Self-concept of left-behind children in China: a systematic review of the literature

Positive Development Patterns in Left-Behind Adolescents: Do Resilience and Making Sense of Adversity Have Beneficial Effects?

Purpose

Despite increased attention to the positive development of left-behind adolescents, research findings remain inconclusive. Utilizing latent profile analysis, we identified various positive development profiles among the left-behind adolescents and explored the association between resilience and positive development profiles, alongside the mediating role of making sense of adversity.

Methods

A multi-stage cluster sampling procedure was employed, randomly selecting four provinces-Zhejiang, Guangdong, Henan, and Jiangxi-from the central and coastal regions. The sample comprised 718 left-behind adolescents recruited from primary and junior high schools across grades 4, 5, 7, and 8. Three scales were utilized, and analyses included latent profile analysis and mediation analysis.

Results

Three latent subgroups of positive development among left-behind adolescents were identified: low, moderate, and high. Those with higher resilience and positive perceptions of adversity tended to belong to the high group rather than the low (β = -0.45, p < 0.001; β = -0.09, p < 0.001) or moderate group (β = -0.23, p < 0.001; β = -0.04, p < 0.05). Left-behind adolescents with higher negative perceptions of adversity tended to belong to the high group rather than the moderate group (β = -0.07, p < 0.01). Mediation analysis revealed that resilience facilitated the development of positive appraisals of adversity, subsequently increasing the likelihood of being categorized into the high (95% CI of -0.09 to -0.03) or moderate group (95% CI of -0.05 to -0.01) rather than the low group.

Conclusion

These findings hold significant implications for intervention formulation. Educators should focus on strengthening resilience and fostering positive perceptions of adversity among the low group. For the moderate group, maintaining moderate negative perceptions of adversity may stimulate the intrinsic potential for positive development more effectively.

Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study

INTRODUCTION

Health equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China.

METHODS

Data were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method.

RESULTS

The CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (-3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (-5.24%) was the top negative contributor, followed by commercial (-1.43%) and basic medical insurance (-0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134).

CONCLUSION

Pro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income.

The practice of social protection policies in China: a systematic review on how left-behind children's mental health can be optimised

AIMS

By discussing the mental health challenges faced by left-behind children, this article recommends or comments on existing social protection policies that can affect left-behind children's mental health at the micro-, meso- and macro-levels to holistically understand how a range of parties can jointly socially include left-behind children, a process which is conducive to the latter's mental health development.

METHODS

J.H. carried out a systematic review by searching through the English bibliographical databases Google Scholar, Web of Science and Scopus, in addition to Chinese bibliographic databases CNKI, Wanfang Data and VIP Chinese Science and Technology Periodicals. Here J.H. searched for the words ('social protection' OR 'socially protected') AND ('mental health' OR 'psychological wellbeing' OR 'mental problems' OR 'psychological problems') AND ('left-behind children' OR 'LBC' OR 'leftover children') AND ('China' OR 'Chinese'). Publication dates of the search results were limited to between 2010 and 2022.

RESULTS

One of the primary problems encountered by left-behind children is their inadequate home supervision. A further study indicates that parental migration serves as a crucial risk factor for child depression. State-level provision of insurance programmes helps curtail these children's encounters of mental health challenges. Moreover, an improvement in family and school protection is essential when optimising the protection system for left-behind rural Chinese children from poor villages. It is necessary for upper-level government units to re-structure their lower-level counterparts to improve the local administration. This allows lower-level government units to exploit preferential policies, refine relevant regulations and policies on child protection, and facilitate the establishment of social organisations where local policies can be successfully implemented to socially include and protect left-behind children in villages.

CONCLUSIONS

At the meso-level, community environment construction should be emphasised. At macro- and meso-levels, government authorities and social organisations should encourage the marketisation of hiring professional surrogate parents. At the micro-level, migrant parents should proactively take an initiative to contact their left-behind children via telecommunications.

Does parents' cognitive ability affect household educational investment? Evidence from Chinese families with left behind children

The large group of left-behind children with the absence of parental accompanying are likely to have serious physical and psychological problems, which may lead to serious public safety and social economic troubles in adulthood. Such unique phenomenon calls us attention on the impact of parents on household educational investment. Based on the data of China Family Panel Studies in 2014, This paper examines the effects of parents' cognitive ability on household educational investment for their children. The research propositions were tested using multiple regression analysis methods. Results indicate that parents' cognitive ability can significantly improve the level of monetary and non-monetary investment in education. We also find that compared with their counterparts, the cognitive ability of left-behind children's parents fails to affect their household educational investment, due to the "parent-child separation effect". Further analysis shows that improving the regional informatization level of parents of left-behind children can alleviate the "parent-child separation effect", and finally facilitate cognitive ability's role in increasing household educational investment. These findings enlighten education policy makers and households a feasible way to alleviate the imbalance and insufficiency of household educational investment among left-behind children families.

Gender differences and left-behind experiences in the relationship between gaming disorder, rumination and sleep quality among a sample of Chinese university students during the late stage of the COVID-19 pandemic

Background and aims

Studies have shown that gaming disorder (GD) is associated with rumination and poor sleep quality. However, the reciprocal relationship between GD, rumination and sleep quality is unclear. Moreover, the differences between gender and between left-behind experiences in the aforementioned relationship remain unknown. Therefore, the present study examined gender differences and left-behind experiences in the relationship between GD, rumination, and sleep quality among a sample of Chinese university students during the late stage of COVID-19 pandemic using a network analysis approach.

Methods

A cross-sectional online survey of 1,872 Chinese university students was conducted comprising demographic information (age, gender, and left-behind experience), gaming experience, gaming frequency, Gaming Disorder Test (GDT), Short Version of Rumination Response Scale (RRS), and Pittsburgh Sleep Quality Index (PSQI).

Results

Among Chinese university students, the prevalence of (i) GD was 3.5% and (ii) sleep disturbance was 14%. GD had positive and weak connection with rumination and sleep quality in the domain-level relational network. The network structures and global strengths both showed no significant differences between gender and between left-behind experiences. The nodes gd3 ("continuation or escalation of gaming") and gd4 ("gaming problems") had the strongest edge in the network.

Conclusion

The results suggest reciprocal relationships between GD, rumination, and sleep quality. Gender and left-behind experiences did not influence the reciprocal relationship between GD, rumination, and sleep quality during the late stage of COVID-19 pandemic. Using network analysis, the findings provide novel insights that rumination and sleep quality may have interacted with GD among Chinese students during the late stage of COVID-19 pandemic. Reducing or eliminating negative rumination may decrease GD and improve sleep quality. Moreover, good sleep quality contributes to positive rumination which may decrease the risk of GD among Chinese university students.

Non-suicidal self-injury and professional psychological help-seeking among Chinese left-behind children: prevalence and influencing factors

BACKGROUND

Non-suicidal self-injury (NSSI) is a risk factor for suicide. This study aimed to investigate the prevalence of NSSI and professional psychological help-seeking status and influencing factors among left-behind children (LBC) in China.

METHODS

We implemented a population-based cross-sectional study in participants aged 10-18 years. Sociodemographic characteristics, NSSI, help-seeking status and coping style were measured by self-reported questionnaires. A total of 16,866 valid questionnaires were collected, including 6096 LBC. Binary logistic regression models were used to analyze the factors influencing NSSI and professional psychological help-seeking.

RESULTS

The incidence of NSSI among LBC was 4.6%, significantly higher than that of non-left-behind children (NLBC). This incidence was higher among girls. Moreover, 53.9% of LBC with NSSI did not receive any treatment and only 22.0% sought professional psychological help. LBC often adopt emotion-oriented coping styles, specifically, those with NSSI. LBC with NSSI who seek professional help tend to adopt problem-oriented coping styles. Logistic regression analysis revealed that girls, learning stage, single-parent, remarried families, patience, and emotional venting were risk factors for NSSI in LBC, while problem-solving and social support seeking were protective factors. Moreover, problem-solving was also a predictor for seeking professional psychological help, patience will prevent it.

LIMITATIONS

This was an online survey.

CONCLUSIONS

The prevalence of NSSI in LBC is high. Gender, grade, family structure, and coping style affect the occurrence of NSSI among LBC. Only a few LBC with NSSI seek professional psychological help, while the coping style will affect the help-seeking behavior.

Parental migration and self-efficacy among rural-origin adolescents in China: Patterns and mechanisms

Large-scale rural-to-urban migration has shaped the socialization contexts of rural adolescents in China and can potentially impact their developmental outcomes. In this study, using data from the first wave of the China Education Panel Study collected in 2013, we focused on self-efficacy, an important but under-studied facet of noncognitive development, and assessed how it was influenced by family migration status. We also explored the mediating role of family and school resources. We compared three groups of rural-origin adolescents with different family migration statuses: rural left-behind children (LBC), rural not-left-behind children (NLBC), and rural-to-urban migrant children (MC). Structural equation modeling was performed to estimate the main effects of rural-origin groups on self-efficacy and the mediating effects of family income, family social capital, and school social capital for the significant group effects on self-efficacy. We found similar levels of self-efficacy among MC and NLBC, who in turn, exhibited greater self-efficacy than LBC. Discrepancies in family and school resources mediated the self-efficacy gaps between LBC and their MC and NLBC counterparts. Notably, when their disadvantages in family and school resources were controlled for, LBC were more efficacious than MC and NLBC, indicating LBC's resilience and the potential for promoting self-efficacy in LBC by providing adequate resources and support.

Plight or light? Elucidating the main and interacting effects of parenting styles and BIS/BAS profiles on left-behind youth’s self-esteem

Today, many labor-aged adults worldwide work and live for a prolonged period outside of their places of origin in locations where the laborers’ school-aged children cannot migrate with their parents, creating a group known as left-behind youth. Empirical studies regarding the impact of parental migration (left-behind versus non-left-behind) on positive youth development, such as self-esteem, remain scarce, and the collective findings are divergent and controversial. Accordingly, the relational and individual correlates of self-esteem among those youth are largely underexplored. Two independent studies were conducted to fill these crucial knowledge gaps. In Study 1 (N = 738; Mage = 15.86; 54.6% girls), I compared the self-esteem of left-behind youth and their non-left-behind peers after adjusting for sociodemographic covariates and social desirability. In Study 2 (N = 1060; Mage = 13.05; 49.5% girls), I aimed to replicate the findings obtained from Study 1 but used a different measurement and another independent sample. Additionally, I extended Study 1 to investigate the main and interactive relationships between parenting styles (parental warmth and control) and the behavioral inhibition/activation system profiles with self-esteem. To clarify the commonality and specificity of these relationships, I also estimated the moderating role of left-behind status herein. Converging findings across both studies challenged the widely vulnerable image of left-behind youth and revealed that this group did not show significant differences in terms of self-esteem, as compared to non-left-behind peers. Interaction analyses also suggested that shy left-behind youth weaken the extent to which their self-esteem is detrimentally affected by low parental warmth/high parental control.

Sleep disturbance and psychotic-like experiences among urban adolescents with and without parental migration

Aim

Sleep disturbance was closely associated with an increased risk of psychotic-like experiences (PLEs). This study aims to explore the association between sleep disturbance and PLEs among urban adolescents with and without parental migration.

Methods

A total of 67, 532 urban Chinese adolescents were recruited in a large web-based survey during April 21st to May 12th, 2021. In our study, sleep disturbance, PLEs, family function, school climate, and a series of socio-demographic were assessed. And hierarchical logistic regression analyses were performed to examine influential factors associated with PLEs.

Results

Urban left-behind children (LBC) had a higher prevalence of sleep disturbance and PLEs than non-LBC. After controlling for confounders, parental migration was associated to PLEs with weak significance (OR = 1.19). Meanwhile, sleep disturbance was found to be a robust risk factor for PLEs (OR = 3.84 and 4.09), with or without the effect of parental migration. In addition, better family function and school climate has significant association with decreased risk of PLEs.

Conclusion

Adolescents with sleep disturbance are more likely to report PLEs. Adolescents' PLEs preventive strategies could focus on reducing sleep disturbance related symptoms as well as improving family function and school climate.

The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses

Adverse childhood experiences (ACEs) are related to increased risk of common mental disorders. This umbrella review of systematic reviews and meta-analyses aimed to identify the key ACEs that are consistently associated with increased risk of mental disorders and suicidality. We searched PsycINFO, PubMed, and Google Scholar for systematic reviews and meta-analyses on the association between ACEs and common mental disorders or suicidality published from January 1, 2009 until July 11, 2019. The methodological quality of included reviews was evaluated using the AMSTAR2 checklist. The effect sizes reported in each meta-analysis were combined using a random-effects model. Meta-regressions were conducted to investigate whether associations vary by gender or age of exposure to ACEs. This review is registered with PROSPERO (CRD42019146431). We included 68 reviews with moderate (55%), low (28%) or critically low (17%) methodological quality. The median number of included studies in these reviews was 14 (2-277). Across identified reviews, 24 ACEs were associated with increased risk of common mental disorders or suicidality. ACEs were associated with a two-fold higher odds of anxiety disorders (pooled odds ratios (ORs): 1.94; 95% CI 1.82, 2.22), internalizing disorders (OR 1.76; 1.59, 1.87), depression (OR 2.01; 1.86, 2.32) and suicidality (OR 2.33; 2.11, 2.56). These associations did not significantly (P > 0.05) vary by gender or the age of exposure. ACEs are consistently associated with increased risk of common mental disorders and suicidality. Well-designed cohort studies to track the impact of ACEs, and trials of interventions to prevent them or reduce their impact should be global research priorities.

Prevalence and Associated Family Factors of Sibling Bullying Among Chinese Children and Adolescents

Sibling bullying is the most common form of aggression within family worldwide, while the prevalence and correlations of sibling bullying is little known in China. The current research focused on the association between family factors and sibling bullying among Chinese adolescents, and explore sex differences in sibling bullying in the context of Chinese culture. A cross-sectional study was conducted to explore the characteristics of sibling bullying by sampling 6302 children and adolescents who had at least 1 sibling living in the household. Of the participants, 1827 (29.0%) were involved in sibling bullying over the past half year, and pure victims, pure bullies, and bully-victims were 486 (7.7%), 510 (8.1%), and 831 (13.2%), respectively. Family factors of sibling bullying were partly different between boys and girls. Parental absence of both father and mother was a risk factor of being a pure bully and a bully-victim for boys, and of being a pure victim for girls. Parental son preference increased the odds of being a pure victim and a bully-victim for boys, and of being all roles of sibling bullying involvement for girls. Besides, parent–parent violence, parent–child violence, and living with a single parent were risk factors of sibling bullying. The results underline the importance of home environment on sibling relationship, and intervention of sibling bullying should include improving family climate.

Mother's and Father's Migrating in China: Differing Relations to Mental Health and Risk Behaviors Among Left-Behind Children

Background

In China, the figure for left-behind children (LBC) of migrants stood at 68. 77 million in 2015. Despite being seen as a whole in the last few decades, LBC today differ broadly in parental migrating status. This study focused on LBC with both parents migrating (BLBC), LBC with only mothers migrating (MLBC), LBC with only fathers migrating (FLBC), and previous LBC with one or both parents migrating (PLBC), separately. We aimed at exploring the extent to which LBC were being affected by each migrant parent on both mental health and risk behaviors.

Methods

Data from 4,832 children were collected by a school-based survey in both rural and urban areas of China's Anhui province. Each participant anonymously completed a self-administered questionnaire containing the sociodemographics, the Strength and Difficulties Questionnaire (SDQ), the items from the Youth Risk Behavior Surveillance System (YRBSS), and Young's Internet Addiction Test for Chinese (YIAT-C). Data were analyzed using one-way ANOVA and the Chi-squared test. Associations were estimated by multiple linear regression and logistic regression analyses adjusted for several confounders.

Results

The results suggested that BLBC (p &lt; 0.001), MLBC (p &lt; 0.05), FLBC (p &lt; 0.01), and PLBC (p &lt; 0.001) significantly scored higher for total difficulties along with emotional symptoms and conduct problems than never left-behind children (NLBC). Besides, BLBC, FLBC, and PLBC further reported a significantly higher rate of smoking (p &lt; 0.001, p &lt; 0.01, and p &lt; 0.001, respectively) and drinking (p &lt; 0.01, p &lt; 0.05, and p &lt; 0.01, respectively) than did NLBC. Also, MLBC appeared higher risks of smoking problems [OR = 2.31, 95% CI (1.45–3.69), p &lt; 0.001] and the internet addiction [OR = 2.15, 95% CI (1.24–3.72), p &lt; 0.01], when compared to NLBC.

Conclusions

The findings provided insight into LBC within the different contexts of parental migrations and contributed to a better understanding of their specific and potentially persistent health risks. Correspondingly, the study highlighted the implications for differentiating LBC to capture the more vulnerable group and tailored interventions to prioritize.

Correlation between reduced telomere length and behavioural and emotional problems in left-behind children in a rural area in China

Evidence shows that being left behind experience (LBE) during childhood may increase the risks of poor psychopathological outcomes. However, it is unclear to what extent the mental health is affected by the LBE. Telomere length (TL), one of the most extensively studied biological markers of cellular ageing, provides a valuable tool for exploring the potential effects of parent-child separation on psychological problems by integrating genetic and environmental factors. In this study, a total of 613 children (mean age = 10.77, SD = 1.92) were recruited from the rural area of Deyang, Sichuan Province, China. We used a self-designed questionnaire to assess LBE, and collected psychopathological outcomes by using the Piers-Harris Children's Self-concept Scale, the Teacher's Report Form 6/18 and the Youth Self-Report 11/18. Terminal restriction fragment analysis was used to measure TL in peripheral blood leukocytes. Analyses revealed that 342 out of 613 participants (55.79%) were Left-behind children. LBE was observed to associated with shorter TL, lower self-esteem, and increased behavioural and emotional problems. The cumulative effects of LBE may be reflected by greater altered telomere homeostasis, decreased self-esteem, and worsened behavioural and emotional problems. The association of the total time of being left behind with self-esteem and behavioural and emotional problems was significantly mediated by altered telomere homeostasis, with estimated effects of 14.19%, 47.95% and 45.13%, respectively. The LBE in childhood, especially prolonged parent-child separation, increases the risk of mental health problems in childhood and adolescence.

The Impact of Parental External Labour Migration on the Social Sustainability of the Next Generation in Developing Countries

Migration is a frequent phenomenon in the current European context. It is culturally differentiated according to every country, and it has a major role in the social sustainability of families and the next generation. This paper aimed to determine the impact of parents leaving to work abroad on the lives of their left-at-home children. This gives rise to a new phenomenon of “social orphans”. This research was carried out with the participation of eight adults who, during their childhood, had a parent who went to work abroad for a period of more than one month. The research tool used was the semi-structured interview guide. The research found that the main reason for parents leaving was the precarious financial situation of their families and their need to support their children (materially, educationally, and financially). The research results showed that the resulting greater financial stability did not guarantee that family ties would develop in a positive direction. More than half of the respondents reported a worsening of relationships with family members and experienced major psycho-emotional deprivation. The family has been negatively impacted in the social sustainability of the next generation.

Internalizing Behavior Problems Among the Left-Behind Children of the Hui Nationality in Rural China: A Cross-Sectional Study

Background

The internalizing behavior problems (IBPs) of left-behind children (LBC) due to parental migration are a widespread public health concern in China. A previous study showed that the detection rate of behavioral problems in the Hui was far higher than in the LBC of the Han nationality. However, to date, limited research has focused on IBPs in Chinese LBC of the Hui nationality. The aims of this present study are to explore the prevalence of IBPs and the influencing factors among the Hui LBC in the rural areas of China.

Methods

A cross-sectional study was conducted among school students from the southern rural areas in Ningxia, China (2012–2013). The caregivers or parents assessed IBPs using Achenbach’s Child Behavior Checklist for parents. The children completed the Egma Minnen av Bardndosnauppforstran, Junior Eysenck Personality Questionnaire and Piers–Harris Children’s Self-concept Scale. Data on 383 Hui LBC aged 6–16 y were included in this study. Multivariate logistic regression analysis was used to examine the relationships between the independent variables and children’s internalizing behaviors.

Results

Among the Hui population, the prevalence of IBPs in LBC and non-left-behind children (non-LBC) was 21.67% (83 of 383) and 18.18% (104 of 572), respectively, with no significant difference between these two groups (χ² = 1.77 and P = 0.18). However, among males of the Hui population, the prevalence of IBPs in LBC was 22.16%, which is significantly higher than in non-LBC (14.07%; χ² = 5.07; and P = 0.02). By controlling for gender and age, the multivariate logistic regression analysis showed that a mother highly favoring the subject (odds ratio [OR] = 2.70), average levels of neuroticism (OR = 9.01), and high levels of neuroticism (OR = 8.44) were risk factors for IBPs in Hui LBC.

Conclusion

Our findings suggest that IBPs among male LBC of the Hui nationality in rural China were positively related to parental migration. Positive measures should be taken to prevent IBPs of male LBC of the Hui nationality in rural China in terms of personality development and parental childrearing patterns.

Problem Mechanism and Solution Strategy of Rural Children’s Community Inclusion—The Role of Peer Environment and Parental Community Participation

Early childhood development intervention has gained considerable achievements in eliminating intergenerational transmission of poverty in rural areas. Paying further attention to rural children’s community inclusion can also promote the sustainable development of the village. However, there is a lack of systematic theoretical constructs on the village inclusion of rural children. In this study, an attempt was made to explore the problem mechanism and solution strategy of community inclusion of rural children using a grounded theory approach of in-depth interviews. Seventeen parents of children in a national-level poverty-stricken county in Inner Mongolia of China were investigated, adopting the strategy of intensity sampling. The results revealed that (1) the content of rural children’s activities demonstrates enhanced participation in the virtual environment and weakened participation in the real community environment. That is, the activities are characterized by more virtualization and individualization. (2) Rural parents and community peers are two major channels for children’s community inclusion, while both the community peer environment and parental community participation show a weakening trend. This may be an important reason for the virtualization and individualization of the children’s psychological development environment. (3) Developmental intervention programs for rural children in poverty-stricken areas should focus on the reconstruction of children’s community peer environment, encourage the community participation of parents, and fully mobilize local-based educational resources.

Sustained effects of left-behind experience during childhood on mental health in Chinese university undergraduates

Rapid industrialization and urbanization in China have resulted in labor migrants leaving children behind. For left-behind children (LBC), disrupted parental attachment may increase the risk of psychiatric morbidity in adulthood. To investigate psychopathological consequences for university students who were LBC and to estimate the effects of one or both parents being migrants, the duration of left-behind experience, and parental absence during critical periods of growth on psychiatric morbidity. We conducted an annual survey of all freshmen at a Chinese university from 2014 to 2018. The questionnaire collected information on left-behind experiences and psychiatric morbidity using standardized self-report instruments. Regression coefficients derived from logistic regression were used to measure the associations among total time left behind, absence of one parent or both parents, age when left behind and psychopathological consequences. A total of 42,505 students were included. Students who were LBC had more psychopathology, including depression, anxiety, somatoform disorder, obsessive-compulsive disorder, self-reported suicide attempts and deliberate self-harm, than those who were not. Students for whom one or both parents were migrants showed a greater risk of psychiatric morbidity. The risk of psychiatric morbidity increased with the length of parental absence. Left-behind experience during childhood represents sustained impacts for university students into early adulthood. The higher prevalence of psychiatric morbidity in young adults who experienced the absence of one or both of their parents, especially in their early childhood, suggests that other factors besides attachment, such as protection from other risks, are important and that further research is necessary.

The interactions between childhood adversities and recent stress were associated with early-adulthood depression among Chinese undergraduate students

BACKGROUND

It is widely acknowledged that childhood adversities (CAs) and recent stress are potential risk factors for adult depression. However, the mechanism(s) by which interactions of CAs with recent stress affect adult depression remain unclear.

AIMS

To investigate the predictive association of the interaction among CAs and recent stress with early-adult depression.

METHOD

We conducted an annual survey of all freshmen for the period of 2016-2018 in a Chinese comprehensive university, with a sample size of 23,206. An online questionnaire including standardized self-report instruments was used to assess sociodemographic factors, childhood experiences of left-behind (CELB), and maltreatments (CEMTs) including beating (CEB), neglect (CEN), sexual abuse (CESA), recent stress, and current depression (measured by the 9-item Patient Health Questionnaire).

RESULTS

The correlation of Individual CAs and recent stress was significant. In addition to their significant independent/direct incremental effects, all surveyed CAs were associated with increased severity of early-adult depression, and increased frequency of clinically significant depression (CSD), through significant associations with recent stress (mediation effect). History of CEMTs including CEB, CEN, and CESA significantly increased the effects of recent stress on depression (moderation effect).

CONCLUSIONS

Chinese undergraduate students reported frequent history of exposure to CAs, which increased the likelihood of depression in early adulthood, not only directly but also through the increasing the likelihood (mediation effect) and impact (moderation effect) of recent stress on depression. These novel findings may help to extend our understanding of environmental determinants of depression, and to guide further research, clinical practice, and policy in this context.

Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder

BACKGROUND

Low self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown.

OBJECTIVE

Investigate global and domain-specific self-esteem in adolescents with RAD or DSED.

PARTICIPANTS AND SETTING

All adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12-20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12-20).

METHODS

Self-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents.

RESULTS

Compared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = -0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = -0.42, p = .005), SA (MD = -0.40, p = .015), AC (MD = -0.22, p = .038), PA (MD = -0.33, p = .048), and SW (MD = -0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = -0.42, p = .012) and SW (MD = -0.32, p = .037). More RAD symptoms were associated with lower SA (B = -0.051, p = .013), AC (B = -0.048, p = .028), RA (B = -0.053, p = .007), and CF (B = -0.052, p = .005). More DSED symptoms were associated with lower SC (B = -0.125, p = .038).

CONCLUSION

Both global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly.

Suicide ideation, suicide plan, and suicide attempt among left-behind children and adolescents: A systematic review and meta-analysis

OBJECTIVE

There are an increasing number of studies that discussed suicide ideation (SI), suicide plan (SP), and suicide attempt (SA) among left-behind children (LBC). However, the prevalence of these indicators of LBC has not been synthesized and the true correlation between these indicators and left-behind status remains unclear.

METHODS

Electronic databases were comprehensively searched, and eligible observational studies were selected to extract useful data. We pooled the rates and their 95% confidence intervals (95% CIs) to determine the prevalence of SI, SP, and SA among LBC. The odds ratios (ORs) and 95% CIs were calculated to reflect the association between left-behind status and risk of SI, SP, and SA.

RESULTS

Among LBC, the pooled prevalence was 18.7% (95% CI: 15.4-21.9) for SI, 6.4% (95% CI: 4.7-8.1) for SP, and 3.1% (95% CI: 2.6-3.6) for SA. Compared to non-LBC, LBC was at higher risk of SI (OR = 1.26), SP (OR = 1.20), and SA (OR = 1.14), but only the effect for SI achieved statistical significance.

CONCLUSION

Overall, the prevalence of SI, SP, and SA is common among LBC, and parental migration has a significant impact on the SI of LBC. Intervention plans and programs are urgently needed to prevent suicidality of this vulnerable group.

Prevalence of unintentional injury among left-behind children in mainland China: Evidence from epidemiological surveys

BACKGROUND

Left-behind children have become a particular concern in mainland China, and unintentional injury among these children has attracted increasing attention. This review aims to present the prevalence of unintentional injury among left-behind children and subgroups in mainland China.

METHODS

A systematic literature search was conducted using four Chinese and two English databases. The included publications were cross-sectional studies in mainland China, of which the population was recruited according to inclusion and exclusion criteria. Information was collected using self-administered questionnaires. The risk of bias was estimated using the Strengthening the Reporting of Observational Studies in Epidemiology, and pooled prevalence was estimated through the DerSimonian-Laird proportion method.

RESULTS

This review included 34 cross-sectional studies consisting 58,348 left-behind children in mainland China. Results showed that the pooled prevalence of unintentional injury was 38.24% (95% confidence interval (CI): 28.40-48.08) among left-behind children. The prevalence was higher among left-behind children (38.76%) than among non-left-behind children (27.94%), with an odds ratio of 1.65 (95% CI: 1.47-1.85). Furthermore, the prevalence of injury was higher among boys (39.12%) than among girls (28.61%), with an odds ratio of 1.58 (95% CI: 1.41-1.77). Falls had the highest prevalence of 20.79% among the types of unintentional injury. Furthermore, home was the occurrence location with the highest prevalence (16.20%). No significant difference in injury prevalence was observed among left-behind children without accompanying parents and those with single parent accompanying them.

CONCLUSIONS

This review showed a relatively high injury prevalence among left-behind children in mainland China. Boys had a higher prevalence than girls. Falls had the highest prevalence, and home was the most common occurrence location.

Physical Violence against Children by Parents among Primary School Students from a Rural Area in Shandong Province, China

Physical violence (PV) against children by parents is a worldwide public health concern. Fewer studies explored the prevalence of PV in rural areas of China. We conducted a cross-sectional survey among primary school students' parents in five rural schools located in a town of Shandong Province. Data about parental PV behaviors against their children during the past 3 months and possible risk factors of parental PV behaviors were collected. Logistic regression analyses were carried out to investigate the risk factors of parental PV behaviors against their children. Of the 978 parents investigated, the parental self-reported prevalence of PV against their children was 50.0%. Parents' favorable attitudes toward the use of corporal punishment to discipline children were found to be associated with their increased use of PV. The findings of higher prevalence of parental PV behaviors against children identified in this sample suggests the need for programs aimed at improving parents' parenting skills in this rural area of China.

Parent Emigration, Physical Health and Related Risk and Preventive Factors of Children Left Behind: A Systematic Review of Literature

The aim of our study was to systematically review the literature on physical health and related consequences of internal and international parental migration on left-behind children (LBC). This review followed PRISMA guidelines. We searched the PubMed, Web of Science, Academic Search Complete, PsycINFO, and Cochrane databases and included studies reporting physical health-related outcomes of children affected by parental migration. The quality of the studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We selected 34 publications from a total of 6061 search results. The study found that LBC suffer from poor physical health as compared with non-LBC. Physical health-related risk factors such as underweight, lower weight, stunted growth, unhealthy food preferences, lower physical activity, smoking, alcohol consumption, injuries, and incomplete vaccination tend to be more prevalent among LBC in China. Studies focussing on international migration argue that having migrant parents might be preventive for undernutrition. Overall, our study showed that children affected by internal or international migration tend to have similar physical health outcomes. Moreover, we identified a lack of evidence on international parental migration that may have influenced the overall impacts. Further studies addressing international migration would contribute to better understand the impacts of migration for LBC.

Community-Based Family Workshop Intervention Improved the Social Adaptation of Left-Behind Children in Rural China

Purpose: With the rapidly developing economy in China, there are more than 50 million left-behind children (LBC) in rural China, whose social adaptation has become a public concern. Thus, the current study aimed to investigate the effect of community-based family workshop intervention on social adaptation among rural LBC in China. Methods: A cluster randomized trial was conducted with 104 LBC, in which 66 LBC-caregivers dyads received guidance from community-based family workshop for 6 months, while the controls (LBC n = 38) received routinely parenting guidance. Social adaptation of the children was assessed by the Strength and Difficulties Questionnaire (SDQ) at the beginning and the end of the intervention. Findings: Compared with controls, results showed remarkable improvement on emotional symptoms (P = 0.050), peer problems (P = 0.050), and total difficulties score (TDS, P = 0.040) in the intervention group, especially those aged 3-6 years. Moreover, SDQ score of TDS (P = 0.039), peer problems (P = 0.013), and hyperactivity-inattention (P = 0.023) decreased after intervention in boys aged 3-6 years, while emotional symptoms (P = 0.048) in girls. Finally, improvement on peer problems (P = 0.005) was observed in participants with high TDS. Conclusions: The findings suggest that community-based family workshop intervention can improve social adaptation of rural LBC. Moreover, this effect was different in boys and girls and also affected by age and baseline total difficulties. The results indicated that community-based family workshop intervention can be implemented in rural China to improve mental and behavioral health among LBC in the future.

Emotional and Behavioral Problems of Left-Behind Children in Impoverished Rural China: A Comparative Cross-Sectional Study of Fourth-Grade Children

PURPOSE

Children who are left behind when their parents migrate for work have a high prevalence of emotional and behavioral problems, which affect social function and increase family burden. To date, no national survey has been conducted on the emotional and behavioral problems of left-behind children (LBC) in China. This study aimed to investigate the emotional and behavioral outcomes of primary school LBC in the fourth grade in impoverished rural China and the possible influences of family environment and parenting practices.

METHODS

A cross-sectional study was carried out in 27 rural counties in the central and western parts of China from November 2016 to January 2017. The method of quota sampling was adopted to achieve a representative sample using postweighting adjustment. The survey sample was distributed proportionately across each county. LBC were defined as children aged <16 years who had two parents leave home to work or one parent leave home while the other lost the capacity to rear their children. The term "non-left-behind children" (NLBC) refers to children who have at least one parent who has not migrated for work. The Strengths and Difficulty Questionnaire (SDQ) was applied to measure children's emotional and behavioral problems.

RESULTS

After the weighted calculations were performed, there were 1,147 LBC and 3,953 NLBC. The proportion of abnormal SDQ total scores (>17) was significantly higher in the LBC group than in the NLBC group (15.6% vs. 11.6%; p < .01). Binary regression analysis showed that high levels of insomnia (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.04-2.27), loneliness (OR 1.65, 95% CI 1.13-2.43), and self-harm (OR 1.92, 95% CI 1.17-3.16) may increase the risk of abnormal SDQ total scores in LBC.

CONCLUSIONS

LBC showed a higher prevalence of abnormal SDQ total scores than NLBC. Insomnia, loneliness, and self-harm behavior were associated with abnormal SDQ total scores in LBC.

Mental health literacy about depression among rural left-behind children in China: a comparative and cross-sectional study

BACKGROUND

Mental health literacy (MHL) is vital for raising mental health awareness, reducing stigma, and improving health-related decision making, which may have lifelong consequences for patients with mental disorders.

AIMS

To examine MHL about depression among rural left-behind children (LBC) in China and explore differences between LBC and non-left-behind children (NLBC).

METHODS

A total of 3456 rural school children (mean age = 13.02 years) in fourth to ninth grades who were living in Sichuan, Anhui, and Henan provinces were surveyed in April and July 2018 using stratified random cluster sampling.

RESULTS

More NLBC correctly recognized depression compared with LBC (p < 0.05). The most common sources of mental health information were the TV and the Internet. LBC felt more uneasy if they asked for help (p < 0.01). Statistical differences in help-seeking barriers were observed between LBC and NLBC (p < 0.05).

CONCLUSIONS

Respondents showed low levels of depression-related MHL compared with peer groups in other countries, LBC showed lower MHL than NLBC in terms of the correct recognition rate of depression, attitude toward seeking help, etc. More school-based interventions should be implemented in rural schools, and parent involvement and digital-based educational strategies should be considered.

Left behind, not alone: feeling, function and neurophysiological markers of self-expansion among left-behind children and not left-behind peers

Four in 10 young rural Chinese children are ‘left behind’ by parents migrating for economic opportunities. Left-behind children do as well academically and imagine as many possible futures for themselves as their peers, implying that they must compensate in some ways for loss of everyday contact with their parents. Three studies test and find support for the prediction that compensation entails self-expansion to include a caregiving grandmother rather than one’s mother in self-concept, as is typical in Chinese culture. We measured self-expansion with feeling, function and neurophysiological variables. Twelve-year-old middle school left-behind children (Study 1, N = 66) and 20-year-old formerly left-behind children (now in college, Studies 2 and 3, N = 162) felt closer to their grandmothers and not as close to their mothers as their peers. Self-expansion had functional consequence (spontaneous depth-of-processing) and left a neurophysiological trace (event-related potential, Study 3). Left-behind participants had enhanced recall for information incidentally connected to grandmothers (Studies 1 and 3, not Study 2). Our results provide important insights into how left-behind children cope with the loss of parental presence: they include their grandmother in their sense of self. Future studies are needed to test downstream consequences for emotional and motivational resilience.

Effects of International Labour Migration on the Mental Health and Well-Being of Left-Behind Children: A Systematic Literature Review

Labour migration is a challenge for the globalised world due to its long-term effects such as the formation of transnational families. These families, where family members of migrant workers are “left-behind”, are becoming a common phenomenon in many low- and middle-income countries. Our systematic literature review investigated the effects of international parental labour migration on the mental health and well-being of left-behind children. Following the PRISMA guidelines, we performed searches in PubMed, PsychINFO, Web of Science, Cochrane Library and Google Scholar, resulting in 30 finally included studies. We found that mental health and well-being outcomes of left-behind children differed across and sometimes even within regions. However, only studies conducted in the Americas and South Asia observed purely negative effects. Overall, left-behind children show abnormal Strengths and Difficulties Questionnaire scores and report higher levels of depression and loneliness than children who do not live in transnational families. Evidence from the studies suggests that gender of the migrant parent, culture and other transnational family characteristics contribute to the well-being and mental health of left-behind children. Further research utilising longitudinal data is needed to better understand the complex and lasting effects on left-behind children.

Parental Migration, Children's Safety and Psychological Adjustment in Rural China: A Meta-Analysis

Studies concerning left-behind children in rural China have shown that parental absence due to migration is associated with greater risk of child victimization and accidental injuries, and a range of psychosocial problems. The authors conducted this meta-analysis to determine the extent to which left-behind children are affected by parental migration, as compared to children in nonmigrant rural families. A comprehensive literature search was conducted, and 90 studies published before 2017 were included in the data synthesis and analysis. The results revealed that compared to non-left-behind children, rural left-behind children are generally more disadvantaged in regard to child safety (d = 0.27) and psychological adjustment (d = 0.25). The effect sizes, though interpreted as small, revealed that children in rural China are significantly affected by parental migration. Children's educational stage was a significant variable that moderated the effect sizes of child safety and psychological adjustment. The findings of the meta-analysis indicated that mother-only migration may have the most harmful effect on children. In terms of implications for interventions, the results suggest more attention should be given to rural left-behind children and to "mother-absent children" in particular. Future research is warranted to explore the association between left-behind children's psychological adjustment and their exposure to injury and victimization.

Mental health and its influencing factors among left-behind children in South China: a cross-sectional study

BACKGROUND

With rapid development of China's economy, there were over 68.7 million left-behind children (LBC) in China whose mental health has become a problem of public concern. The present cross-sectional study aimed to investigate the status of mental health and its associated factors of LBC aged 3-16 years old in both rural and urban areas.

METHODS

A total of 4187 children (aged 3-16), including 1471 LBC and 2716 non-left-behind children (NLBC), were recruited from 50 communities (22 in urban areas and 28 in rural areas) in Guangdong, China in August, 2014. The mental health problems were assessed using the Strength and Difficulties Questionnaire (SDQ).

RESULTS

No statistically significant difference of SDQ subscales scores about difficulties were found between LBC and NLBC on the whole participants as well as in rural areas or in urban areas within the same age group after adjustments were made (all p > 0.05). However, compared with NLBC in the same areas, urban LBC tended to have higher prosocial behaviours scores, while rural LBC had the lowest prosocial behaviours scores not only in the whole age group but also in different age subgroups (p < 0.05). Besides, compared with urban LBC, rural LBC were not worse in SDQ subscales scores except for prosocial behaviour at 7-9 age group (p = 0.003). Furthermore, higher paternal educational level and longer duration of parental absence, were associated with less difficulties in both rural and urban LBC. Besides, shorter duration of talk per-time but higher communication frequency were associated with less difficulties in rural LBC.

CONCLUSIONS

The present study demonstrated that in general, no difference of mental health problems were found between LBC and NLBC. Besides, longer duration of parental absence, shorter duration of talk per time but more communication frequency, and higher paternal educational level tend to have better development of mental health. The findings reinforce the importance of the stability of caregivers and the effective parent-child communication for Chinese rural LBC.

The association between family members' migration and Epstein-Barr virus antibody titers among people left behind in rural Fujian, China

OBJECTIVES

In contrast to the health of migrants, which has been extensively studied, little attention has been paid to the health of adults left behind by family members who out-migrated to other locations. This study was performed to investigate the association between being left behind and the Epstein-Barr virus (EBV) antibody titer, which is an indicator of cellular immune functioning previously shown to be associated with psychological stress.

METHODS

A cross-sectional survey was conducted in rural communities in Fujian, China, in 2015. Questionnaire data and dried blood spot samples were collected from 748 adults. A mixed effect regression analysis was conducted to investigate the association.

RESULTS

Results indicated that the EBV antibody titers were higher among people who had been left behind compared with those who had not.

CONCLUSIONS

Our findings suggest that, in rural Fujian, China, family separation following the out-migration of family members is an important determinant of psychological stress.

Perception on risk factors of child maltreatment in China: a qualitative study among health professionals

OBJECTIVES

The aim of this study was to explore health professionals' perception of risk factors related to child maltreatment in China.

DESIGN

Qualitative research.

SETTING

The study was conducted in November and December 2014 in Hunan, Zhejiang, Shaanxi and Guangdong provinces in China.

PARTICIPANTS

Five urban communities and five rural communities were randomly selected in each province, and interviews were conducted in maternal and child health hospitals, children's hospitals, community health service centres and township hospitals in the selected areas. Doctors, nurses and administrators involved in child healthcare services were selected for in-depth-interview.

RESULTS

A total of 102 health professionals were approached but 95 completed the interview. From their perspective, risk factors causing child maltreatment were categorised into four domains: (1) cultural factors, including parents' absolute authority over their children and son preference; (2) social factors, including a fast-paced and stressful lifestyle, children left behind by migrant worker parents and lack of quality child care and education; (3) family factors, including economic status, family structure, parents' inability to provide parental care, experience of maltreatment and parents' illnesses; (4) children's factors, including gender, temper, disabilities and poor awareness of self-protection.

CONCLUSIONS

The results indicate that health professionals in China are aware of certain risk factors for child maltreatment; however, some views are outdated and wrong. Based on the perception of health professionals, targeted training courses are needed to enable them to correctly identify and deal with suspected cases of child maltreatment.

Personal psychological resources mediate parent-child relationship and mental health among left-behind children

Discrepant findings on the impact of parental migration on left-behind children's (LBC) psychological health have been noted in the literature. While several studies have shown the negative effects of parental migration, burgeoning research has demonstrated contradictory findings. The present study aimed to clarify this issue by examining the association between family resources and mental health as mediated by personal psychological resources (PPRs). A sample comprised of 466 LBC (aged 11-17 years) answered a set of questionnaires assessing parent-child relationship, PPRs, and mental health symptoms. The results showed that PPRs, particularly emotional resources, significantly mediated the link between family resources and mental health. This suggests that LBC who have rich family resources (i.e., close parent-child relationship) have lower mental health problems due to higher emotional resources (i.e., satisfaction in life). Conversely, those who reported having poor family resources experienced a lower level of PPRs (i.e., emotional well-being), which in turn, increased their risk of having psychological distress. The "caravanning" of resources from family to personal resources is vital in protecting LBC's mental health.

Brain Structural Alterations in Left-Behind Children: A Magnetic Resonance Imaging Study

Parental migration has caused millions of children left behind, especially in China and India. Left-behind children (LBC) have a high risk of mental disorders and may present negative life outcomes in the future. However, little is known whether there are cerebral structural alterations in LBC in relative to those with parents. This study is to explore the effect of parental migration on brain maturation by comparing gray matter volume (GMV) and fractional anisotropy (FA) of LBC with well-matched non-LBC. Thirty-eight LBC (21 boys, age = 9.60 ± 1.8 years) and 30 non-LBC (19 boys, age = 10.00 ± 1.95 years) were recruited and underwent brain scans in 3.0 T MR. Intelligence quotient and other factors including family income, guardians’ educational level and separation time were also acquired. GMV and FA were measured for each participant and compared between groups using 2-sample t-tests with atlas-based analysis. Compared to non-LBC, LBC exhibited greater GMV in emotional and cortico-striato-thalamo-cortical circuits, and altered FA in bilateral superior occipitofrontal fasciculi and right medial lemniscus (p < 0.05, Cohen’s d > 0.89, corrected for false-discovery rate). Other factors including family income, guardians’ educational level and separation time were not associated with these brain changes. Our study provides empirical evidence of altered brain structure in LBC compared to non-LBC, responsible for emotion regulation and processing, which may account for mental disorders and negative life outcome of LBC. Our study suggests that absence of direct biological parental care may impact children’s brain development. Therefore, public health efforts may be needed to provide additional academic and social/emotional supports to LBC when their parents migrate to seeking better economic circumstances, which has become increasingly common in developing countries.

Influence of earthquake exposure and left-behind status on severity of post-traumatic stress disorder and depression in Chinese adolescents

In the Longmenshan seismic fault zone in the Sichuan province of China, many children and adolescents have been exposed to the 2008 Wenchuan earthquake and/or the 2013 Lushan earthquake, and many are left alone for extended periods by parents who migrate to larger cities for work. We wished to examine how these two kinds of trauma-earthquake exposure and left-behind status-influence severity of post-traumatic stress disorder (PTSD) and depressive reactions. A cross-sectional survey of 2447 adolescents aged 13-18 at 11 schools in three cities in the Longmenshan fault zone was conducted in 2016. Potential relationships of scores on the Children's Revised Impact of Event Scale (CRIES-13) and the Depression Self-Rating Scale (KADS-6) with severity of PTSD and depression symptoms were explored using ANOVA and multiple hierarchical linear regression. Prevalence of post-traumatic stress and depression symptoms were higher among left-behind children than among those not left behind, and both types of symptoms were more severe in children exposed to both earthquakes than in children exposed only to the Lushan earthquake. Our results suggest that earthquake exposure is a strong risk factor for PTSD, whereas being left behind is a strong risk factor for depression.

Direct and interactive effects of peer support and resilience on psychosocial adjustment in emerging adults with early left-behind experiences

Background: Although abundant research documented the vulnerability of left-behind children in rural China, little is known about whether early left-behind experiences are linked to their positive psychosocial functioning in later life, as well as the potential protective factors for their psychosocial adjustment. Purpose: Informed by positive youth development framework and a positive adjustment framework in migrants, the current study compares psychosocial adjustment characterized by self-esteem and prosocial behavior between emerging adults with early left-behind experiences (LB-E) and their counterparts (Non-LB-E). Of importance, this study also examines the potential protective roles of social context (ie, peer support) and individual characteristic (ie, resilience) in psychosocial outcomes among Chinese emerging adults with and without early left-behind experiences. Methods: A propensity score matching was used to balance the two groups regarding age, gender, socioeconomic status, and potentially traumatic life events. Finally, a total of 182 emerging adults with early left-behind experiences and 182 their counterparts was involved in the current study, who were asked to complete self-report questionnaires. Results: The results showed that there were no significant differences in self-esteem and prosocial behavior between the two groups. In addition, resilience was found to moderate the link between peer support and self-esteem. Specifically, in the context of higher levels of peer support, emerging adults with higher levels of resilience reported higher levels of self-esteem. Conclusion: The current study suggests that early left-behind experiences are not an adversity for emerging adults' positive psychosocial adjustment, and the protective roles of peer support and resilience are highlighted in Chinese emerging adults. Intervention or prevention programs may focus on the enhancement of resilience as well as the quality of peer relationships, shifting away from risk towards positive development models.

Anxiety, happiness and self-esteem of western Chinese left-behind children

China's unprecedented economic boom has led a massive number of children left-behind by their peasant parents who have immigrated to urban areas in search of work. In current study, we explored how being left behind is associated with children's positive emotions and negative psychological traits by examining the differences in levels of happiness, self-esteem and anxiety between left-behind children (LBC) and non-LBC. A total of 448 students (aged 7-16) from three schools in Sichuan Province in China responded to the questionnaire. Fourteen teachers of LBC were invited to one-to-one interviews for in depth responses to LBC's behaviors and psychological well-being. The results revealed that non-LBC showed a higher level of happiness (t=-0.21, df=258, p<0.01) and a lower level of anxiety (t=1.41, df=406, p<0.05) than LBC children. Among LBC, low grade children (primary school grades 3 and 4) reported a lower level of happiness (t=-0.73, df=216, p<0.01) and self-esteem (t=-0.24, df=191, p<0.01) than their older counterparts (primary school grades 5 and 6). The teachers' accounts confirmed the statistical results that LBC suffered from the deprivation of parental care. According to the teachers, as LBC grew older, they developed an understanding of their own circumstances and came to appreciate their parents' decisions. With appropriate and adequate support provided to both LBC and the caretakers around them such as relatives and teachers, it may be possible to reduce the adverse impacts of parental deprivation on LBC.

Mental health and psychosocial problems among Chinese left-behind children: A cross-sectional comparative study

BACKGROUND

Separation from migrant parents threatens the mental health of approximately 61 million left-behind children (LBC) in China. This study compared the prevalence of mental health and psychosocial problems between LBC and controls in Sichuan province, China.

METHODS

We randomly recruited LBC and adolescents aged 12-16 years old from 16 rural high schools in 8 counties in Sichuan province. We compared frequency of school bullying, self-esteem, panic symptoms, depression and severe psychological distress(SPD) between LBC and controls from the same schools. These variables were assessed through face-to-face interviews and self-report questionnaires.

RESULTS

The prevalence of mental health problems was 43.4% among LBC(n = 1663) but 30.8% among controls(n = 1683), and the prevalence of specific psychological symptoms was also higher among LBC: SPD, 12.1% vs. 4.8%; panic, 32.4% vs. 22.1%; and depressive symptoms, 26.5% vs. 16.3%. Low self-esteem was more prevalent among LBC(26.6% vs. 18.2%) as was severe school bullying(18.5% vs. 11.3%). Among LBC, low self-esteem was associated with an increased risk of depression or SPD, and school bullying was a significant predictor of depression, panic symptoms and SPD. Low self-esteem and depression increased with longer separation from parents, and this risk was higher when the primary caregivers were LBC themselves or relatives compared to single parents or grandparents.

LIMITATION

LBC misbehavior, such as internet addiction, smoking and drinking, may also explain our findings; these factors need to be explored in future studies.

CONCLUSION

Our results highlight the urgent need for school-based and targeted interventions for LBC to prevent negative mental health outcomes.

Theory of Mind Development in School-Aged Left-Behind Children in Rural China

The current study aimed to investigate differences in theory of mind between left-behind children and non-left-behind children in rural China and to examine the potential protective role of general reasoning ability in left-behind children's theory of mind. Participants included 213 children aged 7.10-13.67 years (111 boys and 102 girls, M = 10.51 years, SD = 1.33), 101 of whom were left behind in rural areas by one or both migrating parents for at least 6 months. The Strange Stories task, a second-order false belief task, and a faux pas task were used to measure children's theory of mind, and Sessions B and C in Raven's Standard Progressive Matrices were used to test children's general reasoning ability. The results showed that left-behind children scored lower on both the faux pas task and Strange Stories task. Additionally, on second-order false belief understanding, left-behind boys performed worse than non-left-behind boys, while left-behind girls scored higher than non-left behind girls. Moreover, children's general reasoning ability moderated the relationship between parental migrant status and children's faux pas understanding: For children with high levels of general reasoning ability, left-behind children performed similarly to non-left-behind children, while for children with low levels of general reasoning ability, left-behind children scored lower than non-left-behind children, indicating that general reasoning ability buffered the negative effect of being left behind on children's theory of mind development. The implications of these findings for training directed at left-behind children are discussed.

Self-concept in institutionalized children with disturbed attachment: The mediating role of exploratory behaviours

BACKGROUND

Self-concept is seen as both an outcome of sociocognitive and emotional development, and a factor in social and mental health outcomes. Although the contribution of attachment experiences to self-concept has been limited to quality of primary attachment relationships, little is known of the effects of disturbed attachment on self-concept in institutionalized children. Thus, the current study examined associations between disturbed attachment behaviours in institutionalized children and self-concept, testing limited exploration as an explanatory factor.

METHODS

Thirty-three institutionalized children, aged 4-12, participated in a multimethod and multi-informant assessment of disturbed attachment behaviours (i.e., Disturbances of Attachment Interview and Behavioral Signs of Disturbed Attachment in Young Children), self-concept (i.e., Pictorial Scale of Perceived Competence and Social Acceptance for Young Children), and exploratory behaviours (i.e., Student Exploratory Behaviours Observation Scale). Analyses were conducted using bootstrapping techniques.

RESULTS

Global self-concept converged with teacher-rated children's self-concept, except for physical competence domain. Disturbed attachment behaviours were identified in 62.5% of the children, and this was associated with lower levels of exploration and lower scores on self-concept, compared with children without disturbed attachment behaviours. Furthermore, exploratory behaviours mediated the effects of disturbed attachment behaviours on self-concept.

CONCLUSIONS

Institution-reared children with disturbed attachment behaviours were likely to have a negative perception of self and one's own competences. Limited exploratory behaviours explained this linkage. Targeting disordered attachment in children reared in institutions and their caregivers should become a high priority as a means for preventing socioemotional development issues.

Does Parental Migration Have Negative Impact on the Growth of Left-Behind Children?-New Evidence from Longitudinal Data in Rural China

The soaring number of left-behind children (LBC) in China has raised concerns about whether or not they can receive adequate care. This study investigated the impact of parents’ migration on LBC’s growth. LBC were divided into father-left children (F-LBC) and at least mother left children (M-LBC), both of which were compared with non-left-behind children (non-LBC) in terms of growth indicators. Data of 466 children with two continuous measurements were obtained from the four recent waves of the China Health and Nutrition Survey (CHNS). Anthropometric measures and 24-h recall of three consecutive days of dietary intake were extracted. The disparity of growth and nutrition status were compared by the difference-in-difference (DID) method. Results showed that LBC had significantly worse height and weight than non-LBC at baseline, respectively (p = 0.006, p = 0.003). This disadvantage was improved after parental migration, especially for M-LBC. However, the impact on growth status caused by parents’ migration was statistically insignificant once the pre-treatment disparity was removed. Further analysis on nutrition status indicated that fathers’ migration had a significant negative impact on F-LBC’s calorie intake (p = 0.014), which was mainly caused by the decline of carbohydrates (p = 0.008). This study indicated that the negative impact detected in previous studies might be caused by the retarded growth of LBC before parents’ migration.

Depression among left-behind children in China

By retrieving literature published from 2005 to 2015 from Chinese National Knowledge Infrastructure, Wanfang, Vip, PubMed, and Web of Science, we filtered out studies using the Children’s Depression Inventory only and compared left-behind children and non-left-behind children. The methodological quality of the papers was evaluated using the Newcastle–Ottawa Scale. Finally, we included six studies to carry out a meta-analysis. The results showed that the Children’s Depression Inventory scores of left-behind children are significantly higher than those of non-left-behind children (standardized mean difference: −0.233, 95% confidence interval: −0.036 to −0.430, p < 0.05).

Parental absence, child victimization, and psychological well-being in rural China

Using cross-sectional data regarding 793 rural children aged 10-16 in Sichuan Province of China, the present study examined the preceding-year rates of seven forms of child victimization (physical assault, property crime, peer/sibling victimization, child maltreatment, sexual victimization, witnessing family violence, and exposure to community violence) and poly-victimization, and found children's victimization experiences increased as the degree of parental absence increased (from the presence of two biological parents, to parental migration and parental separation and divorce). Elevated levels of depression were also found among left-behind children and children of separated or divorced parents, compared to children living with both biological parents; and child poly-victimization added to the risk of child depression. Certain demographic characteristics (being a boy and younger) and parental factors were associated with child victimization in rural China. This study highlights the need for child protection in rural China, and in particular for parent-absent children.

The consequences of parental labor migration in China for children's emotional wellbeing

Using data from the 2010 wave of the China Family Panel Studies (CFPS), we study the effects of internal migration in China on the emotional wellbeing of children age 10-15. The 2010 CFPS, a national probability sample survey of the Chinese population, includes 3464 children within this age range. We compare five groups: rural children with local registration living with both parents; urban children with local registration living with both parents; children accompanying their migrant parent(s), children left behind with one parent when the other parent goes out to work; and children left behind or sent to live with others when both parents go out to work. We expect the last three groups to be at risk of increased emotional difficulties compared to children living with both parents. We test these expectations using both conventional regression models and community fixed-effects models. The evidence supporting our expectations is very weak and inconsistent, leading us to conclude that in the Chinese context family arrangements have little impact on the emotional wellbeing of children. We conclude by offering some conjectures as to why this is so.

Child feeding and stunting prevalence in left-behind children: a descriptive analysis of data from a central and western Chinese population

Objectives

To examine the effect of parental rural-to-urban internal migration on nutritional status of left-behind children and how this is related to guardianship.

Methods

We used UNICEF China’s maternal and child health survey data to investigate stunting prevalence and feeding practices in children left behind by rural-to-urban internal migrant parents. We also assessed the effects of primary guardianship which is related closely with parental migration.

Results

Of 6136 children aged 0–3 years, over one-third was left behind by one or both parents. About 13 % were left behind by mothers, leaving guardianship primarily to grandmothers. Left-behind status was not associated with stunting, yet children who were cared for primarily by their fathers had a 32 % increase of stunting compared to children cared for by the mothers [adjusted odds ratio (aOR) = 1.32; 95 % confidence interval = 1.04–1.67]. Children with migrant mothers were less likely to receive age-appropriate breastfeeding (aOR = 0.04;0.02–0.10) and a minimum acceptable diet (aOR = 0.56;0.39–0.79) compared with non-left-behind children.

Conclusions

Guardian’s feeding behaviours varied, and was inappropriate for both children affected and not affected by parent’s rural-to-urban internal migration. Community-based infant and young child feeding counselling and support should be provided to all caregivers.

Electronic supplementary material

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Food preferences, personality and parental rearing styles: analysis of factors influencing health of left-behind children

PURPOSE

To understand the health status and problems of left-behind children (LBC) in rural China, those whose parents have moved to urban areas without them, and to focus on ways to improve their physical and mental health.

METHODS

The study examined 827 children between 7 and 15 years old, selected using stratified cluster random sampling from five towns in Xiji County of the Ningxia Hui Autonomous Region. Each child was classified as either LBC or non-LBC. Measures included age- and sex-specific height and body mass index (kg/m²), a food preference questionnaire, the Revised Junior Eysenck Personality Questionnaire, and the Egna Minnen av Barndoms Uppfostran-My Memories of Upbringing (EMBU).

RESULTS

Malnutrition rates for LBC and non-LBC were 14.83 % (70/472) and 7.04 % (25/355) (χ ²  = 11.86, p < 0.01). More LBC reported hating vegetables and fruits. Eysenck Personality Questionnaire profiles of LBC revealed a significantly higher degree of neuroticism and psychoticism, and a significantly lower lie scale score (p < 0.01). LBC's EMBU profiles showed that the paternal approach lacked emotional warmth and understanding and the maternal approach was characterized by favoritism, over-interference and overprotection. There were a significant negative correlation between the personality characteristic of neuroticism and liking vegetables and fruits (p < 0.01), and a negative correlation between psychoticism and liking vegetables (p < 0.05).

CONCLUSION

The health status of LBC is problematic. Food preferences, personality type and parenting styles should be taken into account when measures are developed to improve the health of these children.

The impact of life skills training on behavior problems in left-behind children in rural China: A pilot study

A randomized controlled experimental pilot study was conducted in order to investigate the effect of life skills training on behavior problems in left-behind children (LBC) in rural China. Sixty-eight LBC were recruited from a middle school in rural China. The intervention group took a ten-week-long life skills training course. The Child Behavior Checklist (CBCL) and Teacher’s Report Form (TRF) were used to evaluate the behavioral problems of the children at three separate intervals: Prior to the intervention, the first week following the intervention, and three months after the intervention. Children in the intervention group showed significant improvement both in the CBCL and the TRF compared to children in the control group. Significant improvements were found in the CBCL total scores, internalizing behavior, externalizing behavior and seven subscales scores ( p > 0.05). In TRF, similar significant improvements were found, except in internalizing behavior and the subscale of thought problems ( p > 0.05). The effect of intervention remained the same three months after the intervention. As a pilot study, the life skill training was found to be effective in improving behavior problems in the LBC in rural China, with the exception of thought problems.