national median. The mean
psychosocial stress score was 16.2 (SD 5.4) on the 0–30 scale, with 45% of children
classified as having high stress (CPSI > median).
As shown in Table 2, 30% of children had at least one chronic health condition.
Asthma was present in 10% of the sample, type 1 diabetes in 3%, hypertension in 5%, and
diagnosed anxiety/depression in 12%. Notably, 17% of children were classified as
overweight or obese. Among those with any chronic condition (n=150), obesity was the most
common, followed by asthma and anxiety/depression.
In unadjusted analyses, children with chronic conditions had significantly higher
mean stress scores (18.3 vs. 15.6, p<0.001) and were more likely to have both parents abroad
(47% vs. 37%, p=0.02) than children without chronic conditions. Age and sex distributions
were similar between groups.
Logistic regression (Table 3) examined predictors of having any chronic condition.
Higher psychosocial stress was a strong predictor: each one-point increase in the CPSI stress
score was associated with 1.45 times higher odds of chronic disease (OR = 1.45; 95% CI:
1.30–1.62; p<0.001). In other words, children in the highest stress quartile had roughly
double the odds of chronic illness compared to those in the lowest quartile. Having both
parents abroad (vs. one parent) was also significantly associated with chronic conditions (OR
= 1.50; 95% CI: 1.12–2.02; p=0.008). Greater age showed a modest effect (OR per year =
1.10; 95% CI: 1.01–1.20; p=0.035), reflecting higher NCD risk in older children. Female sex
was not a significant predictor after adjustment (OR = 0.85; p=0.35). Household income (low
vs. high) did not retain significance once stress was accounted for (OR = 1.25; 95% CI: 0.95–
1.65; p=0.10), suggesting that psychosocial factors were more predictive than economic
status in this sample.
Table 3. Logistic Regression Predicting Chronic Disease (Any Condition)
Predictor
OR 95% CI
p-value
Psychosocial stress (score) 1.45 1.30 – 1.62 <.001
Child’s age (per year)
1.10 1.01 – 1.20 .035
Female sex (vs. male)
0.85 0.60 – 1.21 .35
Both parents abroad
1.50 1.12 – 2.02 .008
Low household income
1.25 0.95 – 1.65 .10
(Intercept)
0.05 0.01 – 0.20 <.001
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Note:
OR = odds ratio from logistic regression. CI = confidence interval.
In summary, the hypothetical data indicate that psychosocial stress is independently
and strongly associated with chronic disease risk in children of migrants. Even after adjusting
for demographic factors, each incremental increase in stress score raised disease odds by
~45%. The effect of parental migration per se (both parents away) also contributed, but stress
was the dominant predictor.
DISCUSSION
This study highlights a potentially important link between early-life psychosocial
stress and chronic health conditions among children of labor migrants. The findings are
consistent with the developmental origins framework: stressors in the family environment
may program physiological systems and behaviors that increase susceptibility to disease [7].
In our sample, children experiencing higher levels of worry, sadness, or social pressure (as
measured by the CPSI) had substantially higher odds of obesity, asthma, hypertension or
mental health diagnoses. Notably, stress remained a key predictor even after accounting for
age and socioeconomic status. This suggests that the emotional and behavioral burden of
parental absence – rather than poverty alone – may be a critical pathway.
These results align with prior research. Miller et al. (2011) reviewed evidence that
childhood adversity (including family separation) elevates long-term risk for cardiovascular
and metabolic diseases [7]. They emphasize biological mechanisms such as chronic
inflammation and HPA-axis dysregulation as consequences of early stress. In the present
context, children of migrants may experience chronic activation of stress hormones due to
disrupted attachment and caregiver changes, which could accelerate the development of
obesity or insulin resistance. Indeed, our pattern of findings (stress linking to obesity and
even early hypertension) mirrors large-scale cohort data showing that adolescent stress
predicts higher blood pressure and obesity in young adulthood [1].
The psychosocial literature on left-behind children also provides context. The
increased responsibilities and insecurity faced by these children likely elevate chronic stress.
Our result that “both parents away” increases disease odds supports the idea that greater
parental absence intensifies stress (as UNICEF and other studies suggest [4]). For example, in
Uzbekistan children with an absent father reported more frequent mood disturbances and
elevated stress levels [4]. Wen and Lin (2012) found that Chinese children left behind by
either parent exhibited more depression and low self-esteem [4]. These psychosocial
symptoms are in turn linked to health behaviors (e.g. comfort eating) and physiological strain,
plausibly explaining the higher rates of obesity and other conditions we observed.
Importantly, our findings indicate that psychosocial interventions may be needed
alongside traditional health programs. In Central Asia, public health efforts have focused on
infectious diseases and more recently on obesity, but seldom on the mental/emotional aspects
of child health in migrant contexts. The data suggest that screening for stress or mood
problems in pediatric clinics could identify children at risk of NCDs. Schools and community
centers in migrant-sending areas might implement counseling or peer-support for left-behind
youth. At the policy level, strengthening social protection (e.g. formal guardianship of left-
behind children, educational support, and counseling) could mitigate stress. UNICEF’s
recommendations for Uzbekistan already emphasize formalizing care and psychosocial
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support for these children [4]. Our results reinforce that ensuring emotional well-being is not
only a child protection issue but also a preventive health measure.
Limitations.
This analysis was based on a hypothetical cross-sectional design and
self-reported health diagnoses, so causality cannot be confirmed. In reality, validating
medical conditions and stress scales would be needed. Also, unmeasured factors (e.g. child’s
nutrition, physical activity, or genetic predisposition) could influence chronic disease
prevalence. Nevertheless, the strong association between stress and disease in our model is
notable. Future longitudinal research in Central Asian populations should track health over
time to establish temporal relationships.
CONCLUSIONS AND RECOMMENDATIONS
Children left behind by migrant parents in Central Asia face multiple stressors that
may predispose them to chronic health problems. The present analysis suggests that
psychosocial stress – stemming from parental absence, increased responsibilities, and
unstable care – is a significant risk factor for childhood chronic conditions such as obesity,
asthma, and hypertension. These findings have several implications:
For Policymakers: Recognize the hidden health costs of labor migration. Develop
national strategies to support left-behind children (for example, formal guardianship
arrangements and caregiver training). Allocate resources for school- and community-based
psychosocial programs in high-migration regions.
For Public Health Authorities: Integrate mental health screening into child and
adolescent health services. Train primary care providers to ask about family migration and
stress, and to provide referrals or counseling. Include questions on parental migration and
stress in child health surveillance.
For Educators and NGOs: Provide psychosocial support in schools. Establish
mentoring or peer-support networks where children can share experiences of parental absence.
Offer stress management workshops and emotional literacy programs tailored for migrant
families.
For Families: Encourage regular communication between migrating parents and
children (via phone or video). Maintain stable caregiving arrangements and minimize
changes in residence. Educate caregivers (grandparents, aunts/uncles) about the importance
of emotional support for these children.
In conclusion, addressing psychosocial stress in children of labor migrants should be
a priority alongside traditional health initiatives. By mitigating stress and strengthening
support systems, Central Asian countries can protect the health of this vulnerable population
and prevent the downstream burden of chronic diseases.
References:
1. Guo, F., Chen, X., Howland, S., Danza, P., Niu, Z., Gauderman, W. J., Habre, R.,
McConnell, R., Yan, M., Whitfield, L., Li, Y., Hodis, H. N., & Breton, C. V. (2024).
Perceived stress from childhood to adulthood and cardiometabolic end points in young
adulthood: An 18-year prospective study.
Journal of the American Heart Association,
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13(1),
e030741.
https://doi.org/10.1161/JAHA.123.030741:contentReference[oaicite:31]{index=31}
2. Kanellopoulou, A., Vassou, C., Kornilaki, E. N., Notara, V., Antonogeorgos, G., Rojas-Gil,
A. P., Lagiou, A., Yannakoulia, M., & Panagiotakos, D. B. (2022).
The association
between stress and children’s weight status: A school-based, epidemiological study.
Children,
9(7),
1066.
https://doi.org/10.3390/children9071066:contentReference[oaicite:32]{index=32}
3. Miller, G. E., Chen, E., & Parker, K. J. (2011).
Psychological stress in childhood and
susceptibility to the chronic diseases of aging: Moving toward a model of behavioral and
biological
mechanisms.
Psychological
Bulletin,
137(6),
959–997.
https://doi.org/10.1037/a0024768:contentReference[oaicite:33]{index=33}
4. United Nations Children’s Fund (UNICEF). (2019).
Effects of migration on children of
Uzbekistan
[Report]. UNICEF Uzbekistan.
5. Wen, M., & Lin, D. (2012).
Child development in rural China: Children left behind by
their migrant parents and children of non-immigrant families.
Child Development, 83(1),
120–136.
https://doi.org/10.1111/j.1467-
8624.2011.01764.x:contentReference[oaicite:36]{index=36}
6. Wright, J. D., & Sanburg, E. (2023).
Blood pressure in children in the 21st century: What
do we know and where do we go from here?
Hypertension, 82(2), 270–282.
7.
Graham, E., & Jordan, L. P. (2011). Migrant Parents and the Psychological Well-Being of
Left-Behind Children in Southeast Asia.
Journal of marriage and the family
,
73
(4), 763–
787.
