Resilience as moderator of the relationship between left-behind experience and mental health of Chinese adolescents

Long-term effects of various experiences of parental migration on adult health: A nationwide survey in China

BACKGROUND

Despite numerous literature studies on the short-term effects of diverse experiences of being left-behind, migrant, or both on children, the research on their long-term effects remains inadequate. The purpose of current study is to explore the long-term impact of being left-behind, migrant or experiencing both during childhood on health in adulthood. Simultaneously, we investigate the impact of psychological resilience on adults in the presence of diverse experiences of parental migration.

METHOD

A total of 2,371 samples were selected from 28 provinces in China, consisting of 656 participants who had been left behind but never migrated (PLBNM), 205 participants who had migrated but never been left behind (PMNLB), 265 participants who had both been left behind and migrated (PLBM), and 1,245 participants who had no left-behind/migrant experiences (NLBM). The mental health, health condition, and psychological resilience were measured using the 12-item General Health Questionnaire (GHQ-12), Self-Rated Health, and the Connor-Davidson Resilience Scale (CD-RISC), respectively.

RESULTS

The results of the regression model indicated that PLBNM (OR = 2.10, 95% CI [1.59, 2.77], p < .001), PMNLB (1.93, [1.27, 2.94], p < .01), and PLBM (2.01, [1.37, 2.94], p < .001) displayed lower self-rated health compared to NLBM. However, only PLBNM (1.29, [1.05, 1.58], p < .05) reported higher mental health problems compared to NLBM. Our results also showed a strong association between psychological resilience and adults' lower self-rated health (0.72, [0.64, 0.82], p < .001).

CONCLUSION

The negative long-term impact of various experiences regarding being left-behind, migrant, or both, on adult's mental health and self-rated health were more pronounced. The Chinese government ought to create unique policy frameworks that offer assistance to those adults.

Childhood psychological maltreatment and social anxiety in college students: The roles of parasympathetic nervous system activity and parent-child separation experience

BACKGROUND

Childhood psychological maltreatment is a risk factor for social anxiety in adulthood. Parent-child separation, as one of the most serious adversities in early life, may exacerbate the risk of psychological maltreatment and influence the interactions between childhood psychological maltreatment and biological sensitivity to stress in relation to social anxiety. However, there has been a dearth of work on this issue.

OBJECTIVE

This study investigated the interactive effects between childhood psychological maltreatment and parasympathetic nervous system (PNS) activity on social anxiety in college students by comparing those who experienced parent-child separation versus those who did not. Potential sex differences in the aforementioned associations were tested as an exploratory aim.

PARTICIPANTS AND SETTING

Data were obtained from 264 college students (Mage = 18.45 years, SD = 0.69), including 156 students who experienced parent-child separation and 108 students without this experience.

METHODS

Participants completed measures of childhood psychological maltreatment and social anxiety and reported their parent-child separation experience. The data of PNS activity, measured by respiratory sinus arrhythmia (RSA) reactivity, were obtained during the Trier Social Stress Test (TSST) in the lab.

RESULTS

Childhood psychological maltreatment was positively associated with college students' social anxiety. RSA reactivity moderated the relationship between childhood psychological maltreatment and college students' social anxiety, and the moderating role of RSA reactivity varied with parent-child separation experience and sex.

CONCLUSIONS

Parent-child separation experience influenced the biosocial interactions between childhood psychological maltreatment and PNS activity in relation to individuals' social anxiety, and this effect persisted in adulthood.

Family function and emotional behavior problems in Chinese children and adolescents: A moderated mediation model

BACKGROUND

Studies have shown that family function is associated with emotional behavior problems. However, the underlying relationship mechanisms between family function and emotional behavior problems in children and adolescents is not fully understood. Therefore, the purpose of this study is to explore the mediating effect of resilience and the moderating effect of sleep quality using a moderated mediation model.

METHODS

6363 children and adolescents in grades four to nine were surveyed in some areas of Anhui Province, China. Family function, resilience, sleep quality, and emotional behavior problems were measured through a self-administered questionnaire. All data analysis was by performed by SPSS 23.0.

RESULTS

The results showed that family function was negatively associated with emotional behavior problems (r = -0.307, p < 0.01). Resilience partially mediated the relationship between family function and emotional behavior problems (indirect effect = -0.108, accounted for 38.4 %). Sleep quality moderated the relationship between family function and resilience (β = -0.039, P < 0.001).

CONCLUSION

Resilience and sleep quality respectively played a mediating and moderating effect in the relationship between family function and emotional behavior problems. These findings suggest that we should pay attention to the family function of children and adolescents in time, improve their resilience and sleep quality, so as to effectively reduce the occurrence of emotional behavior problems.

Psychological Resilience of Chinese College Students: A Cross-Sectional Study after the Deblocking of China's COVID-19 Pandemic Strategy

Psychological resilience (PR) plays an important role in fortifying mental health during pandemics. This study aimed to examine the PR and its related factors of college students in China after the deblocking of the China's COVID-19 pandemic strategy. A total of 1100 college students from 15 universities participated in this cross-sectional survey by multi-stage stratified sampling. Data were collected by self-designed socio-demographic information, the family function assessment scale (APGAR), a general health questionnaire (GHQ-12), the general self-efficacy scale (GSES), and a psychological resilience scale. The average score of PR was 135.65 ± 18.54. Cluster analysis of PR scores showed that 24.9% of the college students had weak PR. The higher PR, the higher mental health status (r = 0.352, p < 0.05). Females had higher PR than males (OR = 0.550, 95% CI: 0.367-0.827). High self-efficacy was an independent protective factor of high PR (OR = 0.093, 95% CI: 0.059-0.145). Low family contact frequency, poor family function, and bad mental health status were the independent risk factors of high PR. In conclusion, the PR of Chinese college students were insufficient after the deblocking of China's COVID-19 pandemic strategy, indicating an improvement of PR should be put into practice immediately. Frequent monthly contact with family, family function, self-efficacy, mental health status, and gender were the influencing factors of PR, which provides an intervention strategy for the future.

Development of psychological resilience and associations with emotional and behavioral health among preschool left-behind children

PURPOSE

This study aimed to explore the development of psychological resilience and its associations with emotional and behavioral health among preschool left-behind children (LBC).

METHODS

LBC in 26 preschools of Fuyang City, Hefei City, and Maanshan City of Anhui Province were included at baseline survey; and baseline children in the junior and middle classes of preschools as targeted samples were recruited for the 1-year follow-up. Multivariable linear regression models were performed to examine associations of psychological resilience with emotional and behavioral health.

RESULTS

In total, 1463 LBC were included at baseline and 568 of the 905 targeted LBC completed the 1-year follow-up. Change patterns of psychological resilience were identified as the stable-high pattern (19.0%), increasing pattern (18.3%), declining pattern (15.9%), and stable-low pattern (46.8%). The results showed that psychological resilience at baseline was positively associated with later dietary behavior habits and prosocial behaviors, and negatively associated with later problematic behaviors and sleep problems. In addition, children with the declining pattern had more problematic behaviors and sleep problems, and fewer prosocial behaviors at follow-up. Children with the increasing pattern and stable-high pattern had more prosocial behaviors, better dietary behavior habits, and fewer problematic behaviors and sleep problems at follow-up.

CONCLUSIONS

The majority of preschool LBC had lower psychological resilience and its level among some LBC changed during the follow-up. Higher psychological resilience was a protective factor for emotional and behavioral health. Timely assessing psychological resilience and then strengthening it are needed to promote the emotional and behavioral health of preschool LBC.

Parental neglect, anxious attachment, perceived social support, and mental health among Chinese college students with left-behind experience: A longitudinal study

The harm of childhood parental neglect to emerging adults' maladjustment has garnered empirical support. For college students who have left-behind experience (LBE), this relationship is rarely discussed and the psychological process underlying this relationship is not well understood. Using a longitudinal study and guided by the Risky Families model, this study aimed to explore the mediating roles of anxious attachment and perceived social support in the link between parental neglect and maladjustment of LBE college students. We used two-wave longitudinal data, with a time lag of 3 months, collected among Chinese college students with LBE in Chongqing (N = 391). The results revealed that parental neglect in wave one was positively associated with maladjustment (depression, anxiety, and stress) in wave two. Anxious attachment and perceived social support in wave two separately mediated the relationship between parental neglect in wave one and maladjustment in wave two. Anxious attachment and perceived social support in wave two only sequentially mediated the pathway from parental neglect to later depression. These findings emphasize the importance of anxious attachment and social support in resilience and have significant implications for LBE college students' social work practice in China.

Family Background Issues as Predictors of Mental Health Problems for University Students

Mental health problems are common among university students. Specific type of family background is one of the important factors contributing to these problems. This study aimed to evaluate the proportion of severe mental health problems and the associations between severity and types of problems and family backgrounds. This was a cross-sectional descriptive study. We reviewed the database and medical records of 125 university students aged over 18 years who attended the mental health consultation clinic for university students, 123 Primary Care Unit, Khon Kaen University, between 1 January and 31 December 2018. The characteristics of the participants were summarized using descriptive statistics. We performed an analysis using logistic regression to obtain the crude and adjusted odds ratio. The proportion of severe mental health problems was 50.4%. The most common problem was learning problems (54.4%). The severity of the problems reported by the students was associated with communication failure in the family (AOR = 3.30 [95% CI: 1.14-9.52], p = 0.027). All students who experienced domestic violence in their family had severe mental health problems. This study re-appraised the utility of the context of the family as a predictor of current problems of university students.

Racism and Stress-Related Growth Among Asian Internationals: Ethnic Identity, Resilience, and Coping During COVID-19

Experiences of anti-Asian discrimination following COVID-19 has deleterious effects on the mental health of Asian internationals residing in the United States. In this study, hierarchical regression models and Hayes’ PROCESS models were used to examine the main effect and moderating effect of ethnic identity, coping strategy, and resilience on stress-related growth among Asian international students and workers (N = 237) in the United States who experienced racism during the pandemic. The findings indicated coping strategies and resilience were significantly associated with stress-related growth. Ethnic identity and coping strategies additionally moderated the link between the experience of racism and stress-related growth.

A Prospective Study on Resilience Among Children with Different Migrant and Left-behind Trajectories

Parental migration has been an important predictor of children's psychological resilience. The present study discusses the effect of parental migration on children's resilience in rural western China from a dynamic viewpoint. Using sequence analysis, this study investigates children's entire migration trajectory over the course of childhood (ages 1-12) and identifies the typical patterns of the dynamic family structure associated with parental migration: continuously nonmigrant (N = 4,238), continuously migrant (N = 923), continuously left behind by one parent (N = 872), continuously left behind by both parents (N = 796) and frequent transition between migrant or left-behind statuses (N = 1,624). The results show that the trajectories of left-behind status and transition have a significant negative impact on children's resilience, which demonstrates that both the effects of parent-child separation and family instability compromise children's psychological functioning. Family resources can buffer these negative effects, but they work asymmetrically across different groups of children. Family economic resources serve as a significant protective factor among children continuously left behind by both parents, while family social resources are more protective for children in unstable families.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12187-022-09945-1.

The Effect of Left-Behind Experience and Self-Esteem on Aggressive Behavior in Young Adults in China : A Cross-Sectional Study

There is little investigation on the independent effects of left-behind experience (LBE) on self-esteem and aggressive behavior in Chinese young adult populations, or the interaction effects of LBE and self-esteem on aggressive behavior. Thus, a school-based health survey was conducted in Anhui province in China in 2017. A total of 4,154 college students completed standard questionnaires which contain details of left-behind-related characters, self-esteem, aggressive behavior, and sociodemographic profile. Of included students, 55.3% were those with LBE (LBEs). Compared to students without left-behind experiences (NLBEs), LBEs had significantly increased scores of aggressive behavior and decreased score of self-esteem. The increased aggression in LBEs was highly related to longer left-behind duration, younger age of left-behind for the first time, and decreased self-esteem. On the other side, the aggressive behavior was demonstrated negatively correlated with self-esteem in both LBEs and NLBEs. There was an interaction effect of left-behind duration and self-esteem on physical aggression and of frequency of contacting with parents and self-esteem on verbal aggression. Besides, the interaction of primary caregiver and self-esteem on hostility and aggression toward self were also observed, respectively. Our results indicated LBEs and low self-esteem are associated with increased risk of aggressive behavior in Chinese young adults. The increased aggressive behavior in LBEs were highly related to longer left-behind duration, younger age of left-behind for the first time and decreased self-esteem. In those LBEs with some certain left-behind-related characters, aggressive behavior decreased more prominently with the increase of self-esteem. Strategies to improve self-esteem, particularly among young adults who have certain characters of LBE, should be a significant component of prevention and interventions of aggressive behavior.

Correlations Between Social Support and Loneliness, Self-Esteem, and Resilience Among Left-Behind Children in Mainland China: A Meta-Analysis

BACKGROUND

Social support is frequently reported to be correlated with loneliness, self-esteem, and resilience among left-behind children in mainland China. However, to date, there is no consensus on the extent to which those factors are correlated with social support among left-behind children. We thus performed a meta-analysis to quantitatively synthesize the previous findings.

METHODS

Two investigators systematically and independently searched PubMed, EMBASE, Web of Science, PsycINFO, Wan Fang, Chinese National Knowledge Infrastructure (CNKI) and China Science Technology Journal Database (VIP) on January 9, 2022. Pooled Pearson's correlation coefficients between social support and loneliness, self-esteem, and resilience were calculated by Stata 16.0 software using random effects model.

RESULTS

Forty-seven studies involving a total of 30 212 left-behind children were identified. A large degree of negative correlation was found between social support and loneliness [summary r: -0.36 (95% CI: -0.42- -0.30), p < 0.001]. Large positive correlations were found between social support and self-esteem, and resilience [self-esteem: summary r: 0.33 (95% CI: 0.24-0.41), p < 0.001; resilience: summary r: 0.45 (95% CI: 0.38-0.50), p < 0.001]. The pooled correlations revealed some discrepancies when stratified by some moderators. Sensitivity analysis also revealed the robustness of the findings. The Egger regression and Duvall and Tweedle trim-and-fill procedure suggest the absence of publication bias.

CONCLUSION

The current meta-analysis provided solid evidence that social support has a high degree of negative correlation with loneliness and a high degree of positive correlation with self-esteem and resilience among left-behind children in mainland China. This indicated that left-behind children with high levels of social support tend to have lower levels of loneliness and higher levels of self-esteem and resilience. More studies, especially large prospective studies, are warranted to verify our findings.

Social determinants of health that permeate the mental suffering of children on the french-brazilian border

OBJECTIVES

to understand the determinants involved in the mental suffering of schoolchildren on the French-Brazilian border.

METHODS

a qualitative study was conducted with children from 6 to 12 years of age from four State schools in the municipality of Oiapoque, located on the French-Brazilian border. The data were obtained through interviews, analyzed by the IRAMUTEQ software, and interpreted in the light of the Dahlgren and Whitehead's social determinants of health model.

RESULTS

data indicate that the mental suffering experienced by children, especially characterized by anxious symptoms, such as concern of becoming fat and worries, were permeated by social situations that children went through daily, such as family abandonment, domestic violence, and bullying.

FINAL CONSIDERATIONS

social determinants can be predictors of mental suffering in children, especially in environments of extreme vulnerability, such as the border, in a context of financial difficulties, domestic violence, and absence of parenting.

A mixed method study to examine the mental health problems of college students who had left-behind experiences

BACKGROUND

China's rapid urbanization has created a large number of labour transferring from rural to urban areas and large numbers of college students with left-behind experience (LBE). LBE was an important influencing factor on college students' mental health.

METHODS

A mixed method involving quantitative survey and qualitative interview was emplyed to explore the influence of LBE on mental health of college students. In the quantitative survey, 1605 college students from three different universities of Shandong province in China were recruited. Their mental health status was measured using Symptom Check-list 90(SCL-90 scale) compiled by American psychologist Derogatis. In the qualitative interview, 40 college students with left-behind experience from the same three universities were interviewed.

RESULTS

The prevalence estimate of total mental health problems among left-behind students was 2.14 times higher than that among those without left-behindexperience. LBE increased the problems of somatization, obsessive-compulsion (Ocd), international sensitivity, depression, anxiety, hostility, terror, paranoia, psychoticism and other symptoms. The result of qualitative interview showed the mental health problems of the college students with left-behind experience were mainly on anxiety, depression, Ocd, interpersonal sensitive and hostility, which was consistent with the results of quantitative survey.

LIMITATION

Representativeness of the sample is the major limitation of our study. Due to rare similar studies performed in other countries, we could not compare the results in China to that in other countries.

CONCLUSION

Left-behind experience was an important factor associated with the mental health of college students. The mental health of college students with LBE needs more attention.

Childhood maltreatment and self-harm in Chinese adolescents: moderation and mediation via resilience

Background

Published studies examining the association between childhood maltreatment (CM) and self-harm (SH) among adolescents have been accumulated. It is possible that resilience serves as a moderator or mediator in CM-SH association, nevertheless, this topic has never been thoroughly investigated.

Methods

In this population-based cross-sectional study, we surveyed 3146 students aged 10–17 in southwest China. The Childhood Trauma Questionnaire (CTQ), the Modified version of Adolescents Self-Harm Scale (MASHS), and the Resilience Scale for Chinese Adolescents (RSCA) were used to measure CM, SH, and resilience. Correlational analyses, hierarchical multivariate linear regression, and structural equation modeling (SEM) were performed to test the moderation and mediation of resilience in CM-SH association.

Results

Findings revealed that, resilience with its five dimensions, CM, and SH were significantly correlated with each other. Resilience partially moderated and mediated the association between CM and SH. Besides, among all dimensions of resilience, emotion regulation, interpersonal assistance, and family support presented the strongest mediation in CM-SH association.

Conclusions

Our results highlight the importance of resilience in CM related SH among Chinese teenagers. Resilience-oriented intervention could be considered in SH intervention measures for adolescents who had experienced CM.

Factors Associated with Self-Esteem, Resilience, Mental Health, and Psychological Self-Care Among University Students in Northern Thailand

Background

The severity of mental health issues among university students in rural areas can affect the outcomes of their studies. The purpose of this study was to identify factors associated with self-esteem, resilience, mental health, and psychological self-care among university students.

Methods

We conducted a cross-sectional survey of 729 undergraduate students by a self-administered questionnaire. Using convenience sampling, the participants were chosen from four majoring in Public Health at University of Phayao in Northern Thailand.

Results

Approximately 82% of university students had mental health problem. Backward logistic regression analysis showed that 1) a good relationship with family had a significantly positive effect on self-esteem (p-value <0.05); 2) a good relationship with friends was significantly associated with high resilience (p-value <0.05); 3) having a disease/s and a relationship with family had a significant effect on mental health problem (p-value <0.05); 4) being female, perceived normal weight, and a good relationship with family were significantly related to high psychological self-care (p-value <0.05).

Conclusion

Gender, incurrent disease, perceived weight status, relationship with friends and family were associated with self-esteem, resilience, mental health, and psychological self-care among university students. Our findings can be incorporated in a support policy and integrated into the public health curriculum. University administrators and faculty have an opportunity to formulate an intervention program and provide services that could mitigate mental health problems and improve the well-being of students at their university.

Physical Activity and Resilience among College Students: The Mediating Effects of Basic Psychological Needs

Considering the significance of resilience in coping with adversity, how to improve college students' resilience is worthy of attention. Previous studies have revealed that physical activity can promote resilience; however, few studies examined the mediating factors between them. The purpose of this study was to investigate the effect of physical activity on resilience, as well as the mediating effects of competence need, autonomy need, and relatedness need between physical activity and resilience. The study involved 2375 college students (1110 males and 1265 females), with an average age of 20.25 years (SD = 2.04). Participants completed the International Physical Activity Questionnaire Short Form, Basic Needs Satisfaction in General Scale, and Connor-Davidson Resilience Scale. Results showed that physical activity was positively associated with resilience, and the three basic needs played significant mediating roles between physical activity and resilience. The indirect effect of competence need was significantly greater than that of autonomy need and relatedness need. To conclude, physical activity plays an important role in resilience among college students, and the satisfaction of competence, autonomy, and relatedness needs mediates the relationship between physical activity and resilience, among which, competence need appears as the strongest mediator.

The Impact of Childhood Left-Behind Experience on the Mental Health of Late Adolescents: Evidence from Chinese College Freshmen

A paucity of public service afforded to migrant workers often begets a wide range of social problems. In China, hundreds of millions of migrant worker parents have to leave children behind in their hometowns. This paper investigated the long-term effects of the childhood experience of being left behind on the mental well-being of late adolescents. Mandatory university personality inventory (UPI) surveys (involving psychosomatic problems such as anxiety, depression, and stress) were conducted at a university in Jiangsu, China, during 2014–2017. The study sample consisted of 15,804 first-year college students aged between 15 and 28 years. The PSM method and the OLS regression model were employed. Controlling for the confounding factors (gender, age, single-child status, hometown location, ethnicity, and economic status), our empirical investigation demonstrated that childhood left-behind experience significantly worsened the mental health of the study sample, increasing the measure of mental ill-being by 0.661 standard deviations (p < 0.01). Moreover, the effects were consistently significant in subsamples divided by gender, single-child status, and hometown location; and the effects were greater for females, single-child students, and urban residents.

The relationships between resilience and student personal factors in an undergraduate medical program

BACKGROUND

Resilience is an essential aspect of wellbeing that plays a major role in undergraduate medical education. Various personal and social factors are known to affect resilience. Empirical evidence remains limited regarding resilience and the personal factors that affect it among undergraduate medical students in an Asian setting. Therefore, this study aims to identify undergraduate medical students' level of resilience and its relationships to personal factors in Indonesia.

METHODS

This cross-sectional study was conducted among undergraduate medical students in years 1-6. Respondents were asked to complete three validated questionnaires: the Connor-Davidson Resilience Scale (CD-RISC) to measure resilience, the Brief-COPE to assess coping mechanisms, and the Big Five Personality Test to measure five personality dimensions. Descriptive and Pearson's correlation analyses were completed to explore relationships between each variable. Regression analysis was completed to analyze the extent to which coping mechanisms, personality, and academic achievement explained the variation in resilience scores.

RESULTS

A total of 1040 respondents completed the questionnaires (a 75.42% response rate). Students in both preclinical and clinical stages had quite good levels of resilience and higher scores on adaptive coping mechanisms than on maladaptive coping mechanisms. Adaptive and maladaptive coping mechanisms, Big Five Personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness), and students' academic achievement explained 46.9% of students' resilience scores.

CONCLUSIONS

Although the resilience scores in this study were comparable to resilience scores among undergraduate medical students in other settings, we found that coping mechanisms, personality traits, and academic performance may predict resilience among medical students.

The Moderating Effect of Resilience on the Relationship between Adverse Childhood Experiences (ACEs) and Quality of Physical and Mental Health among Adult Sexual and Gender Minorities

Sexual and gender minority (SGM) individuals experience a greater burden of poor mental health compared to heterosexual individuals. One factor that helps to explain this disparity is trauma experienced during childhood. SGM are more likely to report traumatic experiences during childhood contributing to this disparity. Previous research has shown that resilience moderates the relationship between childhood trauma and adults mental health outcomes. As part of the Strengthening Colors of Pride project, data on 463 SGM adults living in San Antonio were collected using surveys. A diverse recruitment strategy was used in conjunction with a community advisory board. The brief resilience scale (BRS) was used to assess intrapersonal level resilience to determine if there was an effect on the relationship between ACEs and quality of mental and physical health. Differences were noted for some items across low, normal, and high levels of resilience. Both ACEs and BRS significantly predicted quality of mental and physical health. We also noted a significant interaction between ACEs and BRS with regard to quality of mental health. Findings suggest there is a relationship between intrapersonal level resilience, ACEs, and quality of mental health.

The relationship between left-behind experience and obsessive-compulsive symptoms in college students in China: the mediation effect of self-esteem

The number of left-behind children in China is gradually increasing, and college students with left-behind experience (LBE) have more severe mental health problems. The aim of this study was to evaluate the association of LBE and the obsessive-compulsive (OC) symptoms of college students, explore the mediation role of self-esteem in the relationship between them. A total of 4145 college students were recruited in Anhui province, China. The Chinese Obsessive-Compulsive Inventory-Revised (OCI-R) and Rosenberg Self-Esteem Scale (RSES) were used to measure OC symptoms and self-esteem. Bootstrap program was used to test the mediation effect. The results showed that the detection rate of OC symptoms was 24.1%. Multiple linear regression analyses found that LBE was positively associated with OC symptoms (t = 2.928, p = 0.003). High self-esteem scores in college students were significantly associated with a lower probability of OC symptoms (t = -17.023, p < 0.001). Furthermore, the test of Bootstrap showed that the indirect effect of self-esteem between LBE and OC symptoms was significant for 95% CI (LLCI = 0.3586, ULCL = 0.7264) and the mediation effect was 0.5396. The ratio of the indirect effect to the total effect was 0.408. OC symptoms were common mental health problems among college students. LBE had a positive predictive effect for OC symptomsand self-esteem plays a mediating role between them. Improving self-esteem will be beneficial to prevent and control the OC symptoms of college students.

Factors associated with psychological resilience in left-behind children in southwest China

Psychological resilience of Chinese left-behind children (LBC) remains under-studied. In this cross-sectional survey, we intended to analyze factors associated with resilience in a large group of LBC. One-stage random cluster sampling was used to select 2898 LBC aged between 10 and 17 years in Yunnan province of southwestern China. Face-to-face interview was used to collect relevant information from the participants. Resilience was measured by the Resilience Scale for Chinese Adolescents (RSCA). Multivariate logistic regression models revealed that having a better educated mother, feeling closer to people living in the same residence, and having more close friends were associated with higher psychological resilience in LBC. LBC who felt less close to people living in the same residence were consistently lower in all five dimensions of resilience. Compared with LBC with 2 or less close friends, LBC with more close friends had significantly greater resilience in goal concentration, family support, and interpersonal assistance. Higher mother's education level was related to higher resilience in emotion regulation, family support, and interpersonal assistance. Our findings suggest that dimension-specific intervention measures should be developed and implemented to improve psychological resilience of LBC.

Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis

BACKGROUND

Globally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs).

METHODS

For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science, PsychINFO, Global Index Medicus, Scopus, and Popline from inception to April 27, 2017, without language restrictions, for observational studies investigating the effects of parental migration on nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy, and abuse in left-behind children (aged 0-19 years) in LMICs. We excluded studies in which less than 50% of participants were aged 0-19 years, the mean or median age of participants was more than 19 years, fewer than 50% of parents had migrated for more than 6 months, or the mean or median duration of migration was less than 6 months. We screened studies using systematic review software and extracted summary estimates from published reports independently. The main outcomes were risk and prevalence of health outcomes, including nutrition (stunting, wasting, underweight, overweight and obesity, low birthweight, and anaemia), mental health (depressive disorder, anxiety disorder, conduct disorders, self-harm, and suicide), unintentional injuries, substance use, abuse, and infectious disease. We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs) using random-effects models. This study is registered with PROSPERO, number CRD42017064871.

FINDINGS

Our search identified 10 284 records, of which 111 studies were included for analysis, including a total of 264 967 children (n=106 167 left-behind children and adolescents; n=158 800 children and adolescents of non-migrant parents). 91 studies were done in China and focused on effects of internal labour migration. Compared with children of non-migrants, left-behind children had increased risk of depression and higher depression scores (RR 1·52 [95% CI 1·27-1·82]; SMD 0·16 [0·10-0·21]), anxiety (RR 1·85 [1·36-2·53]; SMD 0·18 [0·11-0·26]), suicidal ideation (RR 1·70 [1·28-2·26]), conduct disorder (SMD 0·16 [0·04-0·28]), substance use (RR 1·24 [1·00-1·52]), wasting (RR 1·13 [1·02-1·24]) and stunting (RR 1·12 [1·00-1·26]). No differences were identified between left-behind children and children of non-migrants for other nutrition outcomes, unintentional injury, abuse, or diarrhoea. No studies reported outcomes for other infectious diseases, self-harm, unprotected sex, or early pregnancy. Study quality varied across the included studies, with 43% of studies at high or unclear risk of bias across five or more domains.

INTERPRETATION

Parental migration is detrimental to the health of left-behind children and adolescents, with no evidence of any benefit. Policy makers and health-care professionals need to take action to improve the health of these young people.

FUNDING

Wellcome Trust.

Influence of the Left-Behind Experience on Self-Efficacy of College Students

The left-behind experience refers to the experience of children who were taken care of by caregivers in their hometowns for ≥6 months before reaching age 18, as one or both parents left the rural hometown for better paying jobs in bigger cities. The current study was conducted with college students to test the effect of the left-behind experience on self-efficacy. The General Self-Efficacy Scale and a questionnaire designed by the authors were adopted for a survey of 200 Chinese college students in their final year of university. Of 200 students, 72 (36%) students had ≥6 months of left-behind experience before reaching age 18. Results did not show statistically significant difference in self-efficacy between college students with or without left-behind experience (p > 0.05). In addition, researchers found no significant difference in self-efficacy between college students with left-behind experience from different backgrounds. Further research and focus on this area is necessary. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

The resilience status of Chinese left-behind children in rural areas: a meta-analysis

The resilience has become the main trend of the left-behind children's (LBC) mental health research. To evaluate the resilience status of Chinese LBC in rural areas, a meta-analysis was performed. Relevant studies were identified using electronic databases from 1990 to 2017. Pooled weighted mean difference (WMD) and 95% confidence interval (95% CI) were calculated with fixed and random effects models. A total of 14 cross-sectional studies with 9777 individuals were included in this meta-analysis. The results showed there was significant difference in the aspects of family support and RSCA (Resilience Scale for Chinese Adolescents) total score between LBC and non-left-behind children (NLBC). After stratification subgroup, significant difference in RSCA total score was also found in subgroup with sample size ≥700 and target population (LBC) between LBC and NLBC. In addition, there was no significant difference in resilience of male and female among LBC (P >0.05). We also found RSCA total score of LBC whose one parents migratingwere higher than both parents (P <0.05) and the time of parental migration (≤2 years) were higher than others (>2 years). In conclusion, more attention should be paid to the LBC, especially both parents migrating or parental migration (>2 years).