Depressive symptoms, parenting attitude, and violent discipline among caregivers of left-behind children in rural China: a cross-sectional study

BACKGROUND

The situation of mental health and discipline behaviors of left-behind children's caregivers were not optimistic in rural China. Caregivers' depression might increase the risk of using violent discipline. However, the specific ways in which depressive symptoms impact violent discipline have rarely been explored in rural areas. This study aims to assess the prevalence of violent discipline among left-behind children under 6 years of age in rural China and explore the potential mechanisms of how caregivers' depressive symptoms affect violent discipline.

METHODS

We enrolled a total of 396 pairs of left-behind children and their caregivers in our study, which was conducted in 5 counties of Hebei, Henan, Jiangxi, Guizhou, and Sichuan provinces in China. The depressive symptoms of caregivers were measured by using Zung Self-rating Depression Scale (ZSDS) and violent discipline was assessed by the Child Discipline Module of Multiple Indicator Cluster Surveys (MICS). A self-designed questionnaire was utilized to measure caregiver's parenting attitude. Based on the cross-sectional data, controlling for potential confounders, structural equation modeling (SEM) was used to assess the direct and indirect effects of the mediation models by applying the weighted least squares with mean and variance adjusted (WLSMV) estimate.

RESULTS

The prevalence of violent discipline, psychological aggression, and physical punishment was 72.7%, 59.3%, and 60.4% respectively of left-behind children under 6 years of age. According to the results of SEM, parenting attitude acted as a suppressor, suppressing the association between caregivers' depressive symptoms and physical punishment/psychological aggression/violent discipline. The caregivers' depressive symptoms positively influenced all the outcome variables by affecting parenting attitudes (p = 0.002, p = 0.013, p = 0.002).

CONCLUSIONS

The presence of depressive symptoms in caregivers increases the use of violent discipline through negative parenting attitudes. The mental health status of primary caregivers of left-behind children in rural China needed emphasis and improvement.

Uncovering the symptom relationship between anxiety, depression, and internet addiction among left-behind children: A large-scale purposive sampling network analysis

Facing long-term separation from their parents, left-behind children are at risk of the co-occurrence of internalizing and externalizing problems. Although previous research has gained substantial information examining the relationship between anxiety, depression, and internet addiction at the aggregate level of variables, little is known about the heterogeneity and interactions between these components at the symptom level with a large-scale purposive sample. Adopting the network approach, two network pathways, depression and anxiety, and associations between these variables and internet addiction were constructed. Our sample included 5367 left-behind children (Mage = 13.57; SDage = 1.37; 50.07% females). Relevant bridging, central symptoms, and network stability were identified. Two relatively stable networks were obtained. For the network of anxiety and depression, sleep problems and tachycardia were vital bridging symptoms. Central symptoms, including tachycardia, restlessness, fatigue, and emptiness, were symptoms of depression. For the network of symptoms of anxiety, depression, and internet addiction, the bridging symptoms remained the same, and the central symptoms included tachycardia, restlessness, loss of control, and emptiness. By identifying relevant bridging and central symptoms, those with higher levels of these symptoms could be regarded as intervention targets, providing a reference for the current issue of valuing diagnosis over prevention in left-behind children.

Associations of latent patterns of parent‒child communication with communication quality and mental health outcomes among Chinese left-behind children

BACKGROUND

Parent‒child communication in migrant families is essential to family bonds and the mental health of left-behind children (LBC). Little is known about the different patterns of communication between migrant parents and LBC and associated communication quality and mental health outcomes.

METHODS

A sample of 2,183 Chinese children (mean age = 12.95 ± 1.29 years) from Anhui province, including LBC whose parents had both migrated (n = 1,025) and children whose parents had never migrated (never-LBC, n = 1,158), was analyzed. With the LBC sample, latent class analysis was applied to identify the patterns of parent‒child communication. Multinomial logistic regression analysis was conducted to assess the associations between the sociodemographic variables and class membership of LBC. Analysis of covariance and chi-square tests were used to compare communication quality and mental health outcome differences among the classes of LBC and between each of the classes and never-LBC.

RESULTS

Five latent classes of communication formed through different media or channels between migrant parents and their LBC were identified. Higher household economic status (OR = 2.81, p < 0.05) was associated with adequate communication. LBC in Class 1, defined by frequent technologically-mediated and face-to-face communication, had a significantly higher quality of communication with their migrant parents (F = 8.92, p < 0.001) and better mental health than those in other latent classes; these children did not have significantly worse mental health outcomes compared to never -LBC.

CONCLUSIONS

Facilitating multichannel parent‒child communication is a practical way of reducing mental health inequities between LBC and their peers.

Early stimulation and responsive care: A mediator of caregivers' depression on the suspected developmental delay of left-behind children in China

BACKGROUND

Due to multiple factors, left-behind children in rural areas suffer from neurodevelopment delay and their caregivers suffer from depressive symptoms. This study aimed to analyze the effect of caregivers' depressive symptoms on left-behind children's neurodevelopment, with early stimulation and responsive care mediating.

METHODS

We conducted a cross-sectional survey in five counties in China. A total of 904 left-behind children aged 0-3 and their primary caregivers were enrolled. The Zung Self-rating Depression Scale (ZSDS) was used to measure caregivers' depressive symptoms. The Ages and Stages questionnaires-third edition (ASQ-3), which contains five domains: communication (CM), gross motor (GM), fine motor (FM), problem-solving (CG), and personal social (PS), was used to screen children for suspected developmental delay (SDD).

RESULTS

31.4 % of left-behind children suffered from SDD, while 39.7 % of left-behind children's caregivers experienced depressive symptoms. Caregivers' ZSDS scores were positively correlated with the SDD on four domains (FM, GM, CG, and PS), while Early stimulation and responsive care was negatively correlated with the SDD on four domains (CM, FM, CG, and PS).

LIMITATIONS

The cross-sectional design limited the ability to ascertain causal relations. Besides, the findings may not be generalized to all regions of China due to the heterogeneity of the study population.

CONCLUSIONS

Left-behind children under three years old in rural China were at high risk of SDD, while a substantial proportion of their caregivers had depressive symptoms. Caregivers' depressive symptoms may negatively affect the SDD of left-behind children through caregivers providing less early stimulation and responsive care.

Parent-Child Separation and Diurnal Cortisol Rhythms Among Left-Behind Adolescents: The Moderating Role of Sex

Prior research examining parent-child separation and the hypothalamic-pituitary-adrenal (HPA) axis functioning has primarily focused on separation due to parental divorce or loss or forced migration. Less clear is the impact of parental economic migration on adolescents' HPA axis functioning. The present study fills this gap by examining diurnal cortisol patterns among left-behind adolescents who experienced separation from their migrant parents. Participants were 293 Chinese adolescents (33.4% girls, 66.21% left-behind adolescents; M_age = 10.80 years old, SD = 0.82 years). Two-level multilevel modeling was conducted to examine the associations between parent-child separation experiences and diurnal cortisol patterns. Although no significant differences were found between left-behind adolescents and their non-left-behind peers, results revealed that left-behind adolescents who experienced parent-child separation at earlier ages had more blunted diurnal cortisol slopes (usually signaling poorer mental and physical health), compared to their counterparts who experienced separation at older ages. Left-behind adolescent girls who had more adverse separation experiences exhibited smaller waking cortisol and blunted diurnal slopes; these findings were not observed among left-behind adolescent boys. Observing the association between timing of parent-child separation and adolescents' diurnal cortisol and the moderating effects of child sex, this study contributes uniquely to the developmental science of left-behind adolescents' physiological health.

Does social capital aid in leveling the income gradient in child mental health? A structural analysis of the left-behind and not-left-behind Chinese children

BACKGROUND

Few prior studies have investigated the income gradient in child mental health from a socio-environmental perspective. In an age when child mental health problems in a rapidly changing social environment have become a worldwide issue, an understanding of the socio-environmental mechanisms of the income disparities in child mental health outcomes is imperative and cost-effective.

METHODS

By conducting structural equation analyses with Chinese nationally representative survey data, this study explored the family income gradient in child depression and its potential socio-environmental pathways at the neighborhood, family and school levels, differentiating left-behind and not-left-behind children.

RESULTS

We found a robust family income gradient in depressive symptoms. Neighborhood cohesion mitigated the income gradient in depressive symptoms by playing a suppression role. School social capital acted as a mediator. Neighborhood trust, neighborhood safety and family social capital played no significant impact. The mitigating and mediating roles of social capital components were significant among only the not-left-behind children.

CONCLUSIONS

To reduce income-related inequalities in child mental health in the long run, integrating policies that directly reduce poverty with policies that improve distal socio-environments is necessary.

Unintentional injury and its associated factors among left-behind children: a cross-sectional study

BACKGROUND

Unintentional injuries among children and adolescents are a major public health problem worldwide. These injuries not only have negative effects on children's physiology and psychology, but also bring huge economic losses and social burdens to families and society. Unintentional injuries are the leading cause of disability and death among Chinese adolescents, and left-behind children (LBC) are more prone to experience unintentional injury. The purpose of this study was to evaluate the type and incidence of unintentional injury among Chinese children and adolescents and explore the influences of personal and environmental factors by comparing the differences between LBC and not left-behind children (NLBC).

METHODS

This cross-sectional study was conducted in January and February 2019. Additionally, 2786 children and adolescents from 10 to 19 years old in Liaoning Province in China were collected in the form of self-filled questionnaires, including Unintentional Injury Investigation, Unintentional Injury Perception Questionnaire, Multidimensional Subhealth Questionnaire of Adolescent (MSQA), Negative life events, "My Class" questionnaire and Bullying/victim Questionnaire. Multiple logistic regression analysis was used to explore the factors associated with unintentional injury among children and adolescents. Binary logistic regression analysis was used to explore the factors affecting unintentional injuries between LBC and NLBC.

RESULTS

The top three unintentional injuries were falling injuries (29.7%), sprains (27.2%) and burns and scalds (20.3%) in our study population. The incidence of unintentional injuries in LBC was higher than that in NLBC. Burn and scalds, cutting injury and animal bites in LBC were higher than those in NLBC. The results show that junior high school students (odds ratio (OR) = 1.296, CI = 1.066-1.574) were more likely to report multiple unintentional injuries than primary school students. Girls (OR = 1.252, CI = 1.042-1.504) had higher odds of reporting multiple unintentional injuries. The odds of multiple injuries in children and adolescents with low levels of unintentional injury perception were higher than those in children and adolescents with high levels of unintentional injury perception (OR = 1.321, C = 1.013-1.568). Children and adolescents with a higher levels of mental health symptoms (OR = 1.442, CI = 1.193-1.744) had higher odds of reporting multiple unintentional injuries. Compared with teenagers who had never experienced negative life events, teenagers who had experienced negative life events many times (OR = 2.724, CI = 2.121-3.499) were more likely to suffer unintentional injuries many times. Low-level discipline and order (OR = 1.277, CI = 1.036-1.574) had higher odds of reporting multiple unintentional injuries. In-school adolescents who were bullied were more likely to report being injured multiple times than their counterparts who were not bullied (OR = 2.340, CI = 1.925-2.845). Low levels of unintentional injury perception, experienced negative life events and bullying had greater impacts on LBC than on NLBC.

CONCLUSION

The survey found that the incidence of at least one unintentional injury was 64.8%. School level, sex, unintentional injury perception, subhealth, negative life events, discipline and order and bullying were associated with incidents of unintentional injury. Compared with NLBC, LBC had a higher incidence of unintentional injury, and special attention should be given to this group.

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.

Longitudinal associations between parental migration and children's psychological well-being in Southeast Asia: The roles of caregivers' mental health and caregiving quality

OBJECTIVE

This study investigates the longer-term effects of parental migration on the psychological well-being of children who stay behind in two major labor-sending countries in Southeast Asia, namely, Indonesia and the Philippines. Adopting the framework of the 'care triangle', we further examine how caregivers' mental health and caregiving quality moderate the associations between parental migration and children's psychological well-being.

METHODS

Using longitudinal data collected in 2008 and 2016/17, we assess children's psychological well-being during early childhood (aged 3-5 years) and again in adolescence (aged 11-13 years). We apply both fixed-effects and random-effects models, using the Hausman test to indicate the preferred model.

RESULTS

The findings indicate that there is no significant longer-term effect of parental migration on children's psychological well-being, but parental migration tends to show adverse effects on Filipino children's psychological well-being when they are cared for by a caregiver with poor mental health.

CONCLUSIONS

The two-country comparison demonstrates the complexities of understanding the gender-based influences of parental migration on children's psychological well-being. The findings also highlight the caregiver's role in maintaining frequent communications with migrant parents within the care triangle, which is crucial to children's well-being.

The relationship between home environment and early childhood development of left-behind children under 3 years in rural China

BACKGROUND

Home environment provides stimulation and learning opportunities required for children's early development. However, few studies have focused on the effects of home environment on left-behind children's development in rural China. The study aimed to investigate the relationship between home environment and early childhood development of left-behind children under 3 years old in rural China.

METHODS

Information about sociodemographic characteristics, caregivers' mental health, home environment and children's development was collected. Infant/Toddler Home Observation for Measurement of the Environment Inventory (IT-HOME) was used to assess home environment. Child's development was evaluated with the Chinese version of the Ages & Stages Questionnaire - third edition.

RESULTS

Elevated caregivers' depressive symptoms were associated with a higher risk of total suspected development delay. An increase of one score in the IT-HOME resulted in a 7% decrease in total suspected development delay. Higher scores in the dimensions of involvement and variety were associated with a lower risk of suspected development delay adjusting for covariates.

CONCLUSIONS

Our results have implications for home-based intervention aiming at promoting nurturing care as well as caregivers' mental health, which is required for early development of young left-behind children in rural areas of China.

A cross-sectional study on knowledge and behavior regarding medication usage among guardians of left-behind children: evidence from China

PURPOSE

The primary objective of this study was to evaluate knowledge and behavior of medication use among guardians of left-behind children (LBC) and non-left-behind children (NLBC).

METHODS

A cross-sectional study was conducted in Chengdu, the major city of southwestern China from May 2020 to August 2020. A logistic regression model was conducted to assess medication-related knowledge and behavior of guardians between the LBC group and NLBC group, adjusted for confounders. Stratified analysis was further performed.

RESULTS

The overall mean scores for knowledge and for behavior were 20.22 (standard deviation = 4.472) and 15.77 (standard deviation = 3.604), respectively. No significant difference was found in medication-related knowledge and behavior scores between LBC and NLBC guardians (P > 0.05). A significant difference was only observed after adjusting for past medical history and history of present illness (HPI).

CONCLUSION

There was no significant difference in the awareness and behavior of medication use between guardians of LBC and NLBC in this study, having more contact with the doctor was an effective method of health education that could possibly improve their health literacy.

The impact of parental migration on left-behind children's vision health in rural China

BACKGROUND

Parental migration is an important factor affecting left-behind children's health. However, few studies have addressed the effect of parental migration on children's vision health in China. To fill the gap, this study aimed to assess the impact of parental migration on left-behind children's vision health and to explore the possible mechanisms of the effect.

METHODS

Data were obtained from the baseline survey of the China Education Panel Survey (CEPS), which included over 10,000 junior high school students. This study used myopia, the most common vision problem among junior high school students, and tried to analyze whether myopia was corrected with eyeglasses as indicator variables of vision health. The impact of parental migration on vision health was assessed using an instrumental variables approach.

RESULTS

The results show that parental migration reduced the likelihood of myopia in left-behind children and decreased the possibility of myopic left-behind children being corrected. This result passed a series of robustness tests. The mechanism analysis indicated that compared to non-left-behind children, left-behind children spent more time on outdoor activities and less time on after-school classes, reducing their risk of being myopic. Further, because left-behind children live apart from their parents, their myopia problem is more difficult for parents to notice, and left-behind children are less likely to inform their parents of their myopia than non-left-behind children actively. This helps to explain why left-behind children have a lower correction rate with eyeglasses.

CONCLUSIONS

Our findings suggest that parental migration, while not increasing the prevalence of myopia in left-behind children, has led to inequity in myopic left-behind children's correction. Given the severe consequences of uncorrected myopia, action is required to enhance the correction rate of myopic left-behind children.

Multicenter analysis on the non-suicidal self-injury behaviors and related influencing factors-A case study of left-behind children in northeastern Sichuan

BACKGROUND

Few studies have been conducted focusing on the non-suicidal self-injury (NSSI) incidence rate and influencing factors among left-behind children in northeastern Sichuan, China. In this study, we investigated the incidence rate of the NSSI behaviors, levels of anxiety and depression in left-behind children in northeastern Sichuan, and relevant sociodemographic factors.

METHODS

The NSSI behaviors were identified using the Ottawa Self-injury Inventory (Chinese version). Its incidence rate and related influencing factors were evaluated by Cluster sampling; the Depression Anxiety Stress Scale-21 Items (DASS-21) was adopted to assess the levels of anxiety, depression, and stress.

RESULTS

A total of 9450 adolescents met the inclusion criteria, including 543 with NSSI behaviors, and the prevalence of NSSI was 5.7 %. There were 3596 left-behind children, and 243 of them had NSSI behaviors, the NSSI incidence in left-behind children was 6.8 %. There were 5854 non-left-behind children, and the NSSI incidence in non-left-behind children was 5.1 %. Left-behind children's NSSI behaviors were remarkably correlated with five risk factors: being female (OR = 2.411, 95%CI = 1.773-3.279), parents' divorce (OR = 1.742, 95%CI = 1.262-2.404), elder age (OR = 1.120, 95%CI = 1.028-1.219), severe depression (OR = 1.212, 95%CI = 1.148-1.281), and high anxiety (OR = 1.170, 95%CI = 1.093-1.251).

LIMITATIONS

This is a cross-sectional study, we cannot probe into the causality between NSSI behaviors and corresponding risk factors. Reporting and recalling biases may be unavoidable as questionnaires are performed by self-rating scales and retrospective reports.

CONCLUSION

The NSSI behaviors are common in left-behind children in northeastern Sichuan. This study proposes that prevention and intervention measures are necessary for the healthy growth of such children.

A prospective study of peer victimization and depressive symptoms among left-behind children in rural China: the mediating effect of stressful life events

BACKGROUND

The Ministry of Civil Affairs of the People's Republic of China reported that in 2018, 6.97 million left-behind children (LBC), children who live in rural areas away from their parents, were being cared for by grandparents, relatives, elder siblings, or often living alone. Their parents have migrated to cities for better income opportunities. While a number of studies have detailed elevated depressive symptoms among LBC, relatively little is known about the causes of poorer mental health in LBC.

METHODS

This study used longitudinal data to examine associations between peer victimization, stressful life events, and depressive symptom severity in LBC from four randomly-selected middle schools in Guizhou Province, China. A total of 862 children aged 11-18 years, with 472 LBC (54.76%) and 390 non-left-behind children (NLBC) (45.24%), were included in the analysis. T-test was used to compare the depressive symptoms, peer victimization, and stressful life events between LBC and NLBC at baseline and follow-up (6 months later). Multivariable linear regression models were used to examine the mediation effect of follow-up stressful life events on the relationship between baseline peer victimization and follow-up depressive symptoms among LBC.

RESULTS

Results suggested that LBC had higher peer victimization and stressful life events than NLBC (β = 1.28, p = 0.04), and peer victimization and stressful life events at baseline were associated with increased follow-up depressive symptoms among LBC (Peer victimization: β = 0.25, p < 0.0001; Stressful life events: β = 0.15, p < 0.001). Peer victimization affected depressive symptoms partially through stressful life events for female LBC and completely through stressful life events for male LBC, controlling for age, perceived socioeconomic status, and school.

CONCLUSIONS

This study highlights the vulnerability of LBC exhibiting negative mental health outcomes as they were found to experience more peer victimization and feel more stressed when stressful life events happened, compared with NLBC. Results of this study suggested that protecting LBC from peer victimization experiences can potentially prevent LBC from experiencing an increased impact of other stressful life events, thus decreasing the likelihood of their depressive symptoms. Intervention design should consider the different mediating effects of stressful life events on the relationship between peer victimization and depressive symptoms among female and male LBC.

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 chain mediating role of cognitive styles and alienation between life events and depression among rural left-behind children in poor areas in Southwest China

BACKGROUND

Compared with no-left-behind children, left-behind children show more psychological and behavioral problems, among which depression is the most common and most influential psychological problem in childhood. Many studies have documented the impact of life events on depression among left-behind children, but few studies have focus on the mediating mechanisms behind this relationship. Based on theoretical and empirical research on cognitive style and alienation, this study constructed a chain mediation model to test whether cognitive style and alienation play a mediating role in life events and depression of left-behind children.

METHODS

We recruited 13,035 participants from 25 districts and counties in Chongqing. After screening, 5127 questionnaires of left-behind children were included in the data analysis. They all completed self-report measures of demographic information, life events, cognitive styles, alienation and depression. We used SIF, CDI, ASLEC, CCSQ and IAP to collect the information of the variables and used the SPSS to analyze the data.

RESULTS

(1) There were significant positive correlations among life events and depression. (2) Left-behind children's depression was affected by life events through 3 different pathways: the mediating role of cognitive styles, the mediating role of alienation, and the chain mediating role of both cognitive styles and alienation.

LIMITATIONS

This is a cross-sectional study and the data used in our study is self-reported.

CONCLUSIONS

Cognitive styles and alienation could mediate the association between life events and depression among left-behind children.

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.

Externalizing Behavior Problems Among Hui Ethnicity Left-Behind Children in Rural China: A Cross-Sectional Study

OBJECTIVE

This study aimed to investigate the prevalence of externalizing behavior problems (EBPs) and its influencing factors among Hui left-behind children (LBC) in rural China.

METHODS

A cross-sectional study was conducted among school students from the southern rural areas in Ningxia, China (2012-2013). The general self-made questionnaire, Egma Minnen av Bardndosna Uppforstran, Eysenck Personality Questionnaire (for Children), Piers-Harris Children's Self-Concept Scale, and Achenbach's Child Behavior Checklist (for parents) were used to investigate the related information. Binary logistic regressions were conducted.

RESULTS

The prevalence of EBPs in boys Hui LBC was significantly higher than that of non-LBC (12.37% vs. 6.84%, χ2=4.09, and p=0.04). Multivariate logistic regression analysis showed that low self-awareness of behavior (odds ratio [OR]=29.78), introversion (OR=21.67) and intermediate personality (OR=15.83), poor academic performance (OR=11.65) and both parent migrating (OR=2.73) were the risk factors for the EBPs of Hui LBC, while middle and high father refusal and denial (OR=0.11, OR=0.09) were their protective factors.

CONCLUSION

Our findings suggest that both parent migrating is a potential risk factor for EBPs among Hui LBC. Hui boys LBC should be paid more attention when formulating relevant policies.

Word of Mouth from Left-Behind Children in Rural China: Exploring Their Psychological, Academic and Physical Well-being During COVID-19

COVID-19 has had considerable effects on people's lives worldwide, particularly left-behind children in China as they tragically witnessed the outbreak. From the outset, millions of left-behind children in rural areas experienced extensive physical and psychological disturbances because their migrant parents who lived in the city or another province could not be with them. This study explored the psychological, academic, and physical well-being of rural left-behind children during COVID-19. We captured the experiences of 10- to 15-year-old children and adolescents who were left behind by their migrant parents before the COVID-19 outbreak. The results of the present study suggest that left-behind children have exhibited severe psychological illnesses since the pandemic has limited their social interactions with peers and increased improper caretaking from grandparents.

Parental migration and non-cognitive abilities of left-behind children in rural China: Causal effects by an instrumental variable approach

BACKGROUND

Extensive research has confirmed the disadvantages of left-behind children in the development of human capital in rural China; however, evidence is limited on non-cognitive abilities, especially in the identification of causal effects. In recent years, the role of non-cognitive abilities on children has become increasingly prominent.

OBJECTIVE

This study identifies the causal effects of parental migration and the decline of non-cognitive of left-behind children and explores the potential mechanisms.

PARTICIPANTS AND SETTING

The participants were 4636 rural students in the seventh and ninth grades of 43 secondary schools from 26 counties based on the China Education Panel Survey (CEPS) in the 2013-2014 academic year.

METHOD

We adopt an endogenous treatment effect model with the instrumental variable (IV) to identify the causal effects by constructing a comprehensive index to measure children's non-cognitive abilities based on the Big Five Personality Model.

RESULTS

Parental migration is significantly detrimental to non-cognitive abilities of rural left-behind children. Worse, except for agreeableness, the score of rural left-behind children in the other four sub-items is significantly lower. The negative impact of parental migration is partially explained by the fewer shadow education, the reduction in parent-child interactions, and the parental education participation, especially parent-child interactions in a major position.

CONCLUSION

Our findings are consistent with previous studies and further provide evidence that parental migration is the cause of the decline of non-cognitive abilities of rural left-behind children. These results indicate that it is necessary to formulate some public policies to focus on the neglected non-cognitive abilities of left-behind children.

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.

Impact of parental divorce versus separation due to migration on mental health and self-injury of Chinese children: a cross sectional survey

BACKGROUND

There has been an increasing prevalence of parental separation in China due to divorce or migration for work in recent decades. However, few studies have compared the impacts of these two types of separation on children's mental health. This study aimed to investigate how parental divorce and parental migration impact children's mental health and self-injurious thoughts and behaviors (SITB), while considering positive factors, including parent-adolescent communication and psychological resilience.

METHODS

We randomly recruited participants in grades 5-8 from 18 schools in 2 counties in Anhui Province. A self-administered questionnaire was conducted to measure children's mental health, SITB, parent-adolescent communication, psychological resilience, and socio-demographic characteristics.

RESULTS

Data from 1026 children with both parents migrating (BLBC), 1322 children with one parent migrating (SLBC), 475 children living in a divorced family (DC) and 1160 children with non-migrating parents (NLBC) were included. Regression model results showed that, compared to the other three groups (BLBC, SLBC, NLBC), DC exhibited higher internalizing problems (p < 0.05), higher externalizing problems (p < 0.01), less prosocial behaviors (p < 0.05), and higher rates of suicidal ideation (SI) (p < 0.05) and non-suicidal self-injury (NSSI) behaviors (p < 0.05) when adjusting for social-demographic variables. However, when further adjusting for parent-adolescent communication and psychological resilience, DC no longer had higher levels of internalizing problems, externalizing problems, NSSI and SI than left-behind groups (BLBC, SLBC).

CONCLUSIONS

The experience of separation from divorced parents had stronger negative effects on the mental health of children than was observed in LBC. The Chinese government should design special policy frameworks that provide support to DC.

Resilience mediates the association between self-harm and suicidal ideation in Chinese left-behind children

Background

A significant association between self-harm (SH) and suicide ideation (SI) has been found in Chinese left-behind children (LBC). Existing literature suggests that resilience might be a mediator in this association. However, this hypothesis has not been effectively discussed. The major aim of our study is to analyze the possible mediation of resilience in SH-SI association in Chinese LBC.

Methods

A population-based clustering sampling survey of 2619 LBC was conducted in southwestern China Yunnan province. Self-developed structured questionnaire was used to collect relevant information. Univariate and multivariate Logistic regression models were applied to estimate the associations between SH and SI, resilience and SI, and SH and resilience. Path analysis was adopted to measure the mediation of resilience, as well as its 5 dimensions, in the association between SH and SI. A subgroup analysis was further done to explore the mediation of resilience in the associations between SH severity and SI, SH repetition and SI, among self-harmed LBC.

Results

Compared with LBC who reported no SH behaviors, the odds ratio (OR) for SI was 3.37 (95% CI: 2.63–4.31) among self-harmed LBC. Based on the path model, resilience significantly mediated a quarter of the total association between SH and SI. Among the 5 dimensions of resilience, emotion regulation, interpersonal assistance, and family support were the strongest mediators. Subgroup analysis revealed that, the mediation of resilience was only significant for SH severity and SI.

Conclusions

Resilience played as a prominent mediator in SH-SI association among Chinese LBC. Resilience-centered intervention measures could be considered to reduce suicidal risk of this disadvantageous group.

Network analysis of the relationship between negative life events and depressive symptoms in the left-behind children

BACKGROUND

There are 68.77 million left-behind children in China, who are at a great risk of depression associated with negative life events. Our study aims to investigate the most central symptoms of depression in left-behind children and the relationship between depressive symptoms and negative life events using network analysis.

METHOD

A cross-sectional data set (N = 7255) was used, which included children and adolescents aged 7 to 17. Network analysis was used to evaluate: 1) the most central symptoms among the items included in Child Depression Inventory (CDI) of the left-behind children; 2) bridge symptoms between depressive disorder and Adolescent Self-Rating Life Events Check List (ASLEC) of the left-behind children; 3) differences in networks of depressive disorders between left-behind and non-left-behind children, and 4) differences in the network of depression and negative life events between left-behind and non-left-behind children. The stability and centrality indices of the network were also evaluated in the study.

RESULTS

The most central symptoms in the CDI among the left-behind children included self-hatred, crying, fatigue, and sadness. The items with the highest bridge strength centrality in the CDI-ASLEC network included academic stress, discrimination, and school performance decrement. Higher bridge strength values indicate a greater risk of contagion to other communities. The connections in the CDI-ASLEC network are denser in the left-behind children than in non-left-behind children.

LIMITATIONS

The study which was conducted based on cross-sectional data shows that network analysis can only make undirected estimation, but not causal inferences.

CONCLUSIONS

We identified the core symptoms of depression and the bridge symptoms between negative life events and depression in the left-behind children. These findings suggest that more attention should be paid to self-hatred, sadness, and fatigue in the treatment of depression in left-behind children. Intervention for academic stress and discrimination of the left-behind children may help to reduce the contagion of negative life events to depression symptoms.

The Impact of Perceived Personal Discrimination on Problem Behavior of Left-Behind Children: A Moderated Mediating Effect Model

This study aimed to determine how pathological Internet use and emotional intelligence affect the relationship between perceived personal discrimination and problem behavior of left behind children. Data were collected from 406 left-behind students from 6 rural primary and secondary schools in Mainland China. Results indicated that perceived personal discrimination could be a predictor of left-behind children's pathological Internet use, and further cause their problem behavior. Pathological Internet use had a partial mediating effect on the relation between perceived personal discrimination and problem behavior. In addition, emotional intelligence played a moderating role in the relationship between perceived personal discrimination and problem behavior, as well as between pathological Internet use and problem behavior. Emotional intelligence could alleviate the negative impact of perceived personal discrimination on problem behavior, as well as the negative impact of pathological Internet use on problem behavior.

Parental Migration and Early Childhood Development in Rural China

Nearly one-quarter of all children under age 2 in China are left behind in the countryside as parents migrate to urban areas for work. We use a four-wave longitudinal survey following young children from 6 to 30 months of age to provide first evidence on the effects of parental migration on development, health, and nutritional outcomes in the critical first stages of life. We find that maternal migration has a negative effect on cognitive development: migration before children reach 12 months of age reduces cognitive development by 0.3 standard deviations at age 2. Possible mechanisms include reduced dietary diversity and engagement in stimulating activities, both known to be causally associated with skill development in early life. We find no effects on other dimensions of physical and social-emotional health.

Effect pathways of informal family separation on children's outcomes: Paternal labor migration and long-term educational attainment of left-behind children in rural China

Informal family separation due to parental labor migration is an increasingly common experience in the lives of children in many countries. This paper proposes a framework and method for analyzing "effect pathways" by which parental labor migration might affect children's outcomes. The framework incorporates home-environment and child-development mechanisms and is adapted from migration, sociology of education, and child development literatures. We test these pathways using data on father absence and long-term educational outcomes for girls and boys in China. We apply structural equation models with inverse probability of treatment weighting to data from a 15-year longitudinal survey of 2000 children. Significantly, fathers' migration has distinct implications for different effect pathways. It is associated most significantly with reduced human capital at home, which has the largest detrimental effect on children's educational attainment, among those studied. At the same time, father absence is associated with better family economic capital, which partially buffers the negative implications of father absence. Overall, father absence corresponds to a reduction of 0.342 years, on average, in children's educational attainment, but the reduction is larger for boys than for girls. For boys and girls, the reduced availability of literate adults in the household linked to father absence is an important effect pathway. For girls, this detrimental effect is partially offset by a positive income effect, but for boys, the offset effect is trivial.

Effect of mental resilience of left-behind children on self-esteem and emotional processing bias and social coping styles

BACKGROUND

The long-term separation of parents and children as well as the incomplete family structure affect the mental health development of left-behind children and the formation of healthy personality, good interpersonal relationships and positive coping styles in adulthood. At present, there is insufficient empirical investigations on the mental resilience of left-behind children.

OBJECTIVE

It is aimed to understand the mental health of left-behind children and explore the characteristics of mental resilience, self-esteem and emotional processing bias, as well as social coping styles.

METHODS

The random sampling method is used to select the left-behind children as the research subject. The general demographic information questionnaire, RSCA (Resilience Scale for Chinese Adolescent), emotional self-rating scale, SES (Self-Esteem Scale), and coping style questionnaire are used for the survey. Also, the experiments on cognitive processing bias effects of self-esteem and emotion are further carried out.

RESULTS

There are differences in demographic variables in mental resilience, self-esteem level, emotional level, and social coping styles. The low mental resilience group shows a processing bias towards low praise words, while the high mental resilience group shows a processing bias towards high praise words. At a low level of self-esteem, there is an interaction between mental resilience and self-esteem on low praise words. Mental resilience has a significant effect on the cognitive processing bias of emotion. Under the induction of positive emotions, the high mental resilience group responds significantly more slowly to the negative words than the low mental resilience group. Under the induction of negative emotions, the high mental resilience group responds significantly faster to the negative words than the low mental resilience group.

CONCLUSIONS

Promoting the mental health education of left-behind children can start from enhancing positive emotions, reducing negative emotions, developing high self-esteem, and improving mature coping styles.

Impact of parent-child separation on children's social-emotional development: a cross-sectional study of left-behind children in poor rural areas of China

BACKGROUND

Parent-child separation is a considerable adversity for left-behind children (LBC), but there is little evidence on the association between detailed characteristics of parent-child separation and social-emotional development among LBC. This study examined the characteristics of parent-child separation and its impacts on developmental delay among under-3 LBC in poor rural China.

METHODS

We used data from 811 LBC surveyed in five poor counties in rural China in 2018. Detailed characteristics of their parental migration were recalled by their primary caregivers in face-to-face interviews. The children's social-emotional development was measured by using the Ages and Stages Questionnaire: Social-Emotional. Logistic regression was employed to examine the association of detailed characteristics of parent-child separation with early social-emotional problems after adjusting for the children's and primary caregivers' sociodemographic characteristics.

RESULTS

287 (35.4%) children were left behind by fathers and cared for by mothers (FM-MC), while 524 (64.6%) were left behind by both parents and cared for by grandparents (PM-GC). The rate of social-emotional problems among LBC was 36.8% (PM-GC vs FM-MC: 40.6% vs 29.5%; aOR 1.51, 95% CI: 1.06 to 2.16). For paternal migration, the medians of the child's age at the first migration and average duration per migration were 3 months (IQR: 1 to 9 months) and 4.48 months (IQR: 2.38 to 7.54 months), respectively. For maternal migration, the corresponding values were 9 months (IQR: 6 to 13 months) and 4.65 months (IQR: 2.71 to 7.62 months), respectively. On average, LBC had been separated from fathers for 72% of their life due to paternal migration and from mothers for 52% of their life due to maternal migration. No significant association was found between the detailed characteristics of paternal migration and social-emotional development among LBC, while social-emotional problems among LBC were significantly associated with the proportion of cumulative duration of maternal migration in the child's lifetime (aOR 2.83; 95% CI: 1.13 to 7.10).

CONCLUSIONS

LBC under 3 years had a high risk of social-emotional problems in poor rural China. Cumulative exposure to maternal migration may be detrimental to LBC's early social-emotional development. Programs are necessary to support these children as well as their families.

Maternal methylmercury exposure through rice ingestion and child neurodevelopment in the first three years: a prospective cohort study in rural China

BACKGROUND

Rice is an important dietary source for methylmercury; however, rice does not contain the same beneficial nutrients as fish. Our main objective was to assess associations of prenatal methylmercury exposure through rice ingestion with child neurodevelopment in rural China.

METHODS

Eligible peripartum women were enrolled (n = 391), provided peripartum hair samples, and children's neurodevelopment was assessed at 12 months (n = 264, 68%) and 36 months (n = 190, 48%) using the Bayley Scales of Infant Development, 2nd Edition, including the Mental Developmental Index (MDI) and the Psychomotor Developmental Index (PDI). Associations between prenatal methylmercury exposure during the third trimester [log₂ maternal hair total mercury (THg)] and child's neurodevelopment were assessed using linear mixed models for repeated measures.

RESULTS

In adjusted models, a doubling in maternal hair THg corresponded to a 1.3-point decrement in the MDI score [95% confidence interval (CI): - 2.6, - 0.14], and a 1.2-point decrement in the PDI score (95% CI: - 2.6, 0.14). Overall, adverse associations between maternal hair THg and MDI scores attenuated over time. However, associations were robust and stable over time among children whose primary caregiver was their parent(s). During the study follow-up, an increasing proportion of children were raised by grandparents (12 months: 9% versus 36 months: 27%), a trend associated with rural-to-urban parental migration for work.

CONCLUSIONS

For young children living in rural China, a biomarker of prenatal methylmercury exposure was associated with decrements in cognitive function assessed between 12 and 36 months of age. Changes in the family structure over the study follow-up time interval potentially impacted children's sensitivity to prenatal methylmercury exposure.

Left-behind children's social adjustment and relationship with parental coping with children's negative emotions during the COVID-19 pandemic in China

Using data collected from two provinces in China through an online survey, the current study aimed to investigate left‐behind children's emotional and academic adjustment during the COVID‐19 pandemic in China. The participants included 1780 left‐behind (960 boys) and 1500 non‐left‐behind (811 boys) children in elementary and junior high school with a mean age of 11.23. Self‐reported questionnaires concerning children's depression, loneliness, anxiety, and academic adjustment, and parents' coping with children's negative emotions were completed. The results suggested that compared with non‐left‐behind children, left‐behind children's depression and anxiety symptoms were more severe and their academic adjustment was poorer. However, left‐behind children had lower levels of loneliness than non‐left‐behind children. Additionally, supportive coping types, especially emotion‐focused and problem‐focused reactions, were significantly negatively correlated with children's depression and anxiety. Unsupportive coping types, especially distress and punitive reactions, were significantly positively correlated with children's depression and anxiety symptoms. Moreover, the relationships between punitive reactions and depression, ignoring and loneliness and problem‐focused reactions and academic adjustment were significantly stronger in left‐behind children. Hence, during the pandemic, left‐behind children were still at a disadvantage even with their parents' company. However, parents' coping style towards left‐behind children's negative emotions played a significant role in their adjustment.

Self-esteem, social support and coping strategies of left-behind children in rural China, and the intermediary role of subjective support:a cross-sectional survey

BACKGROUND

Negative coping strategies and behavioral problems are common among Chinese left-behind children, which are relate to a variety of negative consequences. At this stage of development, the relevant factors of coping strategies need to be further studied, in which social support and self-esteem are worthy of our attention. The aim of this study is to detect the current situation of self-esteem, social support, and coping styles of left-behind children (LBC) in rural China.

METHODS

322 children from 3 schools in China enrolled in this study, including 236 LBC and 86 non-left-behind children (NLBC) to assess self-esteem, social support and coping strategies.

RESULTS

The LBC group had lower self-esteem score and lower total social support (subjective support, objective support and support-seeking behavior) than the NLBC group. In terms of coping strategies, the LBC group was lower than the NLBC group in problem-solving and rationalization. The self-esteem score in LBC was significant positive associated with the subjective support score, objective support score, problem-solving and help-seeking score. In addition, self-esteem has significant mediating effect between subjective support and problem-solving, subjective support and help-seeking, respectively.

CONCLUSIONS

The finding indicate that Chinese LBC's self-esteem and social support need to be improved. Given the significant correlativity between self-esteem, subjective support and coping strategy, it is necessary to promote Chinese LBC's self-esteem and social support, especially subjective support.

Parental migration and anemia status of children in China

Previous literature on parental migration and children's health outcomes mainly focuses on subjective measures and often omits the selectivity issue. Taking advantage of a unique nationally representative longitudinal dataset from the China Health and Nutrition Survey, this paper uses anemia status as an objective measure of children's health outcomes and examines the different effects of parents' current migration status, migration history, and migration duration. The results show that father's migration does not harm children's physical health, especially for children in rural areas, for whom father's migration decreases the likelihood of being anemic; while mother's migration increases the likelihood of being anemic. Importantly, children with return migrant mothers are less likely to experience anemia. We also find that the longer the father migrated, the better the child's health, but mother's longer migration duration is more detrimental. Our findings highlight the gender dimension in the migration story and indicate that policymakers should encourage the return migration of migrant mothers.

Social Anxiety Status of Left-Behind Children in Rural Areas of Hunan Province and its Relationship with Loneliness

OBJECTIVE

This study was designed to investigate the situation of social anxiety among left-behind children in rural areas of Hunan Province, China, and to study the effect of social anxiety on loneliness.

METHODOLOGY

A total of 797 left-behind children were selected from rural areas in Hunan Province, China. The basic information questionnaire for left-behind children, Social Anxiety Scale for Children, Perceived Social Support Scale and UCLA Loneliness Scale were used for investigation.

RESULTS

(1) The social anxiety score of left-behind children in China is 6.84 ± 4.28, higher than non-left-behind children, and the score of boys is lower than that of girls, with no significant difference. The score of left-behind children in grade 5 is significantly lower than that of left-behind children in other grades. (2) The overall loneliness score is 16.30 ± 5.10, higher than non-left-behind children, and the score of boys is significantly higher than that of girls. (3) Social anxiety has a significant positive predictive effect on loneliness (P < 0.01). Regression analysis shows that social anxiety not only affects loneliness directly, but also affects loneliness indirectly through the mediating role of perceived social support.

CONCLUSIONS

Social anxiety is a risk factor for loneliness of left-behind children in rural areas. In the influence of social anxiety on loneliness, social support plays a partial mediating role.

Physical health, school performance and delinquency: A comparative study of left-behind and non-left-behind children in rural China

BACKGROUND

China's rapid economic development since the late 1970s has resulted in a large-scale migrant population from rural to urban areas, with millions of Chinese children being left behind at home by their parents who migrated to city for work.

OBJECTIVE

The primary objective of this study is to test the effects of family, school and background characteristics on left-behind children's (LBC) and non-left-behind children's (NLBC) physical health, school performance, and delinquent behavior.

PARTICIPANTS

A total of 765 LBC and 468 NLBC in elementary and middle schools participated in the study.

SETTING

Survey data were collected from three middle schools and seven elementary schools in Wuhan, China.

METHODS

The dependent variables included three measures of child development: physical health, school performance and delinquent behavior. The independent and control variables were divided into four groups: school and community attachment, parental attachment, parental and children commitment, and background characteristics. Mean comparisons and regression analyses were conducted to assess whether LBC and NLBC differ in their physical health, academic performance and delinquent behavior.

RESULTS

LBC's physical health is significantly lower than that of NLBC. Being a LBC decreases the odds of being healthy by 51 percent. LBC and NLBC do not differ in their school performance and delinquent behavior.

CONCLUSIONS

Being left behind without proper parental care appears to be detrimental to child physical wellbeing. The damaging impact of left-behind is limited to physical health as LBC and NLBC reported similar levels of educational performance and delinquent acts.

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.

How parental migration affects early social-emotional development of left-behind children in rural China: a structural equation modeling analysis

OBJECTIVES

This study assessed the early social-emotional development of left-behind children (LBC) in rural China and determined the mediating factors linking parental migration to LBC's developmental outcome.

METHODS

We used cross-sectional data of 845 LBC under 3 years old from five counties in rural China in 2018. Social-emotional problems were assessed by the ages and stages questionnaires: social-emotional. Family structure, function, and child nurturing care practices were measured to explore their roles in potential pathways of parental migration affecting early social-emotional development.

RESULTS

36.4% of LBC were identified with social-emotional problems; the rate was higher among LBC with migrant parents than those with migrant fathers (39.9% vs. 30.5%, adjusted OR: 1.40 [95% CI 1.01, 1.93]). Results of structural equation modeling reveal that caregivers' low education and depressive symptoms, poor migrant-caregiver communication, family poverty, and no assistant caregiving weakened home parenting environment, and then contributed to LBC's social-emotional problems.

CONCLUSIONS

LBC in early childhood may be at a high risk of social-emotional problems, which are primarily caused by the transition of family structure and function and consequently weakened home environment.

Cognitive impact of early separation from migrant parents: A spectrum of risk and key mechanisms in child development contexts. A commentary on Hou et al., (2020)

Prolonged separation from migrant parents may lead to child development risks, despite the potential benefits from improved financial circumstances. Within the substantial literature on the health and well-being of the so-called left-behind children, the cognitive impact of parental migration has been inconclusive across different settings globally. In this issue, Hou et al.'s study in rural China focused on school-age children who experience persistent absence of both migrant parents since infancy, and revealed disadvantages in language comprehension outcomes among these children, despite the mitigating effect of higher household income. While results from this study are limited to the ongoing parent-child separation, previous absence of migrant parents has been suggested to have long-lasting negative effects in studies of adolescents in reunited families. Findings from Hou and colleagues' study highlight the needs to better understand migration-related parent-child separation during sensitive developmental periods in infancy and early childhood. A spectrum of risk due to parental migration should be established, accounting for the timing and duration of migration and care arrangements, in order to better identify the at-risk children in communities affected by out-migration. Future research should further explore the mediating and moderating factors in child's environments, and evaluate post-separation adjustment among reunited families after parents' return migration. Research evidence on these aspects will inform the development of tailored intervention programs for left-behind children, and strengthen the abilities of families and communities in best serving the needs of children affected by prolonged parental absence.

The effect of increased family finance and dual-parental absence since infancy on Children's cognitive Abilities

Existing research suggests that parental absence per se does not have a main effect on children's cognitive development. However, this body of research is confounded by decreased family finance resulted from parental absence. Further insights on children's cognitive development can be gained by studying situations where parental absence actually leads to higher family finance. China's rural left-behind children (LBC) are uniquely suited for this purpose because of their extended separation from parents who migrated to work for better family finance. The participants were 74 LBC (M = 9.99 years, SD = 2.66) whose parents both migrated away for work within six months of their births and 74 non-left-behind children (NLBC) (M = 10.03 years, SD = 2.58) of similar backgrounds but whose parents never migrated. We used the 4th Edition of the Wechsler Intelligence Scale for Children (WISC-IV) to individually collected data on the children's Verbal Comprehension (which includes Similarities, Vocabulary, and Comprehension subtests), Perceptual Reasoning (which includes Block Design, Picture Concepts and Matric Reasoning subtests), Working Memory (which includes Digit Span and Letter-Number Sequencing subtests), and Processing Speed (which includes Coding and Symbol Search subtests). We found that the LBC scored lower than the NLBC on the language Comprehension and Vocabulary subtests of the Verbal Comprehension Index (Cohen's d = 0.41; p = .01). Subsequent General Linear Modeling analyses revealed that for the Comprehension subtest: (1) dual-parental absence significantly and negatively predicted Comprehension scores and (2) monthly family income significantly and positively predicted Comprehension scores for the LBC but not for the NLBC. For Vocabulary subtest, only dual-parental absence was significant. Overall, these results offer a deeper understanding on the effect of dual parental absence and changes in family finance on different domains of children's cognitive development.

Impact of earthquake exposure, family adversity and peer problems on anxiety-related emotional disorders in adolescent survivors three years after the Ya'an earthquake

BACKGROUND

Traumatic experiences often give rise to an increased risk of anxiety problems in adolescents. This study investigated the anxiety prevalence in adolescent earthquake survivors and the effect of secondary stressors such as bullying, poverty, or being "left behind" by parents working in the cities.

METHODS

This cross-sectional study was conducted three years after the 2013 Ya'an (China) earthquake on 6,132 adolescents aged 9 to 18 years from 11 public schools in three severely earthquake affected counties. The participants completed self-report questionnaires that assessed anxiety, earthquake exposure, poverty level, left-behind duration and bullying.

RESULTS

Separation anxiety (38.7%) and panic symptoms (32.2%) were found to be the primary contributors to anxiety in this adolescent sample. The regression and structural equation modeling indicated that adolescents who had suffered from high earthquake exposure, peer bullying, being left-behind, or poverty were more likely to report problems in all anxiety subcategories, with females reporting more anxiety symptoms than males. The likelihood of all anxiety disorders except separation anxiety was found to increase with age.

CONCLUSIONS

This study highlighted the need for post-disaster interventions aimed at minimizing post-earthquake adversity such as peer bullying and specialized psychological services that target subgroups that might be more susceptible to anxiety-related emotional problems. The results could be used to identify possible markers for anxiety problems in children who had not experienced any major traumas.

Subjective well-being of left-behind children: a cross-sectional study in a rural area of eastern China

PURPOSE

Psychological well-beings of left-behind children (LBC) in rural areas of China remain under-studied. In this cross-sectional study, we aimed to explore the subjective well-being (SWB) in LBC and its associated factors in a rural area in eastern China.

METHODS

Stratified random cluster sampling was used to select middle school and high school students in Qingyuan County of Zhejiang Province. Relevant information including sociodemographic characteristics was collected from each participant using an organized questionnaire. SWB was measured using the modified scale developed for Chinese adolescents. Univariable and multivariable regression analyses were performed using R version 3.3.0.

RESULTS

A total of 1086 children were recruited and examined in the current analysis, with 365 (33.61%) being left-behind. Compared with non-left-behind children (NLBC), LBC had significantly lower scores in family satisfaction (P = 0.003) and environment satisfaction (P = 0.020). Multivariable regression analysis uncovered that frequent parent-child communication was associated with high positive affect (P = 0.003) and life satisfaction (P < 0.001), and the type of caregivers was associated with negative affect among LBC (P = 0.037).

CONCLUSIONS

Our results suggest SWB was lower in LBC, and targeted interventions including strengthening parental-child communication should be developed and implemented to improve LBC's SWB in rural areas of China.

The impacts of parent-child communication on left-behind children's mental health and suicidal ideation: A cross sectional study in Anhui

This study aimed to investigate the impact of previous maternal migration experiences on left-behind children's (LBC) mental health status and suicidal ideation, and the possible mediating role of parent-child communication. A cross-sectional study among rural children was conducted in Anhui, China, in 2018. LBC who self-reported that (a) their fathers were migrants and (b) they were living with their mothers at the time of the survey were included in this study. The participants were then divided into two subgroups by previous maternal migration experience. Previous maternal migration was associated with worse mental health and a higher prevalence of suicidal ideation among LBC compared with their peers. Healthy communication between children and parents fully mediates the adverse effects caused by previous maternal migration experiences on mental health among LBC, and communication with mother partially mediates the association with suicidal ideation. Communication classes for returning parents offered jointly by governments and schools could be an effective way to mitigate the impacts of maternal migration on child mental health and should be studied.

[Anemia status and related factors among left-behind children in poverty-stricken rural areas, in China, 2016]

Objective: To explore the prevalence of anemia and related factors among left-behind children in poverty-stricken rural areas in China, to provide basic information for anemia prevention and treatment for children. Methods: Data from the National Nutrition Improvement Program for Rural Compulsory Education Students in 2016 were used to express the prevalence of anemia among left-behind children. By using the multistage stratified random cluster sampling method, left-behind children of the 6-17-years-old in poverty-stricken rural areas were recruited in this study. Blood hemoglobin concentration of these students was determined by cyanmethemoglobin method. Anemia was judged by the WHO recommended standard and combined with the sea level elevation correction standard. Frequencies of food intake were collected through questionnaires. Data was then available for analysis including the level of hemoglobin and anemia rates. Relationship between anemia and food intakes as well as other influential factors was also analyzed. Results: The overall anemia prevalence (AP) was 11.6% among the participants. Rates of AP among the 6-, 7-, 15- and 16-17-years-old were 21.1%, 18.0%, 20.6% and 17.3%, respectively. Rates of AP among left-behind girls of 10-11-years-old and the 13-15-years-old were significantly higher than those in boys at the same age (P<0.01) group. Factors including: being girls (OR=1.34, 95%CI: 1.23-1.45), at grade 7 to 9 (OR=1.47, 95%CI:1.30-1.67) and mother being migrant worker (OR=1.32, 95%CI:1.16- 1.50) had higher proportions of getting anemia. Factors as living in the western area (OR=0.85, 95%CI: 0.78-0.93), taking breakfast every day (OR=0.70, 95%CI: 0.64-0.76), having meat more than twice per week (OR=0.84, 95%CI: 0.75-0.93) and having two kinds of vegetables per day (OR=0.85, 95%CI: 0.75-0.96) appeared protective. Conclusions: Prevalence of anemia in left-behind children from the poverty-stricken rural areas was high, including junior middle school students from grade 7 to 9 at the early stage of youth development, girls and children with mothers as migrant workers. Anemia should be reduced by promoting the protective factors as having breakfast, increasing intakes of meat and fresh vegetables.

The association between parental migration and early childhood nutrition of left-behind children in rural China

BACKGROUND

More than one-third of children under 3 years old are left behind at home due to parental migration in rural China, and we know very little about early childhood nutrition of left-behind children (LBC) because of the dearth of research. This study examined the association between parental migration and early childhood nutrition of LBC in rural China.

METHODS

We used repeated cross-sectional data of rural children aged 6-35 months who participated in two surveys in six counties of northern and southern China in 2013 and 2016 respectively. The length, weight, and hemoglobin concentration were measured by trained health-care workers blinded to parental migration status. Stunting, underweight, wasting, and anemia were identified with the standards recommended by WHO. Generalized linear regressions and multivariate logistic regressions were employed to explore the association between parental migration and these nutritional outcomes at each time point.

RESULTS

Two thousand three hundred thirty-six and 2210 children aged 6-35 months were enrolled in 2013 and 2016, respectively. The results show a reduction of the risks of stunting, underweight, and wasting from 2013 (16.4, 8.5, and 3.5%, respectively) to 2016 (12.1, 4.0, and 1.5%, respectively) but highlight a constantly and alarmingly high risk of anemia among these children (44.8% in 2013 and 43.8% in 2016). Children with migrant fathers performed as well as or better than those with non-migrants on these indicators. Children with migrant parents performed slightly worse in 2013, but equal or slightly superior in 2016 on these indicators compared with children with non-migrants and migrant fathers. Children aged 6-17 months with migrant parents had a significantly lower risk of anemia than those living with their mothers or with both parents (43.1% vs. 63.6% and 61.5 in 2013, and 42.5 vs. 60.1 and 66.2% in 2016), even after controlling for children's sociodemographic characteristics.

CONCLUSIONS

Parental migration may be not detrimental and even beneficial to early childhood nutrition of LBC in rural China. Continued nutritional support is needed for all rural children, especially interventions for preventing micronutrient deficiency. Programs for LBC are recommended to continue to focus on nutrition but pay more attention to other important health issues.

Depression and deliberate self-harm among Chinese left-behind adolescents: A dual role of resilience

Existing literature supports the association between depression and deliberate self-harm (DSH), a prominent risk factor of suicide. Our major aim was to evaluate the possible moderation and mediation of resilience in depression-DSH association, an issue which has never been extensively discussed among Chinese left-behind children (LBC). We implemented a population-based cross-sectional study of 2,619 LBC aged from 10 to 17. Multivariate logistic regression model which incorporated the cross-product term of resilience and depression was used to determine the moderation effect of resilience in depression-DSH association, whereas the mediating role of resilience was measured by path analysis. We found that depression was positively associated with DSH whereas resilience was negatively associated with DSH. Resilience in general was a prominent effect moderator in depression-DSH association, meanwhile, resilience also played as a significant mediator in this association, accounted for 26.8 % of the total effect. Our findings indicated that resilience was important moderator and mediator in the association between depression and DSH among Chinese LBC. Building up resilience of LBC may be an ideal choice in preventing depression related DSH.

Perceived social support and suicide ideation in Chinese rural left-behind children: A possible mediating role of depression

OBJECTIVE

Psychologically distressed rural Chinese left-behind children (LBC) are at an increased risk of suicide. However, within this population, suicide and potential associated factors are severely under-discussed. This study primarily aims to explore the association between perceived social support and suicide ideation (SI), and to discuss the possible mediating role of depression in this association.

METHOD

A population representative sampling survey was carried out with 2,898 LBC in southwest China. Relevant information was collected by means of face-to-face interviews. Binary and ordinal logistic regression models were employed to screen factors associated with perceived social support, depression and SI. Path analysis was applied to estimate the direct and indirect associations between social support and SI.

RESULTS

Multivariate logistic regression models revealed that, among the four sources, perceived social support from relatives living together, friends, and parents, but not teachers, was inversely associated with SI in LBC. Moreover, depression and SI were strongly associated with each other: Compared with non-depressed LBC, depressed LBC were 6.76 (95%CI: 3.85, 11.87) times more likely to report prominent SI. Path analysis revealed that it is possible that the association between perceived social support and SI was almost entirely mediated by depression.

CONCLUSIONS

Perceived social support from relatives living together, friends, and parents may be a protective factor against SI among rural Chinese LBC. Intervention strategies and measures that are targeted towards improving social support, especially cultivating closeness between LBC and their grandparents, could be effective in reducing SI in LBC.

Impact of Maternal Separation on Dopamine System and its Association with Parkinson's Disease

As a type of stress, maternal separation (MS) has been one of the most widely used models in neuropsychiatric research. An increasing number of studies has found that MS not only affects the function of the hypothalamic-pituitary-adrenal axis and hippocampal 5-hydroxytryptamine system, but also causes dysfunction of the central dopamine (DA) system and increases the susceptibility of dopaminergic neurons to pathogenic factors of Parkinson's disease (PD), for instance, 6-hydroxydopamine, thus impairing motor function. We reviewed the impact of MS on the DA system and its correlation with PD and found the following: (1) discrepant effects of MS on the DA system have been reported; (2) MS is a good model to study the impact of stress on the occurrence and development of PD, however, unified modeling criteria of MS are required; (3) correlation between MS and PD may involve the impact of MS on the DA system, which however is not the only connection; (4) intervening measures can block pathways between MS and PD, which provides reference for the prevention of PD in specific populations such as left-behind children.

Self-harm behaviors, suicidal ideation, and associated factors among rural left-behind children in west China

PURPOSE

This population-based cross-sectional study describes self-harm (SH) behaviors and associated factors in 2898 Chinese left-behind children (LBC).

METHODS

Descriptive statistics were used to present and compare the distributional characteristics of SH behaviors. Binary and ordinal logistic-regression models for survey data were applied to explore associated factors of SH.

RESULTS

Among the LBC, 48% (95% CI: 42%-54%) reported SH behaviors. SH was prominently associated with suicidal ideation. Boys, junior high-school students, and LBC whose fathers were poorly educated were observed to have higher prevalence of SH. Boys, local ethnic minorities, junior high-school students, and LBC whose fathers were comparatively well educated were observed to be at increased risk of more medically serious SH behaviors.

CONCLUSIONS

SH is a substantial public health problem among rural Chinese LBC. Targeted intervention measures should be developed to reduce future suicide risk.

[Occurrence of injuries among left-behind children from 27 poor rural areas in 12 provinces of China, 2016]

Objective: To understand the injuries among 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, 2016. Methods: Data were collected from the survey of 'Health Service Needs Assessment' (HSNA) program on left-behind children, from poor rural areas in the middle and western parts of China. Factors including causes, types, locations, related activities, ways of treatment and outcomes among left-behind children with injuries in 2016, were described and analyzed by gender and age groups. Results: In 2016, per-person and person-time incidence rates of injuries were 8.88% and 11.21%, among the 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, both higher in boys, than in girls. Most injuries were unintentional with its proportion higher in older children. The main types of injuries were seen as falls, blunt and sharp injuries, with burns and animal injuries more common in younger children. Injuries among left-behind children mainly took place at home, kindergarten/school, and on the highways/streets/roads, during playing. Most common ways of treatment would include at the emergency settings, self-treated, with older children more likely to treat by themselves. Most injuries were cured. Conclusions: In programs on prevention and control of injuries targeting the left-behind children in poor rural areas, special attention should be given to older boys, on falls and blunt/sharp injuries, at home or kindergarten/school. Education programs should pinpoint on self-rescue skills and guidance on kids by the parents, with behavioral norms and social support included. Related comprehensive prevention and control mechanism should be developed in families, schools and communities, with medical resources and insurance mechanism explored to serve these population and districts, including those left-behind children.

Resilience and self-harm among left-behind children in Yunnan, China: a community-based survey

BACKGROUND

Self-harm (SH) behaviors are established risk factors of suicide, however, in Chinese left-behind children (LBC), SH remains severely under-discussed. In this study, we aimed to investigate SH and explore its association between resilience in a large group of LBC.

METHODS

A community-based cross-sectional study of 2898 LBC was conducted in Yunnan province, China. Information was collected by self-reporting questionnaires. Descriptive analysis was used to depict and compare characteristics of the subjects. Univariate and multivariate logistic regression models were applied to estimate the associations between resilience and SH prevalence, SH severity, SH repetition.

RESULTS

The prevalence of SH in LBC was 48.8% (95%CI: 47.0-49.7%). Compared to LBC with lower level of resilience, a higher level of resilience was related to 0.40 folds of SH odds (95%CI: 0.34-0.48). Besides, among all dimensions of resilience, every 1 average score increase of emotion regulation and family support were associated with 0.13 (95%CI: 0.04-0.37) and 0.14 (95%CI: 0.04-0.47) folds of odds in severer SH, respectively; one unit increase in the average score of emotion regulation was related to an OR of 0.23 (95%CI: 0.07-0.71) for repeated SH.

CONCLUSIONS

Psychological resilience presented protective effect on SH in LBC, especially the dimensions of emotion regulation and family support. Intervention measures focusing on enhancing emotion regulation ability and building parent-child connection could be considered in order to reduce SH and suicidal risk in LBC.