Skip to main content

Advertisement

Log in

Parental health and child behavior: evidence from parental health shocks

  • Published:
Review of Economics of the Household Aims and scope Submit manuscript

Abstract

This study examines the importance of parental health in the development of child behavior during early childhood. Our analysis is based on child psychometric measures from a longitudinal German dataset, which tracks mothers and their newborns up to age six. We identify major changes in parental health (shocks) and control for a variety of initial characteristics of the child including prenatal conditions. The results are robust to placebo regressions of health shocks that occur after the outcomes are measured. Our findings point to negative effects of maternal health shocks on children’s emotional symptoms, conduct problems and hyperactivity. We estimate that maternal health shocks worsen outcomes by as much as 0.9 standard deviations. In contrast, paternal health seems to be less relevant to children’s behavioral skills.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Adda et al. (2009), Riphahn (1999) and Smith (2004) provide further evidence on income changes due to health shocks.

  2. Note that our research question differs from the literature on the in utero influences of maternal health on child outcomes (cf. Currie and Almond 2011 for a review). We are interested in how child behavior is affected by variations in parental health in the early years of childhood (after birth). Therefore, initial maternal and child health (at birth) are used as control variables in our empirical approach.

  3. See Currie and Almond (2011) for an international review of further studies. In addition, studies on parental death might be considered as the most extreme health shock (cf. Adda et al. 2011 for a recent paper and a review of the evidence). They find small negative effects on skill development and somewhat lower earnings later in life for the affected children. Based on a difference-in-differences approach, Senne (2014) provides strong evidence that adult mortality has short- and long-run negative impacts on children’s educational outcomes.

  4. Our work also relates to studies that examine the impact of maternal psychiatric illness, the most common of which are depression or substance abuse and smoking during pregnancy, on children’s outcomes. The results consistently show that children of depressed mothers fare worse on a wide range of outcomes, including the development of cognitive and motor skills (Petterson and Albers 2001), problem behavior (Frank and Meara 2009), and social behavior (Kim-Cohen et al. 2005). Farahati et al. (2003) find that parental psychiatric illness is associated with a lower probability of high school graduation among children. Balsa (2008) provides evidence that parental problem drinking exerts negative impacts on children’s labor market performance later in life.

  5. Heymann et al. (2009) systematically assess paid-sick-pay and paid-sick leave policies in 22 countries. While the US ranks worst, Germany is ranked as one of the top five countries (based on coverage for full-time equivalent working-days for median earners). In general, sick-pay in Germany amounts to 100 percent of an employee’s previous salary for up to six weeks. After this period, the public health insurance companies cover about 70 percent of the individual’s regular gross income for up to 78 weeks within each three year period.

  6. Because of different samples and estimation strategies, our findings are not directly comparable to Morefield (2010). Particularly, Morefield (2010) considers a sample of all children up to age 18 when comparing paternal and maternal health events. This analysis does not differentiate between age groups while our results relate to young children up to age three and from age three to age six respectively. Morefield (2010) examines changes in age-adjusted measures conditional on the reported onsets of specific diagnoses and parental health limitations—instead of health shocks—while controlling for parental and child background variables including children’s home learning environment.

  7. Ermisch et al. (2012) use the same data and aggregated behavioral measure as in our paper. They find that multiple maternal relationship changes (due to separations or new partners) are related to an increase in the aggregated measure by about 0.4 standard deviations for children observed when they are about six years old. In terms of magnitude this also corresponds to the size of the estimated parental health effects on the aggregated outcome for children aged 3–6 in our study.

  8. Cf. Wagner et al. (2007) for an overview and introduction to the dataset.

  9. Further SOEP health questions include health limitations, handicaps, chronic diseases, health deteriorations, days of sick leave, current state of health, number of hospital visits, medical care after work accidents, and any doctor’s visits in the previous three months. However, the respective information is only collected biannually, conditional on employment and/or covers limited periods of time. In sum, these measures are not appropriate for our estimation strategy, which relies on year-to-year changes in health measures. In addition, the sample size does not allow for differentiating the specific health conditions that underlie the observed health chocks.

  10. Table 6 in the Appendix provides the detailed questions underlying all the SDQ items.

  11. Table 7 in the Appendix lists all questions to gather the VAB score. However, we do not present more detail on the Vineland Scale since it is solely used to conduct a robustness check. The interested reader is referred to Schmiade et al. (2008) who summarize the use of the Vineland Scale as a measure of child development in the SOEP.

  12. Table I also includes the mean Vineland scores that inform on children’s adaptive behavior at age three. None of the observed differences are statistically significant conditional on parental health at age three (not shown) or age six (included in Table 1).

  13. We opt for the more generous definition of a hospitalization shock in order to obtain a reasonable number of shock observations in our sample. If we used the two standard deviation threshold for hospital-defined health shocks as well, we would observe very few cases of maternal (18 cases) and paternal (14 cases) health shocks for children aged 3–6. Our definition of a shock in health satisfaction is similar to and only slightly less stringent than that used by Riphahn (1999), which is a drop by at least five points for older workers. Our results do not substantially change if we use the two standard deviation threshold for hospitalization shocks. These results are available upon request from the authors. Also note that maternal hospitalization shocks imply a duration exceeding the usual hospitalization periods around childbirth. According to Schneider (2008), German childbearing mothers spend on average 2.8 days in hospital.

  14. The definition of a shock necessitates that a parent starts the observation period with a health satisfaction rating that allows for a drop of four points. In our sample, only five percent of parents report health satisfaction scores below the minimum threshold for a shock (satisfaction ≤3). Removing these low-health-satisfaction respondents from our sample does not alter our results.

  15. We observe that roughly 30 % of mothers who experience a negative change of more than two standard deviations in health satisfaction experienced a corresponding shock, defined by the number of nights spent in hospital, early in children’s lives.

  16. We use an indicator for firstborn children to take birth order into account. As an alternative to the birth-weight specification, we tested specifications that included a high-birth-weight dummy variable (2.5 kg or more). The results are robust if we use this specification.

  17. We control for parental education based on a tertiary education indicator taking the value of one if at least one parent obtained a university degree or a comparable level of (vocational) education. The definition corresponds to a level of 5 or higher according to the UNESCO’s International Standard Classification of Education (ISCED 1997), where ISCED level 5 is defined as the “first stage of tertiary education (not leading directly to an advanced research qualification)” (UNESCO 2006, p. 19). To control for migration background we use an indicator variable taking the value of one if at least one parent holds a non-German nationality. This is true for 16 % of individuals in our sample, mostly with Turkish (40 %) and Italian (13 %) nationality. We also include indicator variables for missing parental information, which take into account that there are single-headed households.

  18. This is also the case in previous studies on parental health effects (e.g. Morefield 2010) and in line with evidence that women in the relevant age group have more episodes of hospitalization than men (cf. Case and Paxson 2005). However, part of the difference reflected in our numbers is due to the fact that there are households headed by single mothers in our sample. According to Table 1, about 21 % of children are growing up without a father. All specifications consider both maternal and paternal health shocks, while we include an indicator variable for households headed by single mothers.

  19. One explanation for the different findings related to optional health shock definitions may be that shocks in health satisfactions relate to different kind of health conditions than shocks in hospitalization. For example, it may be that shocks in health satisfaction are more often due to mental health problems while hospitalization shocks are somewhat more often due to physical health limitations. To this end, our data does not allow distinguishing between mental and physical health conditions to further investigate this issue. We are grateful to an anonymous referee for suggesting this potential explanation.

  20. A simple time-allocation model suggests this type of trade-off if the wage of the father is reduced and the substitution effect dominates the income effect.

  21. Based on our results, we cannot rule out that a contemporaneous negative effect from parental health shocks earlier in children’s life already fades out when children are observed (at age 6). The finding in Morefield (2010)—based on a longer period of observation—hints to a non-significant impact of early health shocks and a permanent effect of the parental health shock for children around school-entry age, but in our data, we do neither observe a longer period of time nor the behavioral outcome for three year-olds. Therefore, we cannot directly test for dynamic effects.

  22. Tonks et al. (2009) summarize that “as the demands of the social environments increase with development, emotion-recognition abilities undergo periods of development in response” (ibid., page 12). For example for social understanding they provide evidence that specific skills are developed throughout the childhood years (e.g. the ability to comprehend misconceiving situations is developed around age 4). The authors note that these development periods are related to development stages of the prefrontal cortex in childhood and adolescence.

  23. Our results may still be biased if (unobserved) events that affect both parental health and child outcomes systematically happen around the time of the reported health shocks. However, in a further robustness check we control for indicators of such events (see the discussion of Table 4) and find robust results.

  24. In addition, our results are robust if we include additional indicator variables for positive shocks in health satisfaction. However, including only these positive shock measures yields “effects” of about 50 % of the statistically significant estimates obtained from the original regressions. This finding is probably due to parents being affected from a negative shock, followed by a period of recovery.

  25. Due to our limited sample size, we do not differentiate the results between boys and girls. However, regressing gender-specific outcomes on aggregated parental health shock indicators suggests that impacts are more pronounced for boys (not shown here). This finding is consistent with Johnson and Reynolds (2013) and Morefield (2010).

  26. According to the German Social Security Act (Sozialgesetzbuch) sick parents can obtain domestic help (Haushaltshilfen), which is organized by the parents’ health insurance company.

References

  • Achenbach, T. M., Becker, A., Döpfner, M., Heiervang, E., Rössner, V., Steinhausen, H.-C., & Rothenberger, A. (2008). Multicultural assessment of child and adolescent psychopathology with ASEBA and SDQ instruments: research finding, applications, and future directions. Journal of Child Psychology and Psychiatry, 49(3), 251–275.

    Article  Google Scholar 

  • Adda, J., Banks, J., & von Gaudecker, H. M. (2009). The impact of income shocks on health: Evidence from cohort data. Journal of the European Economic Association, 7(6), 1361–1399.

    Article  Google Scholar 

  • Adda, J., Björklund, A., & Holmlund, H. (2011). The role of mothers and fathers in providing skills: Evidence from parental deaths. IZA discussion paper, 5425.

  • Andrews, R. J., & Logan, T. D. (2010). Family health, children’s own health and test score gaps. American Economic Review Paper and Proceedings, 100, 195–199.

    Article  Google Scholar 

  • Balsa, A. I. (2008). Parental problem-drinking and adult children‘s labor market outcomes. Journal of Human Resources, 43(2), 454–486.

    Article  Google Scholar 

  • Becker, A., Steinhausen, H.-C., Baldursson, G., Dalsgaard, S., Lorenzo, M., Ralston, S., et al. (2006). Psychopathological screening of children with ADHD: strengths and difficulties questionnaire in a pan-European study. European Child & Adolescence Psychiatry, 15(1), 56–62.

    Article  Google Scholar 

  • Berger, E. M., Peter, F., & Spieß, C. K. (2010). Wie hängen familiäre Veränderungen und das mütterliche Wohlbefinden mit der frühkindlichen Entwicklung zusammen? Quarterly Journal of Economic Research, 79, 27–44.

    Google Scholar 

  • Berger, E. M., & Spieß, C. K. (2011). Maternal life satisfaction and child outcomes: Are they related? Journal of Economic Psychology, 32(1), 142–158.

    Article  Google Scholar 

  • Blomeyer, D., Coneus, K., Laucht, M., & Pfeiffer, F. (2009). Initial risk matrix, home resources, ability development and children’s achievement. Journal of the European Economic Association, 7(2–3), 638–648.

    Article  Google Scholar 

  • Case, A., & Paxson, C. (2005). Sex differences in morbidity and mortality. Demography, 42(2), 189–214.

    Article  Google Scholar 

  • Ciccia, R., & Verloo, M. (2012). Parental leave regulations and the persistence of the male breadwinner model: Using fuzzy-set ideal type analysis to assess gender equality in an enlarged Europe. Journal of European Social Policy, 22(5), 507–528.

    Article  Google Scholar 

  • Coneus, K., Mühlenweg, A. M., & Stichnoth, H. (2014). Orphans at risk in sub-Saharan Africa: Evidence on educational and health outcomes. Review of Economics of the Household, 12(4), 641–662.

    Article  Google Scholar 

  • Cunha, F., & Heckman, J. J. (2008). Formulating, identifying and estimating the technology of cognitive and noncognitive skill formation. Journal of Human Resources, 43(4), 738–782.

    Article  Google Scholar 

  • Cunha, F., Heckman, J. J., Lochner, L., & Masterov, D. V. (2006). Interpreting the evidence on life cycle skill formation. In A. Hanushek & F. Welch (Eds.), Handbook of the economics of education (pp. 697–812). Amsterdam: North-Holland.

    Google Scholar 

  • Currie, J., & Almond, D. (2011). Human capital development before age five. In O. Ashenfelter & R. Layard (Eds.), Handbook of labor economics (pp. 1315–1486). Amsterdam: Elsevier.

    Google Scholar 

  • Currie, J., & Madrian, B. C. (1999). Health, health insurance and the labor market. In O. Ashenfelter & R. Layard (Eds.), Handbook of labor economics (pp. 3309–3416). Amsterdam: North-Holland.

    Google Scholar 

  • Dooley, M., & Stewart, J. (2007). Family income, parenting styles and child behavioural-emotional outcomes. Health Economics, 16(2), 145–162.

    Article  Google Scholar 

  • Ermisch, J., Peter, F. H., & Spiess, C. K. (2012). Early childhood outcomes and family structure. In J. Ermisch, M. Jäntti, & T. Smeeding (Eds.), From parents to children: The intergenerational transmission of advantage (pp. 120–139). New York: Russell Sage Foundation.

    Google Scholar 

  • Farahati, F., Marcotte, D. E., & Wilcox-Gök, V. (2003). The effects of parents’ psychiatric disorders on children’s high school dropout. Economics of Education Review, 22(2), 167–178.

    Article  Google Scholar 

  • Frank, R. G., & Meara, E. (2009). The effect of maternal depression and substance abuse on child human capital development. NBER working paper series, 15314.

  • Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586.

    Article  Google Scholar 

  • Hagan, R., Jones, A. M., & Rice, N. (2009). Health and retirement in Europe. International Journal of Environmental Research and Public Health, 6(10), 2676–2695.

    Article  Google Scholar 

  • Heymann, J., Rho, H. J., Schmitt, J., & Earle, A. (2009). Contagion nation: A comparison of paid sick day policies in 22 countries (No. 2009-19). Center for Economic and Policy Research (CEPR).

  • Johnson, E., & Reynolds, C. L. (2013). The effect of household hospitalizations on the educational attainment of youth. Economics of Education Review, 37, 165–182.

    Article  Google Scholar 

  • Jones, A. M., Rice, N., & Roberts, J. (2010). Sick of work or too sick to work? Evidence on self-reported health shocks and early retirement from the BHPS. Economic Modelling, 27(4), 866–880.

    Article  Google Scholar 

  • Kim-Cohen, J., Moffitt, T. E., Taylor, A., Pawlby, S. J., & Caspi, A. (2005). Maternal depression and children’s antisocial behavior: Nature and nurture effects. Archives of General Psychiatry, 62(2), 173–181.

    Article  Google Scholar 

  • Morefield, B. (2010). Parental health events and children’s skill development. Working papers 10–11, University of North Carolina at Greensboro, Department of Economics.

  • OECD. (2012). The distribution of working hours among adults in couple families by age of the youngest child and number of children. OECD family database, LMF.2.2., OECD Social Policy Division. http://www.oecd.org/els/family/LMF2_2_Usual_working_hours_of_couple_parents_Sep2013.pdf. Accessed 9 Nov 2014.

  • Petterson, S. M., & Albers, A. B. (2001). Effects of poverty and maternal depression on early child development. Child Development, 72(6), 1794–1813.

    Article  Google Scholar 

  • Podor, M., & Halliday, T. J. (2012). Health status and the allocation of time. Health Economics, 21(5), 514–527.

    Article  Google Scholar 

  • Propper, C., Rigg, J., & Burgess, S. (2007). Child health: Evidence on the roles of family income and maternal mental health from a UK birth cohort. Health Economics, 16(11), 1245–1269.

    Article  Google Scholar 

  • Ribar, D. (2004). What do social scientists know about the benefits of marriage? A review of quantitative methodologies. IZA discussion paper, 998.

  • Riphahn, R. T. (1999). Income and employment effects of health shocks a test for the German welfare state. Journal of Population Economics, 12(3), 363–389.

    Article  Google Scholar 

  • Ruhm, C. J. (2004). Parental employment and child cognitive development. Journal of Human Resources, 39(1), 155–192.

    Article  Google Scholar 

  • Schmiade, N., Spieß, C. K., & Tietze, W. (2008). Zur Erhebung des adaptiven Verhaltens von zwei- und dreijährigen Kindern im Sozio-oekonomischen Panel (SOEP). SOEP papers on Multidisciplinary Panel Data Research, 116.

  • Schneider, H. (2008). Natürliche Geburt oder Wunsch–Sectio. Der Gynäkologe, 41, 36–41.

    Article  Google Scholar 

  • Senne, J. N. (2014). Death and schooling decisions over the short and long run in rural madagascar. Journal of Population Economics, 27(2), 497–528.

    Article  Google Scholar 

  • Smith, J. P. (1999). Healthy bodies and thick wallets: The dual relation between health and economic status. The Journal of Economic Perspectives, 13(2), 145–166.

    Article  Google Scholar 

  • Smith, J. P. (2004). Unraveling the SES-health connection. Population and development review, 30, Supplement: Aging, Health, and Public Policy, pp. 108–132.

  • Smith, J. P. (2005). Consequences and predictors of new health events. In D. A. Wise (Ed.), Analysis in the economics of aging (pp. 213–237). Chicago: University of Chicago Press.

    Chapter  Google Scholar 

  • Sun, A., & Yao, Y. (2010). Health shocks and children’s school attainments in rural China. Economics of Education Review, 29(3), 375–382.

    Article  Google Scholar 

  • Todd, P. E., & Wolpin, K. I. (2007). The production of cognitive achievement in children: Home, school, and racial test score gaps. Journal of Human Capital, 1(1), 91–136.

    Article  Google Scholar 

  • Tonks, J., Slater, A., Frampton, I., Wall, S. E., Yates, P., & Williams, W. H. (2009). The development of emotion and empathy skills after childhood brain injury. Developmental Medicine and Child Neurology, 51(1), 8–16.

    Article  Google Scholar 

  • UNESCO. (2006). International standard classification of education, ISCED 1997. May 2006 re-edition, UNESCO-UIS.

  • Violato, M., Petrou, S., Gray, R., & Redshaw, M. (2011). Family income and child cognitive and behavioural development in the United Kingdom: Does money matter? Health Economics, 20(10), 1201–1225.

    Article  Google Scholar 

  • Wagner, G. G., Frick, J. R., & Schupp, J. (2007). The German socio-economic panel study (SOEP)—Scope, evolution and enhancements. Schmollers Jahrbuch, 127(1), 39–169.

    Google Scholar 

  • Wu, S. (2003). The effects of health events on the economic status of married couples. Journal of Human Resources, 38(1), 219–230.

    Article  Google Scholar 

Download references

Acknowledgments

We thank two anonymous referees, Sarah Hofmann, Verena Niepel, Frauke Peter, Patrick Puhani, Dave Ribar, C. Katharina Spieß, Christian Traxler and Joachim Winter for their valuable comments on the earlier versions of this study. We are also grateful to the participants of the International Institute of Public Finance Congress in Dresden, the Royal Economic Society Conference in Cambridge, the Leibniz Network Conference in London and the ZEW Workshop on Health and Human Capital in Mannheim for their fruitful discussions. Financial support by the Leibniz Association within the project “Non-Cognitive Skills: Acquisition and Economic Consequences” is gratefully acknowledged.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Franz G. Westermaier.

Appendix

Appendix

See Tables 5, 6 and 7.

Table 5 Means (standard deviations) of control variables included in the main regression analysis
Table 6 Items of the strengths and difficulties questionnaire (SDQ)
Table 7 Items of the Vineland adaptive behavior scale (VAB), SOEP-version

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mühlenweg, A.M., Westermaier, F.G. & Morefield, B. Parental health and child behavior: evidence from parental health shocks. Rev Econ Household 14, 577–598 (2016). https://doi.org/10.1007/s11150-015-9284-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11150-015-9284-y

Keywords

JEL Classification

Navigation